Our earliest experiences of life, starting in the womb, through pregnancy and birth and into our early years, are vital in laying the foundations for our future health and well-being. Research consistently shows that even short-term improvements in physical, cognitive, behavioural, social and emotional development can lead to benefits throughout childhood and later life.
The Marmot Review, Fair Society, Healthy Lives identified giving every child the best start as the highest priority in reducing the inequalities gap that exists between different groups of people. Action to reduce health inequalities needs to start before birth and be followed through the life of the child to improve adult health outcomes.
Unless otherwise stipulated, the term children and young people refers to those aged between 0–18 years old. For children and young people with special educational needs and disabilities (SEND) and for care leavers the age range is from 0–25 years old.
The Start Well Chapter is made up of the 2019 Children and Young People’s Needs Assessment (CYPNA) which covers children aged 0-18 years. Additional information from Achieving for Children (AfC) who provide the Richmond Children’s Services on the needs of children and young people and their families. The data covers children aged 0–18 years.
Link to the CYPNA.
When assessing need in children and young people, variations also exist between datasets in terms of the categorisation of needs and the consideration of primary or multiple needs. This can make it difficult to map trends in access to and provision of services across the children and young people population. Furthermore, care is required when interpreting data to ensure that a consistent population is used for comparison. For example, some datasets and secondary analyses consider borough residents, and others consider pupils attending schools who may or may not be borough residents. Where different populations or timescales have been used, or information is not held, comparisons becomes challenging.
Needs are individual and often complex, meaning children are known to multiple services. Information about their needs may be categorised or prioritised differently depending on the service they are accessing. Data is also held in different and incompatible systems which creates additional challenges in bringing them together to create a full picture of need.
It is positive to see that the general health and well-being of the population and of children and young people fares well in Richmond. However, there are inequalities and health outcomes are not fairly distributed across children and young people with some groups fairing disproportionately worse than others. Key findings overall, when comparing local indicators with England averages, show the health and well-being of children in Richmond upon Thames is better than England. The infant mortality rate is better than England. However, an average of four infants die before aged one each year. Indicators of population health and well-being among children and young people in Richmond are generally better or similar to the England average. Children in Richmond fare well against the England and London averages.
Note on population: Greater London Authority (GLA) projections and population estimates. These are based on Office of National Statistics (ONS) estimates and projected new housing developments. The population estimates are based on ONS 2018 mid-year estimates. For latest demographic information please go to the population explorer on DataRich.
In Richmond 22.9% (44,489) of the total population are under 18 years in 2021. The percentage of children in the borough is higher than the London average (21.8%) with all ages between 5-17 years making up a larger population percentage than in London. Only the number of children under 5 years of age is proportionately smaller than in London (the figure below).
In Richmond:
In Richmond in 2024, 21.2% (n=42,841) of the total population are under 18 years old. The proportion of children in the borough is 2.9% higher than the London average of 20.6%.
The figure below presents the projected changes in population aged under 18.
Source: © GLA 2021-based demographic projections. Housing-led population projections. Past Delivery 10-year migration, 2023
In Richmond in 2024, 21.7% (n=10,063) of the total population aged under 18 were from BAME ethnic groups. The proportion of children from BAME ethnic groups in the borough is 62.0% lower than the London average of 57.2%.
Source: © GLA 2016-based Demographic Projections, 2017
Infant mortality is an indicator of the general health of an entire population. It reflects the relationship between causes of infant mortality and upstream determinants of population health such as economic, social and environmental conditions. Deaths occurring during the first 28 days of life (the neonatal period) in particular, are considered to reflect the health and care of both mother and newborn.
A report by the Nuffield Trust and the Royal College of Paediatrics and Child Health compares several child health indicators in the UK with those of comparable countries. The data show that the UK is performing well in multiple aspects of child health. However, the UK is behind several similarly developed countries with regards to the percentage of children who are overweight or obese, and the rates of breastfeeding. Where the UK previously outperformed comparable countries in relation to childhood mortality rates, the rate of improvement has slowed to such a degree that the UK now has some of the worst outcomes. Life expectancy, immunisation rates and low birth weight are health indicators that have also previously shown good progress but have worsened or plateaued in recent years. These indicators are amenable to public health interventions and therefore at significant risk of cuts to Children’s Services, particularly Early Years Services. While inter-country comparisons of health outcomes should be made with caution, it is evident that there is considerable room for improvement in relation to child health .
Overall, comparing local indicators with England averages, the health and well-being of children in Richmond is better than England. The infant mortality rate in Richmond is better than England, but on average four infants die before the age of one each year.
