When to share information has been developed as a cross-governmental initiative on behalf of Department of Health, Department for Children, Schools and Families, the Youth Justice Board and the Prison Service. It is set out in a pathway approach, with best practice case studies used to identify when, what, where and how information needs to be shared to ensure improved outcomes for children and young people, as outlined in Every Child Matters: Change for Children.

Trailed in today’s media the report Risky drinking in North West school children and its consequences: A study of fifteen and sixteen year olds is a study of 9,833 15-16 year old school children in the North West, examining relationships between risky drinking behaviours (binge drinking, frequent drinking, drinking in public places) and demographics, income, leisure activities and access to alcohol. Negative consequences of risky drinking such as violence and regretted sex are also investigated.

Safer Children in a Digital World (Executive Summary) focus’ on issues including cyberbullying, violent games and web predators. Recommendations includ:

• Establishment of a UK Council for Child Internet Safety

• A clearer ratings system for video games using the recognised BBFC symbols U, 12, 15 and 18,

• A public information campaign to educate parents and children in online safety

• Strengthening the law against assisting suicides. Social networking sites should monitor discussions and intervene where young users are discussing suicide, by providing useful advice and support to people who may be looking for help.

Trends in children and young people’s care - Emergency admission statistics 1996-2006 for children and young people aged 0 -19 years over the period 1996/97 to 2006/07,  including information on trends for:

• different age groups
• selected consultant specialties most likely to be involved in the care of children and young people
• emergency admission methods
• length of stay in hospital

The Bercow Review of services for Children and Young People (0–19) with Speech, Language and Communication Needs - Interim Report ( Executive Summary) identifies 5 key themes:

• Communication is crucial – communication is at the core of all social interaction.  Communication is a key life skill. Communication is a fundamental human right. For some children and young people, acquiring the ability to communicate is a difficult and ongoing challenge. Just as the nature and severity of their needs will vary, so will the type and extent of the help required to address them.
• Early identification and intervention are essential in order to avoid poor outcomes for children and young people – in addressing delay and disorders, the most important facts we know are the value of early intervention and the danger of its absence. If a child receives the right help early on, he or she has a better chance of tackling problems, communicating adequately and making progress. If a child does not benefit from early intervention, there are multiple risks – of lower educational attainment, of behavioural problems, of emotional and psychological difficulties, of poorer employment prospects and, in some cases, of a descent into criminality.
• A continuum of services, designed around the family, is needed – universal, targeted and specialist services are required to meet the range of needs and, as the Government envisages in its recent Children’s Plan, children, young people and their families must be at their heart.
• Joint working is critical – in planning, commissioning and delivering universal, targeted and specialist provision, it is critical that health services and children’s services, including schools, work together in support of children and young people with SLCN. No single agency can deliver any one of the five Every Child Matters outcomes for children and young people by working in isolation. Separate silos produce misunderstandings, cause divisions and can be bewildering or infuriating to parents for whose children services are delayed or denied as a result.
• The current system is characterised by high variability and a lack of equity – the current system is routinely described by families as a “postcode lottery”, particularly in the context of their access to speech and language therapy (SLT).

WHO/CDC Global Youth Tobacco Survey (GYTS) is a school-based survey designed to enhance the capacity of countries to monitor tobacco use among youth and to guide the implementation and evaluation of tobacco prevention and control programmes.

Essential Indicators

• Knowledge and attitudes of young people towards cigarette smoking
• Prevalence of cigarette smoking and other tobacco use among young people
• Role of the media and advertising in young people’s use of cigarettes
• Access to cigarettes
• Tobacco-related school curriculum
• Environmental tobacco smoke (ETS)
• Cessation of cigarette smoking

You may also be interested in our post on Fresh and alive: Mpower WHO report on the global tobacco epidemic, 2008.

Transition: moving on well - good practice guide on effective transition from children’s to adult services for young people with complex health needs will help ensure that the young person and their family is better prepared for the move to adult care and that the adult care team has been involved in planning for the transfer

Children on bullying report summarises research on children’s views on bullying, defining what bullying is and what to do about it. There are both worrying messages and hopeful signs among the varied responses.

