1,000 days to make a difference

Trudy Mills, Director of Children and Family Health Surrey and Women and Children’s Strategy Lead for Surrey Heartlands Health and Care Partnership, discusses the importance of the first 1,000 days of a child’s life in beating health inequalities.

One of Surrey Heartlands’ main ambitions is for the next generation to lead healthier and more prosperous lives.

The first few years of a child’s life will affect their health outcomes for the rest of their life.

If a child enters school with a health inequality, this gap is likely to never close, so we’ve agreed to focus on the first 1,000 days of each child’s life, working together to do everything we can to maximise their life chances.

There are some historical issues in the area – as there will be across the country – such as difficult Ofsted ratings, high numbers of children and young people in the care system and increasing demand for child and adolescent mental health services.

In order to change the curve, the Surrey Heartlands Transformational Board agreed that we need a response from the whole system – not just children’s services and social care, but also those affecting wider determinants of health and wellbeing, such as housing and education.

Together with Public Health England we’ve developed a family resilience model – often known as a ‘think family’ approach – that looks at families as a whole and helps us pick up as many opportunities as possible to support family life. We’ve asked all our partners to recognise their impact on children’s lives by picking two or three key actions they can contribute to making a difference.

For example, all partners can ‘make every contact count (MECC)’ by supporting healthy changes such as stopping smoking, making appropriate referrals to other services and encouraging smoke-free homes.

We’ve improved service accessibility and now offer antenatal care outside standard office hours. We’ve also introduced a telephone advice and triage line for pregnant women, allowing them to access support from a midwife 24 hours a day. The line is for women under the care of any of our acute hospitals during pregnancy and labour and following the birth of their baby.

For young people we have invested in the ‘Chathealth’ system, which offers online advice from school nurses on issues such as sexual health and emotional health and wellbeing.

All our children’s centres have been accredited under Unicef’s Baby Friendly scheme, meaning we are supporting families with feeding and developing close, loving relationships, ensuring that all babies get the best possible start in life.

We’ve also launched some online parenting advice materials in collaboration with public health, Surrey Health and Surrey County Council.

Surrey County Council is playing a key role in these developments and its chief executive is chair of the child strategy group – a sub-group of the transformational board. The group has tasked early help and children’s services with working up a joint offer for families and a health and wellbeing strategy that links health, social and mental health care.

We also work closely with voluntary sector partners such as the Stripey Stork charity, which supports vulnerable families, and our citizen ambassadors play key roles in our service development. For example, our ambassador for maternity and children helped develop the new parental advice line, acting as a critical friend from a service user perspective.

We’re excited about Woking Borough Council’s offer of a vacant high street shop from which to deliver a family hub for children’s and maternity services, in a non-clinical venue that’s easy to access. Not only will this benefit our patients, it will also help breathe life into the high street itself. We’re in the design phase now and hope to open in early 2019.

There are some gaps yet to be addressed, and we’re working on these as a partnership. For example, we need to grasp from a sustainability and transformation partnership (STP) perspective the advances we can make around IT and sharing digital information. We’re excited to be a partner in delivering the Thames Valley and Surrey Local Health and Care Record Exemplar which will link up care records across this wider area.

We also need a more coordinated pathway for vulnerable parents, linking physical and mental health.

We’re working hard to support better recruitment and retention through the introduction of a children’s academy, which delivers training to new staff from across health and social care, helping bring teams closer together and supporting career development.

The pace of change within Surrey Heartlands has been driven by senior leadership sign-up, teams being given time to build relationships and trust and lots of organisational development support – people aren’t just thrown together and told to get on with it.

This ongoing level of support and the high priority placed on children’s health by the STP can only help drive our work forwards, faster.

Trudy Mills

Trudy Mills began her career as a nurse/midwife in 1988 and her roles within the NHS have included several commissioning posts across local authorities, clinical commissioning groups and NHS England.

She provides overall leadership for Children and Family Health Surrey and is overseeing the ongoing transformation of its services, which are delivered by partners CSH Surrey, Surrey and Borders Partnership NHS Foundation Trust and First Community Health.

Trudy is also the executive strategy lead for women and children’s services within Surrey Heartlands STP, providing executive and strategic support to change management programmes including a single system midwifery management structure across three acute trusts and the standardisation of care pathways for paediatric services.

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