Infant mortality rate: In 2020 - 22, Richmond’s rate was 2.3 per 1,000 (n=14), which was the 3rd lowest in London, 40.4% lower than the England average and 32.6% lower than the London average. The latest Borough figure for 2020 - 22 was also 42.5% lower than in 2001 - 03, in comparison with 26.5% decrease in England’s rate in the equivalent time period.
Source: OHID: Public Health Profiles
The figure below shows how the UK’s infant mortality rates from 2000-2019 compared with that of other Organisation for Economic Co-operation Development (OECD) countries which have been identified as relevant comparators. The US had the highest rates of infant mortality between 2000 and 2017. In comparison, Sweden had one of the lowest rates between 2000 and 2018. Although the rates of infant mortality in the UK have been decreasing overall, as in the other OECD countries, this decline has somewhat plateaued in recent years and remained relatively high compared to other countries. The rate in 2019 was 4 deaths per 1,000 live births .
Source: OECD, Health Status, Maternal and infant mortality. Office for National Statistics, Vital Statistics in the UK (taken from Quality Watch, Nuffield Trust)
Child mortality rate (1-17 years): In 2020 - 22, Richmond’s rate was 12.1 per 100,000 (n=15), which was the 5th highest in London, 16.4% higher than the England average and 30.5% higher than the London average. The latest Borough figure for 2020 - 22 was also 6.5% higher than in 2010 - 12, in comparison with 16.7% decrease in England’s rate in the equivalent time period. Missing time series data for Richmond have been estimated using linear interpolation.
This section contains data published in Richmond’s 2019 Children and Young People’s Needs Assessment (CYPNA) 1. The table below compares the educational attainment of Richmond’s children and young people at different stages with the national and regional averages. Richmond’s performance across all educational stages is higher than both the England and London averages. The most visible difference is at Key Stage 2, with 89% of Richmond’s pupils achieving the expected standards in reading, writing and numeracy in comparison with a 77% in England and 81% in London.
26,851 pupils attend schools in Richmond, of which 81% live in the Borough. In 2018, 90% of schools in Richmond were judged by Ofsted as good or better, compared to 86% in England; 85% of Richmond pupils attending a good or outstanding school. The table below compares Richmond and England’s Ofsted ratings for primary and secondary schools in 2018 and in March 2021.
Source: Ofsted
The table below breaks down Richmond’s schools and early years settings by type. There is only one nursery school in the borough. There are many more maintained nurseries attached to primary schools and other early years settings in the private, voluntary and independent sector.
*- this comprises of 71 full day care settings, 40 sessional settings and 43 out of school settings Source: Children and Young People Needs Assessment (CYPNA), Achieving for Children: Early Years’ Service
The number of looked after children in a local area provides a proxy indicator for the levels of general well-being in society. Children and young people in care are among the most socially excluded children in England. There are significant inequalities in health and social outcomes compared with all children and these contribute to poor health and social exclusion of care leavers later in life. Rates of those in care in Richmond (25/10,000) are significantly below the London 50/10,000 and England rates 65/10,000 and have remained at similar levels since 2011. Richmond retains the lowest rates of children and young people in care of all London Boroughs with just 125 young people in care in an average year.
The Indices of Multiple Deprivation (IMD) is published every 3–5 years by the Ministry of Housing, Communities and Local Government. It measures relative deprivation in England using a methodology that encompasses a wide range of living conditions including income, employment and health. Scores are calculated for each small, geographical area in England (almost 33,000) and the published product ranks these from most to least deprived. The Income Deprivation Affecting Children Index (IDACI) is also calculated and published in the same ranking-style format. The IDACI measures the percentage of children under 16 years that live in low-income households. The map presents Richmond IDACI 2019, relative to the rest of the Borough only e.g., ‘10% most deprived’ is the 10% most deprived in Richmond, rather than England.
Relative to England, Richmond has low levels of deprivation (IDACI). Of the 115 local areas (LSOA) in Richmond, 59 (51%) are within the 20% least deprived in the country and only two LSOAs (1.7%) are within the 20% most deprived.
There are 557 children who live in the lowest 10% of Lower Super Output Areas (LSOA) nationally for deprivation affecting children (using the Income Deprivation Affecting Children Index – IDACI 2015). There are no LSOAs in Richmond which are in the lowest 10–20%. There are approximately 3,000 or 8.3% children under 16 years living in low-income families.
The Marmot Review (2010) suggests there is evidence that childhood poverty leads to premature mortality and poorer health outcomes for adults. There is also a wide variety of evidence to show that children who live in poverty are exposed to a range of risks that can have a serious impact on their mental health. Reducing the number of children who experience poverty should improve their health outcomes in adulthood and increase their healthy life expectancy.