It covers children living away from home in England (in children’s homes, boarding schools, residential special schools, residential further education colleges, foster care, adoption placements or residential family centres), those who are getting help of any sort from the children’s social care services of their local council and care leavers.

 New Trans wellbeing and healthcare documents from the Department of Health.

Medical care for gender variant children and young people: answering families’ questions provides answers to the questions typically asked by parents of gender variant children and young people (up to the age of 17). It helps families to understand about gender variance and gives some suggestions about how to respond.

NHS funding processes and waiting times for adult service-users will help you understand the processes involved in obtaining funding for treatment for gender variant conditions. It answers the questions that service-users typically ask, and it provides guidance on how to navigate this complex system with minimum delay.

A Northwest Framework - to achieve healthy weight for children and families within the context of food & nutrition and physical activity aims to to define and progress the contribution regional organisations can make to achieve the Public Service Agreement (PSA) to improve the health and wellbeing of children and young people.

This report intends to bring coherence to the regional role in achieving children’s healthy weight, within the context ofthe family and wider society. It brings together the many stakeholders, it provides governance arrangements, systems and processes to provide effective planning and delivery as well as creating opportunities for innovative developments.

Also mapped are the inter-relationship between different themes and organisations contributing to obesity and the contribution of food & nutrition and physical activity These Alliances describe how organisations can be grouped to work on particular themes, contributing and strengthening regional delivery.

A study of attitudes and behaviour to inform the development and promotion of outdoor activities from the Scout Association is a study of young people and parents that highlights how eight million young people between the ages of 7-18 (89%) spend far less time engaged in physical activity per week than is recommended by the Department of Health.

As a result a campaign will be focussed at www.kidsoutdoors.com where the emphasis will be on user-generated content such as blogs, video and images of activities, that demonstrate just how fun and easy outdoor activity can be in a safe and secure environment.

The Links Between Diet and Behaviour: The Influence of Nutrition on Mental Health from Associate Parliamentary Food and Health Forum (FHF), an all-party independent forum for the exchange of views and information on food policy in the UK Parliament.

The report makes the following 19 recommendations:

• The Government – principally the Department of Health, the Department for Children, Schools and Families and the Ministry of Justice, working with the FSA and the Medical Research Council – commission and support further research in the areas highlighted in this report.

• The Scientific Advisory Committee on Nutrition (SACN) should be asked to define further the optimum intake of omega-3 polyunsaturated fatty acids (PUFAs) in different stages of life, especially for pregnant women and children.

• The FSA should reconsider its advice to pregnant women about fish consumption, with a view to encouraging them to eat two portions of oily fish, or the equivalent in omega-3 PUFAs, a week.

• The FSA continues to monitor closely levels of mercury, dioxin and dioxin-like polychlorinated biphenyl (PCB) in the different species of oily fish available in the UK.

• The Royal Medical Colleges and the GMC consider upgrading the role of nutrition in the medical curriculum.

• Primary Care Trusts (PCTs) should increase the number of posts for dietitians working in the community and that GP practices should be fully reimbursed if  they employ a dietitian to whom patients can be referred for nutritional advice.

• The Government should take further action to raise public awareness of the significance of good nutrition in pregnancy and to tackle the incidence of low birth-weight in the UK.

• More research to test the effect of selected essential fatty acids on the cognitive skills, mood and behaviour of both “healthy” children (that is, children suffering from no known disorders), as well as children suffering from a range of behavioural disorders should be undertaken.

• Regulations should be introduced to prohibit all artificial colours and on-essential preservatives in food products and soft drinks.

• The Government should include financial support to School Breakfast Clubs as part of the package set up to improve school meals. We strongly recommend that all children entitled to free school lunches should be entitled also to a free school breakfast whose content, like school lunches, should be subject to quantified nutritional standards.

• The Department of Health encourages NHS Trusts to adopt an approach similar to that pursued by the Doncaster and South Humber Healthcare NHS Trust which undertakes a nutritional assessment of patients suffering from depression and patients with early symptoms of psychosis and provides dietary advice to them.

