Our vision is to create an Alliance capable of supporting the new government to deliver its Opportunity Mission.
Our first goal is to create four National Reference Groups – with major stakeholder input – to collate and cascade information and share examples of evidence-based good practice across the UK.
We will develop our current communities of practice (CoPs) that can collate the evidence and provide ‘on the ground’ insights about critical topics. These CoPs will feed into the four National Reference Groups to inform decision-making by Central and Local Governments, Integrated Care Boards, Multiple Academy Trusts, etc.
Child of the North and the Centre for Young Lives have created 12+ CoPs through the creation of their 2024 reports– providing a solid foundation from which our community can build.
Our approach will select exemplar projects from across each developmental phase so we can test and refine a methodology that delivers the goal of the “Birmingham Project”.
The "Manhattan Project" involved extensive collaboration between scientists, engineers, and policymakers. The project demonstrated how humans can collaborate and use science to solve a problem when there is a political desire to achieve a specified goal.
Our “Birmingham Project” aims to improve child health and wellbeing and involves an ambitious, and collaborative approach, bringing together cross-disciplinary experts to tackle the critical problems affecting children's well-being.
The goal of the Birmingham Project is to leverage cutting-edge science, healthcare, education, technology, policy, and collective action to significantly improve outcomes for children across the UK. This will include improving children’s health and education, eradicating inequity, improving mental health, and ensuring children grow up in safe, nurturing environments.
The Birmingham project has humanitarian goals but is driven by the existential inequality crisis affecting the future of the next generation.
Support delivery of a National Opportunity Summit
The meeting explored how the Healthier Together platform can help our Alliance work alongside local communities to create evidence-based support related to pregnancy, from conception to 24 months after birth.
Claire shared her journey of localising and implementing maternal health information via the “Healthier Together” platform. The vision focuses on informing, empowering, and educating women – reducing inequalities and improving maternal and foetal wellbeing. The approach recognised the need to improve health outcomes, reduce risks, and tailor services to be culturally appropriate.
Aneurin Bevan University Health Board started using “BadgerNet” in 2023, a digital maternity healthcare record system. This allowed key readings and articles to be shared weekly – highlighting key maternity concerns and advice. Using Healthier Together as a key resource, maternity services were further improved, aiding the development of a platform where individuals can access clear health information surrounding pregnancy, infancy, and childhood. Page development and staff training finished in March 2024, with the Healthier Together website becoming available across the Aneurin Bevan University Health Board.
Expecting mothers and their families are signposted to the Healthier Together website through individualised SMS links and QR codes, with pages tailored to appointment outcomes. Signposting occurs at all initial maternity appointments to ensure that individuals are aware of Healthier Together information as soon as possible.
The success of BadgerNet and Healthier Together is evident through “clicks” on website pages. For example, after the launch of BadgerNet, visits to the most accessed page, “reduced foetal movements in early pregnancy” rose from 6,200 to 40,000. Furthermore, visits to the RSV vaccination page reached 4,000 in September 2024 alone, highlighting the reach of digital communication and the potential impact on supporting the prevention agenda.
The experience of the Aneurin Bevan University Health Board highlighted key considerations when implementing digital systems - including the importance of monitoring content, checking links, governance, and the continual development of pages when managing the website. Additionally, localisation was paramount to the successful implementation of the programme. The option for the website to be in English or Welsh increased its accessibility, acknowledging the service user’s cultural preference.
Alicec defined perinatal mental health as the mental health of all the family for up to 24 months post-partum. Supporting perinatal mental health is vital, with 1 in 4 expecting individuals experiencing mental health complexities in this period. Furthermore, it has been reported that at least 1 in 10 new fathers are affected by mental health complexities.
These complexities can further impact infancy and childhood, as stress in the womb can increase the risk of low birth weight – putting children at risk later in life. Additionally, pregnant individuals experiencing depression and anxiety are more likely to have adverse mental health post-partum. This may influence parenting and potentially cause adverse childhood experiences (ACEs).
The following characteristics may place individuals at increased risk of mental health difficulties related to pregnancy:
The MBRACE-UK 2022 Missing Voices Report, presents worrying statistics on maternal deaths: 40% of deaths within a year after pregnancy were due to mental health causes. Suicide was the leading cause of direct deaths in 2018-2020.
Further work is required to improve these statistics. Such as through promoting awareness of Perinatal Mental Health Complexities for all who come into contact with parents during this period - making every contact count. Sharing concerns is vital through good MDT working. Additionally, Improved standardisation of resources surrounding perinatal mental health is also required. This could be through resources like the Healthier together website.
Holly shared the importance of triaging and supporting good practice. The local maternity and neonatal system (LMNS) has developed a maternity triage service described as “gold standard” by the Maternity and Neonatal Safety Investigation Programme (MNSI). This service utilises the Healthier Together app, allowing pregnant individuals to access key information on health concerns during pregnancy.