The level of child poverty in Richmond is similar to England, with 6.4% (2,795) of children aged under 16 years living in low-income families 2 and there is a welcome decreasing trend. In 2016 there were 3,260 children in low-income families 8.5%. This is much lower than either the London figure of 18.8% or the national figure of 17%. The percentage of children considered to be in poverty substantially increases when housing costs are factored in. The latest End Child Poverty Report indicates that after housing costs, 21% of Richmond’s children are living in poverty, compared to 30% nationally. Wards with the highest percentage of children living in poverty are Heathfield (29%), Barnes (28%) and Hampton North (27%).
Children in absolute low income families (under 16s):
Absolute low income is defined as a family in low income Before Housing Costs (BHC) in the reference year in comparison with incomes in 2010 to 2011. A family must have claimed one or more of Universal Credit, Tax Credits or Housing Benefit at any point in the year to be classed as low income in these statistics.
Absolute low income takes the 60 percent of median income threshold from 2010 to 2011 and then fixes this in real terms (i.e. the line moves with inflation). This is designed to assess how low incomes are faring with reference to inflation. It measures the number and proportion of individuals who have incomes below this threshold. The percentage of individuals in absolute low income will decrease if individuals with lower incomes see their incomes rise by more than inflation.
In 2022/23, Richmond’s rate was 4.2% (n=1654), which was the lowest in London, 73.1% lower than the England average and 65.9% lower than the London average. The latest Borough figure for 2022/23 was also 19.2% lower than in 2014/15, in comparison with 1.3% increase in England’s rate in the equivalent time period.
Child deprivation is geographically concentrated in a few wards, including Barnes, Ham, Hampton North, Heathfield, Kew and Whitton.
The number of children known to be eligible for FSM is frequently used as an indicator or poverty.
Free school meals: % eligible: In 2022/23, Richmond’s rate was 13.1% (n=3785), which was the lowest in London, 45.1% lower than the England average and 49.4% lower than the London average. The latest Borough figure for 2022/23 was also 51.1% higher than in 2014/15, in comparison with 56.9% increase in England’s rate in the equivalent time period.
Homelessness - households with dependent children owed a duty under the Homelessness Reduction Act: In 2022/23, Richmond’s rate was 10.7 per 1,000 (n=268), which was the 8th lowest in London, 33.4% lower than the England average and 48.4% lower than the London average. The latest Borough figure for 2022/23 was also 123.3% higher than in 2020/21, in comparison with 39.1% increase in England’s rate in the equivalent time period.
In 2018/19, 301 children and young people were in temporary accommodation in Richmond. This is a decrease from 392 children in 2017/18. This indicates that alternative assistance such as prevention may be gaining traction locally. As of 31st March 2019, there were no families in temporary accommodation that were sharing facilities and no families were placed into bed and breakfast accommodation. As of 31st March 2019, there were 8 young people aged 16–18 years placed in temporary housing (self-contained or supported hostels). These young people were the main applicant rather than within a family. In 2018/19, 90% of the families with children who approached for homeless assistance were resolved successfully either through prevention work or being owed a duty to house. 16% of the positive decisions received were via prevention, negating the need of temporary accommodation.
According to the 2011 census 7.9% of households with dependent children are overcrowded compared to 23.6% in London and 9.2% nationally. The demand for social housing has steadily risen on both a national and local scale. Children on the housing queue in Richmond has increased from 2,561 in 2017/8 to 2,954 in 2018/19. Richmond can offer 200 homes which are provided by Housing Associations per year. Priority is accorded to those applicants with a high housing need.
The three most deprived IDACI wards in Richmond are Hampton North, Heathfield and Whitton, and located on, or near to the west of the Borough. There is a correlation between relatively poor IDACI outcomes and higher ethnic diversity. Heathfield (30% ethnic minority groups), Whitton (22%) and Hampton North (16%) are also the three most ethnically diverse wards in the borough. The least deprived wards include Twickenham, Riverside, East Sheen and South Twickenham, which are among the least ethnically diverse in the borough.
Educational attainment of children eligible for the pupil premium grant (on free school meals, in care, adopted or children with parents in the armed services) is significantly less than those of their peers.
Many of the health behaviours and risk factors for poor birth outcomes are established prior to pregnancy. Often there is limited potential to impact on these after conception (the start of pregnancy). For example, 13.7% of adult women smoke and whilst few, if any, take up smoking as a new behaviour while pregnant, in the UK 11% of women are still smoking through to the birth of their baby.
