Early years high impact area 3: Supporting breastfeeding

Question 1

The role of health visitors

Accepted Answer

Health visitors, as public health nurses, use strength-based approaches, building non-dependent relationships to enable efficient and effective working with parents and families to support behaviour change, promote health protection and to keep children safe.

Health visitors also undertake a holistic assessment in partnership with the family, which builds on their strengths as well as identifying any difficulties. It includes the parents’ capacity to meet their infant’s needs, the impact and influence of wider family, community and environmental circumstances. This period is an important opportunity for health promotion, prevention and early intervention approaches to be delivered. Working with parents and families, health visitors identify the most appropriate level of support and intervention for their individual needs.

Question 2

Healthy Child Programme

Accepted Answer

The Healthy Child Programme offers every family a programme of screening tests, immunisations, developmental reviews, information and guidance to support parenting and healthy choices – all services that children and families need to receive if they are to achieve their optimum health and wellbeing.

The Healthy Child Programme is universal in reach. It sets out a range of public health support in local places to build healthy communities and to reduce inequalities. It also includes a schedule of interventions, which range from services for all through extra help to intensive support.

The Healthy Child Programme is personalised in response. All services and interventions need to be personalised to respond to families’ needs across time. For many families this will be met by the universal offer. More targeted, intensive or specialised support and evidence-based interventions should be provided early to meet ‘predicted, assessed and expressed’ needs to improve outcomes.

Question 3

Improving health and wellbeing

Accepted Answer

The high impact areas will focus on interventions at the following levels and will use a place-based approach:

individual and family
community
population

The place-based approach offers new opportunities to help meet the challenges public health and the health and social care system face. This impacts on the whole community and aims to address issues that exist at the community level, such as poor housing, social isolation, poor or fragmented services, or duplication or gaps in service provision.

Health visitors, as leaders in public health and the Healthy Child Programme: Pregnancy and the first 5 years of life, are well placed to support families and communities to engage in this approach. They are essential to the leadership and delivery of integrated services for individuals, communities and population to provide RightCare that maximises place-based systems of care.

Individual and family

Health visitors with additional skills and knowledge in breastfeeding support have been shown to be effective in improving breastfeeding rates. Health visitors can work closely with midwifery services to provide seamless support and care for pregnant women and mothers, giving them an opportunity to learn about infant feeding, the benefits of breastfeeding, the risks associated with not breastfeeding, initiation and sustaining breastfeeding.

Health visitors are effective in enabling mothers to continue breastfeeding and can support those mothers who are unable or do not wish to continue to breastfeed whilst continuing to promote responsive feeding, bonding and secure attachments between mother and infant.

Health visitors are trained in a variety of universal and targeted interventions which could include parenting programmes and intensive home visiting. Many of these programmes have good evidence for supporting important child and parent outcomes. Further details about the evidence and implementation requirements of some of these interventions are listed in the Early Intervention Foundation Guidebook.

Health visitors can also signpost to a wide range of information, services and support, such as parenting support, benefits, housing, relationship advice, alongside other resources, and advice on wider health and wellbeing issues including screening, immunisations, mental health, couple conflict, oral health, muscular skeletal development, preconception care, smoking cessation and contraception.

Health visitors can promote and increase the reach of early years services as they see all children aged between 0 to 5 years old, and their families and work in an inclusive manner which improves engagement. Where women decide not to breastfeed, they should be supported in that decision and provided with individual support as required.

Community

Health visitors can provide practical help and advice to build community capacity to support breastfeeding by working with communities to establish peer support programmes.

Health visitors can work together with professionals including midwives, general practice nurses and key community assets such as peer support and breastfeeding groups. Strong partnership working and developing an understanding of each other’s roles and responsibilities will ensure seamless support and transition between services.

Health visitors are ideally placed to lead the implementation of universal and targeted support in socially disadvantaged areas, thus helping to improve breastfeeding rates and therefore reduce inequalities in health. This may include the provision of group sessions, telephone based support, promoting the National Breastfeeding Helpline, use of social marketing, for example the Start4Life website, promotion of Healthy Start, and signposting to digital technology, for example the Breastfeeding Friend which encourages parents to adopt healthy behaviours and is available as an interactive Facebook Messenger ‘chatbot’, Amazon Alexa and Google Assistant.

Health visitors have knowledge of local and national services, for example breastfeeding peer support groups, breastfeeding cafes, and phone apps, for information and advice to support breastfeeding. Health visitors provide support to women to equip them with the knowledge to be able to plan their return to work whilst breastfeeding and to businesses, shops and public premises within the local authority to enable them to welcome breastfeeding women. Health visitors may also provide education to children and young people about the benefits of breastfeeding, for example through statutory Relationships, Sex and Health Education in all schools.

Population

Health visitors can ensure a whole system approach to promoting breastfeeding by implementing the UNICEF UK Baby Friendly Standards and supporting other settings to become baby friendly, including training for early years staff.