• Consideration of the outcome of the next trial of nutritional supplements in Young Offender Institutes should be a priority for the National Offender Management Service (NOMS) given that our prisons are overcrowded and there is continuing concern about the mental health of prisoners, particularly young offenders at risk of self-harm and suicide.

• Aany dietary intervention that can be used to improve the behaviour and mental well-being of offenders held in custody should be given serious consideration by the NOMS.

• NOMS should look positively at the case for introducing nutrient-based standards for meals in prisons, similar to those introduced for schools, but based on recommended daily intakes for adults.

• Effective measures should be taken in all prisons to inform prisoners about the benefits of a good diet and to enable them to make healthy choices both while they are in custody and after their release.

• In all women’s prisons national nutritional standards should be introduced to ensure that the basic dietary needs of pregnant women prisoners are achieved.

• More research is urgently needed in the area of nutrition and behaviour because of the major potential benefit for the fields of education, crime, health and the well-being of vulnerable sections of society and we recommend that the Government devotes more resources to this, especially in corrective institutions and care homes.

• Department of Health messages on a healthy diet should emphasise the importance of a balanced diet for optimum mental as well as physical health.

• While research continues to identify and produce alternative sources of omega-3 PUFAs, the report recommends that all people in the UK should be encouraged to eat more fish, some of which should be oily fish, or its equivalent in omega-3 PUFAs.

The vital role of interagency working in childrens services is recognised and developed in a new document setting out the Government’s goals for 2020. it identifies a new leadership role for Children’s Trusts in every area, a new role for schools as the centre of their communities, and more effective links between schools, the NHS and other children’s services so that together they can engage parents and tackle all the barriers to the learning, health and happiness of every child are detailed in The Children’s Plan: building brighter futures (Executive Summary).

The plan will

• strengthen support for all families during the formative early years of their children’s lives
• take the next steps in achieving world class schools and an excellent education for every child
• involve parents fully in their children’s learning
• help to make sure that young people have interesting and exciting things to do outside of school
• and provide more places for children to play safely.

The Single Equality Scheme Delivery Plan that underpins the plan emphasises equality of opportunity regadless of disabilty, race and gender.

The NHS has improved dramatically over the last few years, but still cannot guarantee that basic minimum standards are being met for patients throughout England and Wales, according to State of Heatlhcare 2007: Improvements and challenges in services in England and Wales. More than a quarter of NHS hospitals failed to provide adequate emergency services for children and 48% could not provide children with a satisfactory service in outpatient clinics, the Healthcare Commission said in its annual report on the state of the nation’s healthcare.

Key findings are:

The health of the population is improving with significant increases in life expectancy, but there are major disparities around the country, particularly in poorer areas where there are often fewer GPs.

• Men are living over four years longer than they were 20 years ago, while women are living three years longer.
• Men from more deprived areas live for a decade less than those in wealthier areas. Looking at local authority areas, for example, Kensington and Chelsea has the highest life expectancy for both men and women, at 82.2 years and 86.2 years respectively. The lowest life expectancy for men is in Manchester at 72.5 years, and for women in Liverpool at 78.1 years.
• In poorer areas, where people tend to experience worse health, there are 18% fewer GPs than in the least deprived areas (54 per 100,000 people compared to 66).

Patients are positive about hospital services overall but some organisations perform poorly. Beneath the headline figures there are concerns about aspects of care such as dignity and privacy.

• National analysis of the Commission’s survey of 80,000 inpatients at acute hospital trusts shows that 89.2% (149) were ranked “satisfactory” on patient experience, 7.8% (13) were “below average” and 3% (5) were “poor”. Eleven of those in the latter two groups were rated as “below average” or “poor” for the second year running. The survey also shows concern about specific issues such as help with eating - one in five patients who wanted help eating did not get it.
• Almost a third of the complaints about hospitals referred to the Commission for independent review relate to dignity and respect, nutrition and other aspects of basic personal care. They included: patients left in soiled bedding and clothing; no regular baths or showers or oral hygiene; inappropriate or inadequate clothing.