A mix of health-related behaviours, reducing risk factors, and supporting women to alleviate the negative impact of the wider determinants on their health, will enable them to have a healthy pregnancy. Even among those who do plan their pregnancy, relatively few will modify their behaviours 3.
Healthy behaviours include a healthy diet (including folic acid supplements), regular physical activity, and emotional well-being. It is important immunisations, sexual health checks, and smear tests are up to date.
Preconception risk factors include smoking, alcohol, substance misuse, obesity, long term physical and mental health conditions, previous pregnancy complications, genetic risks, maternal age, adverse childhood experiences (ACEs), domestic violence, and migrant health factors 4 and these will often be interlinked. Furthermore, the wider determinants of health such as housing, education and skills, financial security, work, and family relationships also influence pre-conception health. The impacts of these are unequally distributed meaning those with the greatest need may have the most difficulty accessing care. Many of these issues are covered across the whole of the JSNA and will be referenced elsewhere. Only a snapshot of health behaviours and risks factors for Wandsworth will be covered in this chapter.
Women who are overweight or obese before pregnancy have increased risk of infertility. They may also be complications during pregnancy and birth including impaired glucose tolerance/gestational diabetes, miscarriage, preeclampsia, thromboembolism, and maternal death. Babies born to obese women have a higher risk of foetal death, stillbirth, congenital abnormality, shoulder dystocia, macrosomia, and subsequent obesity. In 2016/17 over 55% of women were overweight or obese in England and the prevalence of overweight and obese adults is predicted to reach 70% by 2034.
Some pre-existing conditions such as epilepsy or severe mental illness can be a risk factor for maternal deaths either within pregnancy or for up to a year after the end of the pregnancy. Maternal suicide 5 remains the leading direct cause of maternal deaths. Nationally 1 in 7 women die in the period between six weeks and one year after pregnancy by suicide. Nationally, an estimated 20% of women will develop a mental illness during pregnancy or within the first year after having a baby.
It is estimated in Richmond:
Maternal age is a factor that can influence both pregnancy and childhood outcomes. Teenage pregnancy is associated with a higher risk of late antenatal booking, lower birth weight babies, stillbirth, and infant mortality. The rate of under-18 years conceptions in Wandsworth has seen a substantial reduction over the last decade and has fallen more steeply than those across England 6. The latest data for 2021 shows that in England 13.1/1,000 young women under-18 years became pregnant.
Births to women aged 35 years and over also carry additional risks in relation to birth complications, congenital abnormalities, stillbirth, and emergency sections. However, the exact age at which these risks increase is uncertain and co-existence of additional risk factors e.g., smoking, will increase the chance of adverse birth outcomes. The latest Office of National Statistics (ONS) conception data released in 2021 indicates that between 2011 and 2021, women aged 35 to 39 years and aged 40 years and over, were the only age groups to see an overall increase in conception rates. Since 2011, the conception rates have increased by 3.5% for women aged 35 to 39 years and 19.7% for women aged over 40 years 7. Nationally, women are progressively delaying childbearing. The latest available data shows that over 10% of births in Richmond were to women aged 40+, which ranks the second highest in London and is above the England percentage of 4.4%. Trends in outcomes for newborns:
Smoking is the single biggest modifiable risk factor for poor birth outcomes. Smoking during pregnancy causes up to 2,200 premature births, 5,000 miscarriages and 300 perinatal deaths every year 8. It also increases the risk of stillbirth, complications in pregnancy, low birthweight, and of the child developing other conditions in later life. Currently 13.7% of adult women in the UK smoke cigarettes and nearly 11% of women in England are still recorded as smoking at the time of delivery.
Smoking in early pregnancy: In 2018/19, Richmond’s rate was 3.5%, which was the 5th lowest in London, 72.8% lower than the England average and 42.5% lower than the London average. Time series data were not available for this indicator.
Smoking status at time of delivery: In 2022/23, Richmond’s rate was 5.2% (n=80), which was the 8th highest in London, 40.9% lower than the England average and 13.0% higher than the London average. The latest Borough figure for 2022/23 was also 24.9% higher than in 2010/11, in comparison with 35.5% decrease in England’s rate in the equivalent time period.
Low birthweight (under 2.5kg) is one of the known risk factors for infant deaths.
Low birth weight of term babies: In 2021, Richmond’s rate was 2.3% (n=45), which was the 3rd lowest in London, 15.5% lower than the England average and 28.9% lower than the London average. The latest Borough figure for 2021 was also 9.1% higher than in 2006, in comparison with 8.1% decrease in England’s rate in the equivalent time period.