The UNICEF UK Baby Friendly Initiative is a nationally recognised mark of quality care for babies and mothers. The programme helps to ensure that professionals can provide sensitive and effective care and support for mothers, enabling them to make an informed choice about feeding, get breastfeeding off to a good start and overcome any challenges they may face.

The staged accreditation programme trains health professionals to support mothers to breastfeed and help all parents to build a close and loving relationship with their baby irrespective of feeding method.

UK Baby Friendly accreditation is based on a set of interlinking evidence-based standards for maternity, health visiting, neonatal and children’s centres services. Facilities implement the standards in stages over a number of years. At each stage they are externally assessed by UNICEF UK.

Delivery of breastfeeding support should be co-ordinated across the different sectors. Health visitors work closely with key partners including midwives, GPs, general practice nurses and early years services and as partners in a multi-agency approach to this important shared public health outcome.

Collection and provision of local breastfeeding data by health visitors provides a picture of breastfeeding prevalence locally. This information is used to identify areas of particular need and supports the development of targeted multi-agency interventions.

Question 4

Using evidence to support delivery

Accepted Answer

A place-based or community-centred approach aims to develop local solutions that draw on all the assets and resources of an area, integrating services and building resilience in communities so that people can take control of their health and wellbeing, and have more influence on the factors that underpin good health.

The All Our Health framework brings together resources and evidence that will help to support evidence-based practice and service delivery, Making Every Contact Count and building on the specialist public health skills of health visitors.

Most health and care professionals focus on interventions which tend to be delivered on an individual basis, whilst health visitors are more focused on families and communities. It is critical that all professionals consider the importance of population health as an approach that aims to improve physical and mental health outcomes, promote wellbeing and reduce health inequalities across an entire population.

Social prescribing complements such approaches enabling public health nurses and other health and care professionals to refer people to a range of local, non-clinical services. Health visitors recognise that children and young people’s health is determined primarily by a range of social, economic and environmental factors, social prescribing seeks to address individuals needs in a holistic way, taking greater control of their own health.

Question 5

Measuring success or outcome

Accepted Answer

High quality data, analysis tools and resources are available for all public health professionals to identify the health of the local population. This contributes to the decision making process for the commissioning of services and future plans to improve people’s health and reduce inequalities in their area including child and maternal health profiles, measures of access and service experience. Health visitors and wider stakeholders need to demonstrate impact through improved outcomes. This can be achieved by using local measures.

Access

Measures include:

evidence of up-to-date, evidence-based, multi-agency infant feeding policies setting out best practice in relation to breastfeeding support, via local commissioner and provider data
local commissioner and provider data confirm access to infant feeding support, especially at new birth and 6 to 8 week visit

Effective delivery

Measures include:

Measuring impact

Measures include:

User experience

Measures include:

feedback from NHS Friends and Family Test and from health visitor service user experience on satisfaction with breastfeeding support, via local commissioner and provider data

Other measures can be developed locally and could include measures such as initiatives within health visitors’ building community capacity role, such as developing peer support, engaging fathers or partners, joint developments with parent volunteers and early years services and new approaches such as social marketing and breastfeeding friendly cafes.

Question 6

Connection with other areas

Accepted Answer

The high impact area documents support delivery of the Healthy Child Programme and 0 to 5 agenda and highlights the link with a number of other interconnecting policy areas such as the maternity transformation programme, childhood obesity, speech, language and communication, immunisations, troubled families, mental health and social mobility action plan. The importance of effective outcomes relies on strong partnership authority including early years services, and voluntary sector services.

Best Start in Life has been identified as a priority as part of Public Health England’s (PHE) 5-year strategy which runs from 2020 to 2025. Best start in life is a priority for the government and, as such, is included in the Prevention Green Paper Advancing our Health: prevention in the 2020s.

Improving services for children and young people is part of the NHS Long Term Plan. The Child Digital Strategy and Maternity Programme is currently developing and implementing infrastructure to improve access and timeliness of data with the aim to know where every child is and how well they are. This includes the development and implementation of a Digital Parent Child Health Record. This programme supports the ambitions and modernisation of the Healthy Child Programme.

Collaborative working

Approaches to improving outcomes through collaborative working include:

Early years services play a key role in supporting improved outcomes for children and families as part of the integrated planning, delivery, monitoring and reviewing approach. Partnerships can use information from Joint Strategic Needs Assessment (including early years foundation stage profile data, health data, information about families, communities and the quality of local services and outcomes from integrated reviews) to identify and respond to agreed joint priorities. Children and Family Centres provide a good focus for coordination on this.

Improvements

These include:

Professional or partnership mobilisation

These include:

multi-agency training and supervision on the benefits of breastfeeding, both for physical and emotional health and social development
effective delivery of universal prevention and early intervention programmes
improved understanding of data within the Joint Strategic Needs Assessment and at the local Health and Wellbeing Board to better support integrated working of health visiting services with existing local authority arrangements to provide a holistic, joined up and improved service for young children, parents and families
identification of skills and competencies to inform integrated working and skill mix
training and supervision in evidence-based best practice breastfeeding support
access to specialist lactation consultants
role of health visitors in supervising peer mentor programmes