The service was classed as the “gold standard” through its use of evidence-based practice, clear pathways, and consistent, cohesive care. The app utilised a traffic light approach to assess symptoms – signposting individuals to appropriate services. Furthermore, the service has a centralised triage line, picking up 96% of calls within the first 20 seconds. The Healthier Together app is used on average 2.5 times/month by pregnant women (13,000 visits per month) and the impact has been a 21% reduction in attendance to Day Assessment Units across the region. There are, however, challenges that come with the “gold standard service”, such as the need for shared pathways and centralisation of systems. Work is required to standardise such content nationally to enable rollout; this requires collaboration with national organisations such as the Royal College of Obstetrics and Gynaecology and the Royal College of Midwifery.
The meeting focussed on creating accessible resources to support families of children aged 0-4 years. The discussions centred on collaboration across networks via the Healthier Together platform to ensure a preventative approach.
Alison highlighted that the largest threats to health are preventable.
The key is collaborative working, prevention, and early intervention. Health visitors (HV) should be used to reach families and apply strategies proactively and systematically. There is a complexity of needs within the population, emphasising that health visitors need to possess a range of skills to support families to address these. Alison spoke about two important life lessons from her practice as a HV: (1) All children have hopes and aspirations, however some children are more likely to achieve them than others - it is unfair that some children are in a disadvantaged position to achieve this; (2) Similarly, most families want what is best for their children, but there are many reasons why life may not work out the way they hoped (having a baby born early, SEND, MH problems, domestic abuse, poverty etc…) and getting a bit of extra help/early intervention can make a big difference.
Alison further discussed the concerns surrounding poor child health, widening inequalities, service cuts, and the knock-on effects that these have across service providers as key drivers for change. Alison presented findings from their research on A&E attendance in children 0-4 years. First-time parents are most likely to attend A&E, which tells us a lot about health literacy. Parents wanted their babies to be seen in person and wanted accessible, consistent information. Parents are more likely to take information on board if professionals go through trusted information with them rather than giving them a leaflet to read independently.
The Institute of Health Visiting produced easy-access resources with Healthier Together and training sessions were given to HV for improving parental health literacy. There was a focus on reach, with the aim of getting resources to those who need it. Leaflets were co-created with people with learning differences, with the option of translated resources and alternative formatting.
Sam discussed profiling and measuring health literacy. There is a clear need for health information to be accessible to the most vulnerable in society.
Health literacy is about accessing and appraising information, analysing it, and understanding whether it is reliable and useful. Parents are acting on behalf of their children, and health literacy is vitally important for all parents. However, more than 4 in 10 adults struggle with health content designed for the public, and 6 in 10 adults struggle when the information involves numbers.
We must adopt a new approach within the healthcare environment to guarantee parents receive information from professional and accredited sources rather than other sources, such as social media (TikTok, Instagram, etc).
Health information needs to be understandable, utilising everyday language that is concise and human with a non-judgemental tone, using ‘we’ and ‘you’. Co-production was emphasised as key to making content that is relevant, wanted, and accessible. Creating resources using a grade 6 level of reading is important so users can comprehend the information being provided. AI is also relevant and can be used to transform clinical language into easy, digestible everyday language.
Laura highlighted that children and young people account for 25% of emergency department attendances, so it is essential that parents/carers know when their child can stay at home and safely to reduce the burden on healthcare services. However, there is little knowledge about how to access alternative services and there are challenges within accessing primary care in NENC. Healthier Together provides the opportunity to connect with local communities and organisations, allowing for a more connected healthcare system.
In NENC, 300 staff and volunteers were trained in delivering different sessions over time to over 10,000 families in wave 1 of their model.
The Bright Futures project aims to connect with young mothers in highly deprived areas and was highlighted as a successful service, with families reporting feelings of assurance. Wave 2 of the proposed model has the potential to reach 40,000 families, focusing on organisations and services that are community-based. For example, supporting organisations that work with women suffering from domestic violence allows for greater reach into the local community and access to vulnerable individuals.
Education champions have also focused on school attendance, with 58 education settings and around 19,500 children involved. School staff are trained to promote Healthier Together information to families, alongside carers and mental health organisations acting as supporters of the programme. This has resulted in increased school attendance rates for children. For example, one case study showed a significant increase in attendance, from 78.7% to 86.6%. This was achieved by providing information about when a child does and doesn’t need to be off from school for health reasons and was accessible to families who were anxious about speaking face-to-face with practitioners.
The meeting concluded that we have the opportunity to coordinate healthcare and allow local communities to be supported effectively if we work together to address these questions.
The meeting used the topic of neurodiversity to consider how our Alliance can use the Healthier Together platform to support neurodiverse 5–11-year-old CYPs and encourage a collaborative and multidisciplinary approach across the system.
Mark highlighted how we can all work together to help the new government build a better country for all CYP. First, we need to understand the problem from both a clinical and policy perspective. The moral distress accompanying long waiting lists, missed opportunities for intervention, and extra work taken on by clinicians/staff were identified as key problems exacerbating inequalities.
Guddi urged for a more connected and coordinated approach that reduces the need for reliance on paediatricians as a means to access additional support. With many educational and childcare settings struggling with funding, referrals are not being made for families who are struggling. Policies need to change to overcome these problems.