There have been dramatic improvements in waiting times but there are hidden waits for some services, which are not measured and therefore difficult to address.

• Government standards say no patient should wait longer than 26 weeks for a hospital appointment. In 2006/07, 83% of trusts met this, leaving some 350 patients with longer to wait than 26 weeks. This is a vast improvement on figures for 2000 when 264,000 patients waited this long.
• Waiting time targets do not apply fully to some services, making it difficult for problems to be addressed and patients needs to be met. Evidence suggests that a two-year wait for those referred for psychological therapies is not uncommon. People in some areas are still waiting between 12 and 24 months to have hearing aids fitted.

NHS trusts are performing better overall on quality of services, but the performance of primary care trusts (PCTs) has declined, with many not getting to grips with the needs of their communities so as to provide services to match.

• Overall, the quality of NHS services is improving with 46% of trusts rated ‘excellent’ or ‘good’ in 2006/07, compared to 40% in 2005/6. But for PCTS, only 26% were ‘excellent’ or ‘good’ in 2006/7 compared to 33% in 2005/6. Many PCTs went through a reorganisation over the period but this does not provide a complete explanation for the underperformance.
• The Commission says PCTs form the bedrock of healthcare. They control more than three-quarters of the budget, purchasing services from other providers, including hospitals. They are directly responsible for providing services handling more than 80% of NHS contact with patients, including those carried out by GPs and dentists.
• The report says that many PCTs do not fully understand the health needs of their local people, making it difficult for them to buy targeted services. For instance, last year 2.3 million people did not have their BMI index recorded as planned, with GPs not recording the data, which provides vital statistics on levels of obesity. The number of people diagnosed with heart failure is also considerably less (140,000) than expected, indicating that GPs may not be picking up on signs of serious illness. There is also a poor understanding of the sexual health of local populations at a time when sexually transmitted infections are rising rapidly.
• Where there is a known need, PCTs are not always providing the services required. Some 60,000 people with serious long-term conditions did not get the care from community matrons that was originally planned. Forty-one per cent of PCTs failed to purchase sufficient crisis services for people who are seriously mentally ill, resulting in 5,000 fewer people receiving the service than planned. Some 85% of PCTs did not have arrangements for providing education programmes for patients with diabetes in their area. And 2,000 GP practices did not fulfil their PCT’s plans to establish registers for those people at risk of coronary heart disease, designed to help prevent these patients from becoming seriously ill.

There is progress towards a stronger culture of safety and grounds for cautious optimism in reducing healthcare-associated infection. But trust boards need to show stronger leadership.

• On safety more generally, there has been an encouraging increase in reporting of incidents. Reported figures show more than 229,000 known incidents causing low or moderate harm and more than 9,400 incidents causing severe harm or death.
• Only 58% of NHS trusts complied with all the government’s nine core standards on safety, with infection control, decontamination of medical devices and medicines management the biggest areas of concern.
• Infection control is arguably of greatest public concern; latest figures suggest grounds for cautious optimism. Cases of MRSA fell from 7,096 in 2005/2006 to 6,381 in 2006/2007. There are early signs that increases in cases of Clostridium difficile are slowing. Between 2005 and 2006 the number of cases increased 7% to 55,620, compared to a 16% rise from 2004 to 2005.
• By the end of October 2007 the Commission had visited 87 trusts to check their performance in meeting the requirements of the hygiene code. Only one trust needed to be issued with an improvement notice, suggesting that organisations are taking the issue seriously. But there was a need for stronger leadership from trusts’ boards to improve monitoring, isolation facilities, training, and compliance with policies and procedures.

New figures show that more independent healthcare providers meet core standards, mirroring a similar trend among NHS trusts. But there are concerns about compliance among independent providers of mental healthcare.

