Striving to provide the best start to every child IT IS IMPOSSIBLE to view Northern Ireland’s approach to improving the health of children without seeing it through the prism of poverty. The legacy of the Troubles, the recession and a high cost of living mean that child poverty levels remain well above the UK average. According to figures from the Institute for Fiscal Studies (2013), 21.4% of children were living in poverty in 2010 compared with 17.5% across the UK. By 2020, the difference will be greater – 29.7% as opposed to 23.5%. This has a direct effect on the health outcomes of children. A report by charity Save the Children (2014) describes the poverty levels as unacceptable, pointing out that they were linked to issues that ranged from obesity to delays in cognitive development. It has meant that there has been an emphasis on ensuring that basic needs are met. The Public Health Agency (PHA), set up in 2009 by the Northern Ireland Executive to support the five integrated health and social care trusts, is the main body that promotes this agenda. It has helped oversee a range of programmes targeting nutrition, such as teaching cooking skills and encouraging breastfeeding, as well as playing a key role in the

Tackling poverty is top of the healthcare agenda in Northern Ireland, says Nick Triggle in the final article on the challenges for public health nursing in the UK cross-government initiative to address fuel poverty – the inability to keep a home adequately heated. PHA lead children’s nurse Deirdre Webb says: ‘These are basic needs – and when there are high levels of poverty they simply cannot be met. That has a huge impact on health. There have been improvements, but there is a long way to go.’ Ms Webb says the consequences of this can also be seen in the high levels of mental health problems seen among families, something she says that is inextricably linked to the Troubles. Armed conflict The Department of Health, Social Services and Public Safety (DHSSPS) (2014) estimates that problems in Northern Ireland are 25% higher than in England. Ms Webb says: ‘The reasons are, of course, multifactorial, but the legacy of the Troubles certainly makes a significant contribution.’ Former health visitor Margaret Graham, who co-edited a book on the Troubles called Nurses’ Voices from the Northern


Family-centred initiatives Partnerships The Western Health and Social Care Trust was the first in Northern Ireland to introduce the family nurse partnership. It was set up in 2010 and is available in three areas – Derry/Londonderry, Strabane and Limavady – to provide one-to-one support to teenage mothers from early pregnancy until the child is two. It has helped more than 120 young women, with an evaluation commissioned by the Public Health Agency showing that it has improved outcomes for mothers and babies in the trust. Nadine Melarkey is typical of the teenagers that have benefited. She was aged 15 when she conceived – she credits the support she received as helping her to stay focused on her GCSEs and to adjust to life as a new mother.


Ireland Troubles, agrees. She believes it has made the job of nurses and other health staff more difficult. ‘A lot of families were bereaved or left with severe physical disabilities, and that is having an effect on the next generation and even the one after that. Life can be difficult and complicated for the children and young people growing up with this. How do you deal with this emotional impact? Nurses and health visitors have had to deal with a lot supporting these families. It stretches services even further.’ The mix of poverty, legacy of the Troubles and high rates of mental health problems means, in terms of workload for the nursing workforce, that a huge amount of time is being spent on safeguarding issues. At any one point, there are about 2,000 children on the child protection register – the highest per head of population out of the four UK nations – and closer to 3,000 in looked after care. This means that heath visitors and school nurses, in particular, face a battle to carry out their core public health functions,

September 2014 | Volume 26 | Number 7

‘I would have been lost without this support,’ she says. Breastfeeding Midwives and health visitors play a vital part in encouraging breastfeeding, but the Southern Health and Social Care Trust has also recruited mothers to play their part. The trust has a network of 24 women who have had training over the past 18 months to act as peer supporters. They can provide support over the phone or via home visits to mothers experiencing problems. Breastfeeding peer Emma O’Neill says: ‘From my own experience, I know how lonely you can feel and how support can really pick you up and help you continue to breastfeed successfully.’ NURSING CHILDREN AND YOUNG PEOPLE

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Analysis Save the Children

High levels of poverty make it difficult for healthcare services to meet the health needs of families and children

as PHA assistant director of public health nursing for children and young people Una Turbitt admits. She says: ‘Safeguarding is an increasing part of the workload. Health visitors, in particular, have a unique role as they go into people’s homes. We have been trying to support them. It is about getting the balance right in terms of safeguarding and the wider prevention work they do.’ Protection register But she says it is actually the group of children who do not quite make the threshold in terms of being on the child protection register despite being in vulnerable situations that ‘probably cause the most sleepless nights’. ‘They are the ones that do not always get the support – and that is something we are looking to address,’ she adds. Central to this is Making Life Better, the DHSSPS’s (2014) new ten-year public health strategic framework. One of the key themes was ‘giving every child the best start’. To achieve this, it made a number of recommendations. Some of them involved building on existing programmes. For example, family support hubs, which signpost families to help from statutory, voluntary and community organisations to prevent referrals to social services, are to be extended. So is the family nurse partnership. This was launched in Northern Ireland in 2010 and is now available in three of the five trust areas, helping 400 teenage mothers at any one time. It will now be expanded to the remaining two trusts, bringing the number of places available to between 500 and 600. But this is just the start. The biggest programme is the three-year Early Intervention Transformation Programme, a cross-government initiative aimed at creating a more co-ordinated response to supporting children across the health, education and justice systems. Plans are still being drawn up, but the aim is to create a network of support to equip all parents with the skills they need and support them early on when problems NURSING CHILDREN AND YOUNG PEOPLE

Health in numbers ■■ Northern Ireland has a population of 430,800 under-18s. ■■ More than one fifth live in poverty. ■■ 1,961 are on the child protection register. ■■ 2,806 are looked after children. ■■ 25% of two to ten year olds are overweight or obese.

■■ 17% of babies are breastfed for more than six months and a further 13% for three to six months. ■■ 16% of children have a long-standing illness, with asthma being the most common condition.

(Institute for Fiscal Studies 2013, Department of Health, Social Services and Public Health Safety 2014)

emerge. There are likely to be three levels of support: a universal offer, tailored support including a parenting programme to stop early problems getting worse, and a range of interventions for families where children are at greater risk. Ms Turbitt says: ‘There is still some work to be done in terms of how this will be organised, but many of these services are already in existence, so it is about bringing it all together so that children and their families get the right support. ‘It is a huge opportunity in terms of redefining the way services are run and our approach to supporting children and young people.’ But the big question – as with all the UK nations – is whether there will be enough staff available to ensure the vision for the future is realised? There are about 80 school nurse positions and more than 360 health visitor posts – but figures from last year showed that more than 60 of those were vacant.

RCN head of professional development in Northern Ireland Carolyn Mason says: ‘We are very supportive of the programmes they are putting in place, but there is a shortage of health visitors and school nurses already. ‘They are struggling to do the core child development programme and the risk with the new programmes, such as family nurse partnership, is that you just end up denuding those pools to fill the new positions. Unless we find the money to recruit more it is going to be difficult to make the impact we all want to see.’ Nick Triggle is a freelance writer

References Department of Health, Social Services and Public Health Safety (2014) Making Life Better. A Whole System Strategic Framework for Public Health. Institute for Fiscal Studies (2013) Child and Working-Age Poverty in Northern Ireland from 2010 to 2020. comms/r78.pdf Save the Children (2014) A Fair Start for Every Child.

September 2014 | Volume 26 | Number 7

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Striving to provide the best start to every child.

IT IS IMPOSSIBLE to view Northern Ireland's approach to improving the health of children without seeing it through the prism of poverty. The legacy of...
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