The first 1001 days mark the moment of conception through to a child’s second birthday and have been found to be crucial for laying the foundations for future development and preventing illness in later life.
Ensuring every child has the best start in life is a national and a local priority. Initiating breastfeeding from birth is one of the earliest interventions that can give a child the best possible start, can lay the foundations for future development, and prevent illness in later life. Initial breastfeeding uptake 9 in Wandsworth has seen increases in recent years, and currently stands at 86.7%, which is the third highest in London. Whilst this is encouraging, the child poverty indicators suggest that more needs to be done to ensure early health gains are sustained as children develop.
The World Health Organisation (WHO) and the United Nations International Children’s Emergency Fund (UNICEF) recommend breastfeeding to be initiated within the first hour after birth and continued exclusively for the first six months and beyond with safe weaning onto solids foods. The UK, however, has one of the lowest breastfeeding rates in the world. There is limited breastfeeding data available to compare trends particularly due to the different timescales for data collection internationally.
There are multiple explanations for these low breastfeeding rates. Sometimes mothers experience practical problems when establishing breastfeeding and fail to receive adequate practical support. There are additional concerns about whether a child is receiving sufficient milk, and is often due to advice from friends, family and professionals to supplement with formula milk. This reduces breastmilk production and is strongly associated with premature cessation of breastfeeding 10. Anecdotal evidence reveals that social attitudes about women breastfeeding in public may lead to women feeling uncomfortable about breastfeeding.
In light of these low figures, there are several policy drivers in the UK promoting breastfeeding which include (but are not limited to):
Supporting women to breastfeed ensures babies they have the best possible start with significant health benefits for both mother and baby. For the baby this includes protection against illness and infection, prevention of diarrhoea and respiratory infections, reduced risk of sudden infant death syndrome (SIDS), and risk of breast cancer, postnatal depression, and ovarian cancer for the mother 11.
Breastfed children also perform well on intelligence tests and are less prone to diabetes in later life. There is also growing evidence to suggesting an increased future risk of childhood obesity in those who have not been breastfed. In addition to the health benefits of breastfeeding, a cost/benefit analysis carried out by UNICEF, indicates increasing the number of babies who are breastfed will help save the NHS up to £50 million each year 12 thereby reducing financial pressure on both local and national resources.
Baby’s first fed breastmilk is defined as the percentage of babies whose first feed is breastmilk which includes expressed and donor milk. This first fed breastmilk is important for two reasons:
Baby’s first feed breastmilk (previous method): In 2018/19, Richmond’s rate was 86.6% (n=1770), which was the 4th highest in London, 28.5% higher than the England average and 13.4% higher than the London average. The latest Borough figure for 2018/19 was also 13.6% higher than in 2017/18, in comparison with nan% increase in England’s rate in the equivalent time period.
Breastfeeding initiation (first 48 hours after birth) and uptake at 6–8 weeks are included in the National Institute for Health and Clinical Excellence (NICE) proposals for the Commissioning Outcomes Framework.
Breastfeeding prevalence at 6–8 weeks is defined as the percentage of infants that are totally or partially breastfed at age 6–8 weeks. The table below shows that Richmond’s performance in the last year is significantly better than the England average. Richmond has seen an overall improvement in 6–8 weeks prevalence rates between 2018 to 2019 from 67% in Q1 to 77% in Q4. The overall total for the year is 74.6%. Breastfeeding prevalence at 6–8 weeks for Richmond has remained higher than the England average. This is the first full annual data set available for Richmond since 2012. Going forward this should show an increase the rates of mothers breastfeeding.
Source: Central London Community Healthcare (CLCH) breastfeeding data 2018/19 Q1-4
There are a range of breastfeeding services on offer in the community and in the hospital. Public Health, in partnership with the Children’s Commissioning Team, commission Central London Community Healthcare Trust (CLCH) to provide the Health Visiting Service for Richmond children from 0–19 years. This includes providing evidenced pathways for delivering each of the 6 high impact areas to all levels of family need. The high impact areas are part of the 4-5-6 model which provides an evidence-based framework on which health visitors who are leaders of the Healthy Child Programme, can maximise their contribution. These high impact areas include:
Breastfeeding support for Richmond is provided by the Health Visiting Service and supported by Infant Feeding Leads within the hospital and the community.
