Start as you mean to go on

Nearly half of all 5 year olds in the UK are not reaching a good level of development was the story that the news media picked up from the Marmot review team's latest publication, issued on the anniversary of the original Marmot Review. This figure is based on assessment of children during their first year of school (the Early Years Foundation Stage Profile) and attention on this and other social determinants like young people not in education, employment or training (NEET) plays to the big theme in the Marmot Review, that inequalities are established in childhood. What the headlines omitted was that the EYFSP trend is rising, from 49% of children reaching "a good level of development" in 2008, when the assessment was first introduced, to the present 56%, and the fact remains that the area with the highest EYFSP score, the London Borough of Richmond, only reaches 69%.

Personality disorder

It is estimated that,while up to 11% of the general population is affected by pesonality disorder, the prevelance amongst prisoners is something like 60 - 70%. A guide to working with personality disordered offenders from the National Offender Management Service has just been issued, designed to assist offender managers and others such as mental health nurses working in secure accomodation and the community.

Care and compassion?

All over the news in the past day or so is the Health Service Ombudsman's report on NHS care for older people, which makes challenging reading. Like the earlier Six lives report on treatment of people with learning disabilities, Care and compassion highlights particular cases to make its point. And it pulls no punches: "it is incomprehensible that the Ombudsman needs to hold the NHS to account for the most fundamental aspects of care: clean and comfortable surroundings, assistance with eating if needed, drinking water available and the ability to call someone who will respond." Of the 9 000 complaints properly made to the Parliamentary Ombudsman in 2010, 18% concerned the treatment of older people and of these 226 were accepted for investigation: "more than twice as many as for all other age groups put together."

Child Protection

An interim report from the Munro review of child protection offers some early recommendations for change in such areas as inspection, performance monitoring, and referral and assessment. The final report, due out in April, will examine these issues in more detail. Themed around the child's journey "from needing help to receiving it," this interim report takes a long hard look at the proliferation of reporting and documentation, observing dryly that the core guidance, Working together to safeguard children, "is now 55 times longer than it was in 1974," when it was first published. Separating out the statutory guidance from professional advice is one key task recommended, along with changes in the role and practice of Special Case Reviews and a focus on leadership in most areas and at all levels. Local Government Improvement and Development, along with the London Safeguarding Children Board, has produced a strategic quality assurance framework for safeguarding children.

Smoking Update

An interesting review of the efficacy of smoke-free legislation in England in Tobacco Control looks at the social and behavioural effects of the legislation as regards inequalities. Its authors identify significant variation (by age, gender and ethnicity) in the levels of reduction in tobacco consumption and emphasise the importance of understanding the social context of interventions like this. NICE has issued commissioning guidance on quitting smoking during pregnancy and following childbirth, designed to be read alongside the earlier public health guidance on the subject. Statistics released late last year on levels of smoking at delivery reveal a slight fall in numbers, but regional variations are huge, ranging from 20.2% in the North East to 6.5% in London, reflecting the general trend in smoking in the country.

Migrant health

Helping frontline staff who care for migrants is the aim of the HPA's new web-based guide. It offers assessment tools and guidance on explaining the NHS and entitlements to patients as well as providing country-specific information. It's also worth looking at the e-learning module for GPs if you have access to this (available free to UK NHS General Practitioners, GP Specialty Trainees and GP educators).

Local shop for local people

In the wake of the Localism Bill, a report by Deloitte based on interviews with local authority chief executives, A Little Local Difficulty, suggests that there is something of a "misalignment" between what central government expects and how far local authorities are prepared to change. Evidence from a community based healthy living programme in Wales proves interesting reading with this matter in mind. Developing the programme took a grassroots approach, using existing community forums, recruiting researchers from the community itself, with the forums then developing action plans based on research. The study provides a cost effectiveness evaluation of the intervention: do-able and cheap (but not quick) appears to be the conclusion.

Back to work?

Employment and employability are usually seen as key factors in reducing child poverty. Latests results from the Local Authority Child Poverty Innovation Pilots confirm this. Assessing what's been achieved thus far in the ten pilot programmes, it's clear that employment related support, from basic skills training to in-work support, has been in high demand. The Joseph Rowntree Foundation's latest poverty and social exclusion monitoring report confirms the significance of worklessness, as it reviews the impact of recession on the UK. In-work poverty and underemployment are two issues highlighted by the report's authors, as numbers of children in poverty belonging to working families has started to rise.