Lauren stressed that neurodivergent children often mask whilst at school, only to then ‘erupt’ later. This can significantly elevate their stress levels and affect their mental health in the long run.
Research undertaken by Born in Bradford was used as an example to highlight the disconnect between health and educational settings. Tailored curriculums fit around a social model, and tweaks to our education system can make a whole host of differences. The system is broken; children are not seen as individuals with varying needs but as boxes that need to be ticked. With many sectors struggling, school nurses felt their ability to support children were not being recognised and instead highlighted that they are here to support when needed. Prioritising self-advocacy skills, creating an inclusive class culture, and supporting prevention over intervention are necessary to tackle the problems that both health and education settings face.
Identifying neurodivergent CYP is complex and multifaceted, with many external factors that may not be considered. Demographic and postcode lottery’s, alongside the fact that girls are more likely to go undiagnosed, means children and young people are going through school without the necessary adjustments and support needed. These barriers, linked to structural inequality, prevent CYP from obtaining the support they need. With school attainment and exclusion rates being significantly worse for neurodivergent CYP without early support, we need to utilise the data & research available to intervene and ensure the best outcomes. The diagnosis itself is important, but the support and interventions that follow a diagnosis are key to ensure neurodivergent CYP experience the education system on equal footing as their neurotypical peers.
In the last ten years, the budget spent on early interventions has halved, yet the crisis intervention has doubled – children are being failed. The disconnection across the system, where different professionals carry out diagnosis and intervention, needs to be eradicated to ensure all neurodiverse CYP receive the support they need. The mental toll on neurodiverse individuals without support is often overlooked, and as a society, we need to do more to guarantee our CYP have a sustainable and inclusive future.
After hearing from many frustrated audience members about the long waiting lists and lack of diagnosis, questions arose as to how we could tackle these issues. Families of undiagnosed CYP are often ‘blamed’ by the system, and thus, it is essential to combine clinical and educational settings to ensure neurodivergent CYP and their families have the support they need.
Scientific evidence was presented demonstrating how we can successfully tackle some of the problems neurodivergent CYP face. A successful study conducted by Born In Bradford introduced autism assessment services in schools and found a reduction in the waiting list and number of missed appointments due to mental health stigmas, as well as better parental engagement. Additionally, schools can be utilised to support the diagnosis process, allowing the team to speak to the teachers and SENCOs immediately.
Evie highlighted how the Electronic Development Support Tool could be used in schools to immediately identify any differences within a child’s behaviour and then flagged as potentially being neurodivergent. The success of these two initiatives exemplifies the need to bridge the communication gap between health and education settings. The importance of empowering and educating parents was also discussed, with a solution of having readily available resources (such as those available via the Healthier Together app) so that parents/carers have their questions answered whilst waiting for a diagnosis or additional support. This, in turn, will reduce the burden on healthcare services, and thus, adopting a multidisciplinary and community-wide approach is essential to guarantee neurodivergent CYP are supported as needed.
The conference closed with a discussion on using Healthier Together to address digital literacy for 12–18-year-olds, specifically around health services and accurate information.
Mike highlighted that system change must start with child rights and protecting young people from the harm of being overlooked and forgotten. RCPCH showcase the importance of listening to CYP through their ‘RCPCH &Us’ service, where CYP use their voice to ensure health services meet their needs. RCPCH embeds CYP voices into policy, ensuring children maintain their rights.
What’s the problem?
One of the largest problems within the national health system is the poor state of children’s health – creating poor population health throughout the life course. The case for change is outlined within the RCPCH’s blueprints for transforming child health in England.
The case for change includes four national foundations to recover children’s health services and improve child health outcomes:
The case also includes three targeted areas of focus to address parts of the health system under exceptional pressure:
To facilitate these changes, we must seize opportunities for early intervention, communication, and education. CYP needs must be fully articulated so they are ‘part of the action’ to recover children’s services. Mike further showcased the needs of children’s health through mental health, highlighting the overwhelming impact on services and the lack of resources for CYP.
Furthermore, waiting times are disproportionate with adult services, with CYP waiting years for access to mental health services at key points in their development. Overall, it was clear that CYP voices needed to be present in this ‘call for action’.
Holly described the evidence about what young people want from digital solutions. CYP stated that they already had telehealth, a health app, wearable tech, and access to reliable health information. However, they asked for accessibility, convenience, anonymity and privacy, informed health decisions and digital integration. Digital intervention is mainly concerned with seeing what is out there and what can be integrated to make digital health simpler. For example, CYP could get access to 20+ mental health apps on their device store, yet they were unsure of what to use and what best suited their needs.
Concerns were considered, such as data privacy, security and digital literacy, with a focus on an app in parts of the country where digital literacy is lower. Holly emphasised the point of change CYP are experiencing, explaining how digital solutions may benefit CYP later in life.
Young people and RCPCH&Us are currently contributing to the development of core content on acute illness and mental health for young people. This then has the potential to be accessed by young people across England and the devolved nations.