Hospital: Women receive breastfeeding support from maternity services at Kingston Hospital until around day 10, when the handover to the Health Visiting Service usually commences. The midwives in the hospital are trained to provide baby-friendly standard care by the infant feeding team. Additionally, Kingston Hospital have Breastfeeding Peer Supporters who support the Midwives to provide mothers with breastfeeding support where needed. This team is managed by the hospital’s Infant Feeding Lead. Kingston Hospital offers a Specialist Breastfeeding Support Clinic for complex cases up to 28 days post birth.
Community: The community Infant Feeding Lead delivers training for the health visitors who provide breastfeeding support to mothers when they are discharged from the hospital, usually between day 10 to 14. Breastfeeding Support Clinics are available to support mother and they are led by the Health Team made up of health visitors, nursery nurses and lactation consultants. Additionally, there are voluntary independent organisations that run breastfeeding support groups led by La Leche League leaders and National Childbirth Trust (NCT) breastfeeding counsellors.
Richmond Council has a breastfeeding operational group chaired by the Public Health Children and Young People Lead. Members of the group include the infant feeding leads for both the hospital and community, breastfeeding lactation consultants from the voluntary sectors, health visitors and other Children Services support staff.
UNICEF Baby Friendly Accreditation is an evidence based, staged accreditation programme that supports Maternity, Neonatal, Health Visiting and Children’s Centre Services to deliver effective breastfeeding support. It is an internationally recognised mark of quality care for babies and mothers. In Richmond the infant feeding leads for both the community and the hospital (Kingston Maternity) lead this programme. Our 0-19 years provider service were assessed to receive the Baby Friendly Initiative Stage 2 accreditation in 2019. Feedback provided identified that some health visiting staff required more practical training before accreditation could be awarded. While this was due to commence during 2020 all accreditation programmes were paused due to COVID-19. Reassessment for Stage 2 is now planned for the end of 2021 with the view to achieving Baby Friendly Initiative Stage 3 accreditation by the end of 2022.
Source: UNICEF UK. Baby Friendly Initiative. 2020 (redesigned internally)
UNICEF has put out a “call to action” on the UK Government to enable mothers to breastfeed for as long as they wish and to protect all babies from commercial interests below :
There are a range of evidence-based approaches to promoting breastfeeding in the UK. Some of these have been implemented in Wandsworth. There is overwhelming evidence that shows breastfeeding saves lives. “Breastfeeding practices are highly responsive to interventions delivered in health systems, communities and homes. The largest effects are achieved when interventions are delivered in combination” (Lancet Breastfeeding Series, 2016).
Evidence shows that implementing a multi-faceted approach that considers the parents’ whole journey from pregnancy to new parenthood improves breastfeeding rates significantly. This should include sensitive conversations during pregnancy, skilled support in the immediate post-birth period, ongoing guidance and social support to enable mothers to feel confident and breastfeed successfully for as long as they wish. Additional support from the wider community in welcoming breastfeeding, including in public spaces, in the workplace and through the media is pivotal to the process .
The Baby Friendly Initiative (BFI) is recommended by the National Institute for Health and Clinical Excellence (NICE) and cited in a wide range of policy guidance documents. The programme has been highly successful, with over 90% of maternity units and 80% of health visiting services actively engaged, and therefore breastfeeding initiation rates have improved by over 20% 13.
A systematic review carried out through the UNICEF Baby Friendly Initiative demonstrated that it increases breastfeeding rates up until the age of six weeks and that this is consistent with studies conducted in other resource rich countries 14. Given the international evidence on the low take up of breastfeeding in the UK in comparison to other European countries, it is imperative that public health continue to prioritise and promote the UNICEF initiative.
Public Health in Richmond is working with the National Childbirth Trust (NCT) to create baby friendly places that promote breastfeeding. The programme includes the development of resources (posters, stickers, leaflets) for local businesses, GPs, libraries and other community settings to support their commitment to promote breastfeeding in their environment. Promotional material provides mothers with information on breastfeeding friendly places. Discussions are also in place to develop a ‘Breastfeeding Peer Support Service’ in the community with a timeline to achieve Stage 3 full accreditation within one year of achieving Stage 2 accreditation for the peer scheme.
All babies up to, but not including, their first birthday are eligible for the Newborn Blood Spot Screening (NBSS), otherwise known as the ‘heel prick test’. The aim of the screening programme is to enable early identification, referral, and treatment of babies with nine rare but serious conditions, the last six of which are inherited metabolic diseases, including:
A healthcare professional will usually take a blood spot sample on day 5 (day of birth is day 0) from a child’s heel and send the sample for testing. Babies, who are new to the country or are yet to have a blood spot test, are eligible for testing up to one year old.
