North East and North Cumbria take an integrated approach to addressing children’s healthcare inequalities

Children dressed in school PE kit playing a game

Credit: Ian Paine

Eight out of the ten local authorities in the UK with the highest rates of child poverty are in the North East and Cumbria. The region also has a higher proportion of people living in the 20% most deprived areas than the national average.

Poverty and low income are known factors which influence people’s health, with children from deprived socio-economic backgrounds more likely to experience acute infections requiring treatment.

The Child Health and Wellbeing Network (CHWN) in the North East and North Cumbria is spearheading a programme of work to support parents and families to better manage common childhood illnesses as well as supporting those living in underserved communities to access local services to support their health and wellbeing.

Working to identified priorities, the network also oversees the delivery of the Children and Young People’s Transformation Programme which is committed to making service improvements to reduce health inequalities experienced by children in the region. Open to all working in the child health and wellbeing space, including those from voluntary community and social enterprise organisations, local authorities and education and research, the network has over 1200 members, 40% of which are from health services. The CHWN also has representation from over 80 other youth, child, family voice and professional networks.

The CHWN also oversee the Children’s Integration Centre (CIC) which aims to deliver multiple integration models at pace; connecting relevant organisations to enable expertise to be shared and hosting innovative fellowship posts. This supports the progression of the network’s mature innovations across the large geography and four Integrated Care Partnerships (ICPs).

The innovative and joined up approach, sees professionals from across the board working together to address wider determinants of health and has resulted in children’s urgent and emergency care attendance in the region returning to pre pandemic levels.

Dr Mike McKean, Clinical Lead for the CHWN said, “Nearly a quarter of all children and young people who attend accident and emergency services in the region, do so for non-urgent or minor illnesses and conditions. Children from the most economically deprived areas account for nearly half of these.

“The COVID-19 pandemic and surge in respiratory seasonal viruses following the easing of lockdown restrictions further exacerbated this.

“Working together with partners from across the North East and North Cumbria we have jointly developed priorities which enable us to work in an open and inclusive way and develop a variety of different offers to support families living in the most deprived communities; helping them stay well and get the right support, in the right place at the right time.”

A key part of this work was the development of a guide for parents and families offering expert advice on how to help babies and young children when they’re poorly. The Little Orange Book, developed by Newcastle Gateshead Clinical Commissioning Group, is available online and has received more than 1,000 views in the six months since it has gone live. Twenty-three thousand printed copies have also been distributed to parents and carers through GP practices, health visitors, education and health settings and voluntary and religious organisations. Feedback from local parents has been positive, particularly regarding the reassurance this provides.

A new website ‘Healthier Together’ and mobile application is also now live with information for families on common childhood illnesses, including advice on what ‘red-flag’ signs to look out for and where and how to seek help. The website and app, based on successful work in Wessex and developed by paediatricians and GPs across the region, aims to reduce pressures experienced within the healthcare system by reducing unnecessary attendances in primary, urgent and emergency care.

Asthma is a particular area of focus for the network as the most common condition in children and young people. Regrettably the UK has among the highest mortality rates in Europe for underlying asthma. The majority of clinical commissioning groups in the region have significantly higher rates of asthma admissions for young people aged 10 to 18 than the England average and data suggests, there are also higher rates of emergency attendances.

To support improvements in the quality of asthma care and help individuals and families to manage the condition, the network funded the development of resources on the Beat Asthma website. This includes training for clinicians and other professionals at tier 3 level. A program of interventions to embed the use of these is planned throughout 2022, including the development of an asthma friendly schools accreditation framework and using community asthma advisors to signpost to the existing and newly developing resources. The programme will replicate some of the education interventions used in the work done in Newcastle upon Tyne between 2016 and 2018, involving work with schools, education settings and primary care, which achieved a sustained 29% reduction in hospital admissions. Similar plans are in train for anaphylaxis.

The network has also spread to a pilot project called Zone West in Newcastle’s West End. This project initiated by North East Wellbeing, has connected children with link workers who can help them to access local activities to support their health and wellbeing. The project works with local schools, GP practices and the Great North Children’s Hospital to identify children who may benefit from the project’s support; helping to make sure those young people most at risk of ill health are given access to opportunities that will help.

The project is being replicated in Middlesbrough and is closely aligned with local schools and primary care settings. Focusing on early intervention and prevention for children aged 7 to 11 years old, Zone Boro has demonstrated improved outcomes in social and emotional health, speech and language, school attendance and attainment as well as reducing GP attendance.

The STAR project is another initiative in Middlesbrough which is supported by the network. Using dance to improve the physical and mental wellbeing of children living in the most deprived areas of South Tees, the STAR project seeks to address health inequalities and has been shortlisted for an HSJ award.

A two-day qualification in Youth Mental Health First Aid (YMHFA) is also supported by the network offering face to face training for professionals working in voluntary, community and social enterprise organisations. The course is aimed at people working in the region’s underserved communities and working with children and young people aged 8 to 19 who need support with their mental health and wellbeing.

Dr McKean commented, “The geographic size of our network, as well as the breadth of the child health and wellbeing system, is the challenging context within which we work. Effective communication with such a large audience across all their priorities is a huge challenge and we have adopted engagement techniques based in Marshall Ganz Leadership model to help address this and create contagious commitment to change. While we have made great inroads, there is still much to do.

“These have been excellent steps towards addressing the health inequalities faced by children in our region. However, there is still a long way to go. The North East and North Cumbria Child Health and Wellbeing Network recently published our report into Poverty Proofing Health Settings which identified a number of barriers to children accessing the care they need.  The report lays bare the realities facing our most vulnerable families when it comes to accessing healthcare which we will work hard to address as we move into the second phase of our work.”

More information is available on the North East and North Cumbria Integrated Care System website or you can follow the network on Twitter.

You can also find information on other projects happening across the North East and North Cumbria to address inequalities affecting children and young people in the Network’s project showcase document.