• The proportion of independent healthcare establishments that met the government’s national minimum standards - including those that were not inspected as they were considered not to be at risk - was 63% in 2006/07 compared to 50% the year before. Five per cent of independent establishments failed five or more of the standards.
• Although NHS trusts must meet a different set of standards, the broad picture is similar. The number of trusts that were “fully met” on government core standards rose from 49% in 2005/06 to 55% in 2006/07. Six per cent of trusts were judged “not met” on core standards overall.
• In the independent sector, non-compliance was greatest on national minimum standards covering: monitoring of quality of treatment (C4); ensuring patients get care from appropriately recruited, trained and qualified staff (C9); and taking account of patients’ views (C6).
• Independent mental health providers, which mostly look after NHS patients, performed worse than others in the sector. Non-compliance was greatest in relation to national minimum standards for: ensuring patients receive care from appropriately recruited, trained and qualified staff (C9); providing treatment in safe and appropriate premises (C17); and ensuring patients are resuscitated appropriately (C27).
  Independent providers of mental health services need to focus on ensuring patients are appropriately and safely restrained. In 2006/7, 17% of establishments failed a standard in this area compared with under 9% in 2005/2006.

The NHS often fails to meet the needs of children and young people and there are concerns about other groups requiring specialist care, such as people with mental health problems and with learning difficulties.

• Paediatric hospital services are generally good at looking after children, but other more general services are not. Some 70% of specialist inpatient services were rated “good” or “excellent” by the Commission, but 28% of emergency and day case services were “weak”. Transition from children to adult services is not managed well in services for people with mental health problems, diabetes and disabilities, and those requiring palliative care services. Vulnerable children such as those with disabilities, those in care and young offenders face particular problems in getting appropriate care. One in 20 NHS trusts are not yet compliant with child protection standards.
• On specialist wards for people with mental health problems and people with learning difficulties, more than half of the inpatients were found to be in mixed-sex accommodation.
  Levels of violence in mental health services remain high, although there are signs of it being dealt with better. The report includes new data from an audit into violence in the sector, which found that almost one in 20 patients reported being assaulted. Forty-six per cent of nurses reported being physically assaulted, and 72% said they had been threatened or made to feel unsafe. On older people’s mental health wards, almost two-thirds of nurses reported physical assault by patients.

There have been dramatic improvements in responding to the big killers - cancer, circulatory and respiratory disease - but five-year survival rates for cancer, and mortality rates for respiratory disease, are worse than in other comparable countries.

• The mortality rate for people under 75 diagnosed with cancer fell by almost 17% between 1996 and 2005, which suggests that some 60,000 fewer people died prematurely.
• Despite this improvement, the UK survival rates do not compare favourably with most of Europe. For instance, the survival rate for lung cancer in Holland and Spain is around double that in England, which stands at 6.5% for men and 7.6% of women.

Monitoring poverty and social exclusion 2007 by Guy Palmer, Tom MacInnes and Peter Kenway can be found over at the think tank the New Policy Institute (or just check out the Summary).  It assesses the state of progress on poverty and social exclusion across the UK.  Poverty is showing a rise for the first time in a decade, this report reviews a wide range of evidence to reach an overall conclusion on where the strategy to end child poverty now stands.  Looking to the future, the report tries to assess whether all that is needed is more of the same - or whether instead the time has now come for a fundamental rethink.

Of course on Fade the Blog we recorded the press coverage on this report from the 3rd December.

The sexual health of young UK adults worsened in 2006 despite a concerted public health effort to turn it around, figures show. In 2006, a total of 376,508 new sexually transmitted infections (STIs) were diagnosed - up 2.2% on 2005, the Health Protection Agency found in Testing Times - HIV and other Sexually Transmitted Infections in the United Kingdom: 2007 Young people aged 16-24 made up the bulk of cases of some of the most common STIs, including chlamydia. The report also warns of a continuing HIV and STI epidemic in gay men.

• Intrapartum care: Care of healthy women and their babies during childbirth

• Donepezil, galantamine, rivastigmine (review) and memantine for the treatment of Alzheimer’s disease

• Head injury: triage, assessment, investigation and early management of head injury in infants, children and adults

• Stapled haemorrhoidopexy for the treatment of haemorrhoids

• Magnetic resonance image-guided transcutaneous focused ultrasound ablation for uterine fibroids

• Serial transverse enteroplasty procedures (STEP) for bowel lengthening in parenteral nutrition-dependent children