In 2018/19, 98.9% of babies registered within Richmond CCG that were eligible for NBS screening had a conclusive result recorded on the Child Health Information System (CHIS) by 17 days of age. Furthermore, 95.5% of those who either changed responsible CCG in the first year of life or moved in from another UK country, had a conclusive result recorded on the CHIS within 21 calendar days of notifying the CHRD of movement into Richmond.
Newborn hearing tests help to identify most babies with significant hearing loss. The hearing screening significantly reduces the risk of having undiagnosed hearing problems that can affect children’s speech and social development 15.
Newborn Hearing Screening: Coverage: In 2022/23, Richmond’s rate was 99.2% (n=1753), which was the 9th highest in London, 0.6% higher than the England average and 0.6% higher than the London average. The latest Borough figure for 2022/23 was also 0.3% higher than in 2013/14, in comparison with 0.1% increase in England’s rate in the equivalent time period. Missing time series data for Richmond have been estimated using linear interpolation.
Immunisations in the first few years of life can provide long-term protection against preventable diseases. The target for most immunisations is 95% of the eligible population which ensures that immunity is high enough for the infectious disease not to be passed to others. Immunisations for vaccine preventable diseases include Congenital Rubella Syndrome, Pertussis, Influenza and Hepatitis B infection and are an important element of protecting the health of mother and baby. Maternal Rubella Infection in pregnancy, for example, may result in foetal loss or Congenital Rubella Syndrome and Influenza Infection in pregnancy is associated with risks to the foetus, including still birth.
The complete childhood vaccination schedule 16 covers numerous diseases including Diphtheria, Tetanus, Pertussis (Whooping Cough), Polio, Haemophilus Influenzae Type B (Hib) and Hepatitis B, Meningitis B and Rotavirus Gastroenteritis at 8 weeks old, and Measles, Mumps and Rubella (German measles) from the age of one. Vaccinations for cancers caused by Human Papilloma Virus (HPV) types 16 and 18 (and Genital Warts caused by types 6 and 11) are added at aged 12 years and Meningococcal Groups A, C, W and Y diseases at age 14 years (Year 9). In addition to whole population vaccinations the schedule also includes additional vaccinations for at risk groups such as annual influenza for babies born to Hepatitis B infected mothers and infants in areas of the country with high tuberculosis rates. Additional vaccines are also given to individuals with underlying medical conditions.
An overview of the picture for vaccine uptake across England and London in 2018/19 showed that coverage declined for all 13 routine vaccinations compared to the previous year. There was markedly lower coverage for booster vaccines and second doses of vaccines than for the first dose or primary course of all vaccinations.
Of the 14 Public Health Outcome Indicators relating to the Childhood Vaccination Programme, Richmond ranks significantly worse than both the London and England averages in all but 5 diseases.
The combined DTaP/IPV/Hib is the first in a course of vaccines offered to babies to protect them against Diphtheria, Pertussis (Whooping Cough), Tetanus, Haemophilus Influenza Type B (an important cause of childhood Meningitis and Pneumonia) and Polio (IPV is an inactivated Polio vaccine). Vaccination coverage is the best indicator of the level of protection a population will have against vaccine preventable communicable diseases. Monitoring coverage identifies possible drops in immunity before levels of disease rise. The combined DTaP/IPV/Hib is the first in a course of vaccines offered to babies to protect them against these five diseases. The vaccine is offered when babies are two, three and four months old. Evidence shows that promoting vaccination programmes encourages improvements in uptake levels.
Vaccination coverage is the best indicator of the level of protection a population will have against vaccine preventable communicable diseases. Coverage is closely correlated with levels of disease. Monitoring coverage identifies possible drops in levels of immunity before the levels of disease rise.
Immunisations for vaccine-preventable diseases including Congenital Rubella Syndrome, Pertussis, Influenza and Hepatitis B Infection are an important element of protecting the health of mother and baby. Maternal Rubella Infection in pregnancy, for example, may result in foetal loss or Congenital Rubella Syndrome and Influenza infection in pregnancy is associated with risks to the foetus, including still birth.
To achieve community immunity the required coverage for the childhood vaccinations is 95% of the eligible population.
The combined DTaP/IPV/Hib is the first in a course of vaccines offered to babies to protect them against diphtheria, pertussis (whooping cough), tetanus, haemophilus influenzae type B (an important cause of childhood meningitis and pneumonia), and polio (IPV is inactivated polio vaccine).
The vaccine is offered when babies are two, three and four months old. Monitoring coverage identifies drops in population immunity before levels of disease rise. The combined DTaP/IPV/Hib is the first in a course of vaccines offered to babies to protect them against these five diseases.
