The creation of integrated care boards puts in statute a duty on the NHS and its partners to tackle inequalities and deliver economic and social returns on the investments made in services. This is an opportunity that we cannot miss for our children.
It is a stark reality that a child living in West Yorkshire is more than twice as likely to live in one of the most deprived neighbourhoods of England than the average resident. Poverty intersects with a range of other factors that impact on health inequalities, including engaging with education and access to support services. The Child of the North Report (December 2021) lays bare the reality many children, young people and families face, highlighting an increase in mental health challenges including self-harm, loneliness and missed school due to the pandemic.
This context shapes the vision of the West Yorkshire Integrated Care System's Children, Young People and Families' Programme that ‘All children and young people will have the best start in life and the support to be safe from harm, enjoy healthy lifestyles, do well in learning and have skills for life'.
Delivery is predicated on ambitious collaborative working across health, care, and other sectors to improve outcomes for children. The programme is led by an NHS chief officer and director of children services. The programme governance includes public health specialists, children's social care workers, and VCSE representation. The voice of the child is prominent throughout the programme via the Partnership's Youth Collective Voice.
Our work is based on a children and young people needs assessment and a data informed approach. It builds on good practice and local approaches in Bradford District and Craven; Calderdale, Kirklees, Leeds, and Wakefield District, as well as lessons learned from challenging times.
We are focused on health issues such as respiratory conditions, mental health concerns and end of life care.
- Most unplanned hospital admissions for asthma are linked to households that are cold or damp in areas with poor air quality. We have invested in resources to improve the clinical skills and knowledge of caring for children with asthma and are adopting the asthma friendly schools approach. Practical advice for families has been co-designed too.
- Our confidential Night Owls listening and advice service for young people, parents and carers runs 8am-8pm every day. By April 2022 it had received 1900 contacts. Red Kite View, a co-designed mental health inpatient facility, is bringing care closer to home for 22 children and young people. Our perinatal mental health campaign reached 135,000 households with a focus on minority communities and people living in poorer areas.
- West Yorkshire commissioners have begun to collectively design a 24/7 specialist children and young people palliative care service. Other work includes reducing variation in outcomes through tackling complications of excess weight and the development of safe sleeping guidance and training.
We are also focused on the causes of ill health. West Yorkshire Changing Systems Research (2021) highlighted that deprivation is at the centre of many inequalities that lead to adversity and trauma. This makes our Health Inequalities Network and Academy and Health Equity Fellowship who come from various professional and demographic backgrounds key.
There are potentially 61,220, 11–25-year-olds in West Yorkshire at risk of being involved or experiencing serious violence because of multiple risk factors including income deprivation and high levels of neighbourhood crime. (CREST Report 2020). Our Partnership and the West Yorkshire Violence Reduction Unit have been collaborating since October 2019 to embed a public health approach and contribute to a reduction in serious violent crime (knife crime, youth violent crime, non-domestic homicides, and domestic violence). This is part of our wider ambition to ensure West Yorkshire is a trauma informed and responsive system, and effectively tackling multiple disadvantage.
Our regular knowledge exchange events share good practice, with 600 people joining the session in April. This joint work with the West Yorkshire Violence Reduction Unit includes development of the Accident and Emergency Navigator Programme, based on evidence from Scotland, Sheffield, and London. Navigators complement the work of medical staff by engaging with young people aged 12 - 25 who are affected by violence. The aim is to break the cycle of violence for the young person and ease the pressure that violence places on the NHS.
Debates around integrated care often default to older people and hospital flow. That agenda is an essential component of what we all do. We would argue that children and the young should be seen as of parallel importance. All our futures depend upon it.
Rob Webster CBE is CEO Lead for West Yorkshire Health and Care Partnership (an integrated care system). He is also CEO-designate for NHS West Yorkshire Integrated Care Board. Jenny Lingrell is service director, children's health and wellbeing, at Wakefield Council. She is also part of the Partnership's sector lead group.