Population vaccination coverage: Dtap IPV Hib HepB (1 year old): In 2022/23, Richmond’s rate was 89.2% (n=1876), which was the 12th highest in London, 2.8% lower than the England average and 1.9% higher than the London average. The latest Borough figure for 2022/23 was also 4.6% lower than in 2010/11, in comparison with 2.5% decrease in England’s rate in the equivalent time period.
The reasons for the pronounced dip in vaccine coverage in 2016/17 are not clear. From 1st April 2017 the 19 Child Health Information Service (CHIS) providers in London merged into 4 CHIS Hubs to cover the entirety of London. This was part of NHS England’s Healthy Children: Transforming Child Health Information. The change coincided with the period of data submission for the Cover of Vaccination Evaluated Rapidly (COVER) programme.
The first data submitted from the new hubs are representative of the changes in the system although it is not clear whether this contributed to the marked decline seen in Richmond. It was expected that data quality issues could persist in some London COVER returns for the next few reports. PHE advised that changes in local authority vaccine coverage in London should be interpreted with caution Health Protection Report . It has further been suggested by the Head of Information at the South West London CHIS that a change of clinical system, problems with data transfer or data extract from Richmond GP Practices, and issues with immunisation data recording may have affected the data.
Population vaccination coverage: DTaP and IPV booster (5 years): In 2022/23, Richmond’s rate was 71.4% (n=1912), which was the 16th lowest in London, 14.2% lower than the England average and 1.7% lower than the London average. The latest Borough figure for 2022/23 was also 8.4% higher than in 2015/16, in comparison with 3.4% decrease in England’s rate in the equivalent time period.
MMR is the combined vaccine that protects against Measles, Mumps and Rubella. Measles, Mumps and Rubella are highly infectious, common conditions that can have serious complications, including Meningitis, swelling of the brain (Encephalitis) and deafness. They can also lead to complications in pregnancy that affect the unborn baby and can lead to miscarriage.
The first MMR vaccine is given to children as part of the routine vaccination schedule, usually within a month of their first birthday. They will then have a booster dose before starting school, which is usually between 3-5 years of age. There was a rise in confirmed measles cases in England during 2018. In Richmond there has been a significant increase in the number of cases, from less than five in 2017 to 11 in 2018.
Population vaccination coverage: MMR for one dose (2 years old): In 2022/23, Richmond’s rate was 85.5% (n=1769), which was the 11th highest in London, 4.3% lower than the England average and 3.8% higher than the London average. The latest Borough figure for 2022/23 was also 0.3% higher than in 2010/11, in comparison with 0.2% increase in England’s rate in the equivalent time period.
Population vaccination coverage: MMR for two doses (5 years old): In 2022/23, Richmond’s rate was 74.1% (n=1983), which was the 16th highest in London, 12.3% lower than the England average and 0.2% higher than the London average. The latest Borough figure for 2022/23 was also 2.2% lower than in 2010/11, in comparison with 0.4% increase in England’s rate in the equivalent time period.
Some types of Human Papillomavirus Virus (HPV) are linked to the development of cancers, such as cervical cancer (more than 70% of these cancers are linked to HPV), anal cancer, genital cancers, and cancers of the head and neck. Two doses of HPV vaccine protect against four types of HPV: 6, 11, 16 and 18. Type 16 and 18 significantly increase the chances of developing cancer.
The 1st dose of the HPV vaccine was routinely offered to girls aged 12 and 13 years in school, with the 2nd dose offered usually within one year from the first dose. For school year 2019/20 boys and girls in Year 8 are eligible for the HPV vaccine 17.
Population vaccination coverage: HPV vaccination coverage for two doses (13 to 14 years old): In 2022/23, Richmond’s rate was 73.9% (n=948), which was the 4th highest in London, 17.5% higher than the England average and 39.9% higher than the London average. The latest Borough figure for 2022/23 was also 4.0% lower than in 2015/16, in comparison with 26.1% decrease in England’s rate in the equivalent time period.
MenACWY vaccine protects against four strains of the Meningococcal bacteria – A, C, W, Y – which cause meningitis and blood poisoning (septicaemia). Children aged 13 to 15 are routinely offered the MenACWY vaccine in schools 18.
Population vaccination coverage: Meningococcal ACWY conjugate vaccine (MenACWY) (14 to 15 years): In 2021/22, Richmond’s rate was 88.7% (n=2448), which was the 3rd highest in London, 11.4% higher than the England average and 17.8% higher than the London average. The latest Borough figure for 2021/22 was also 8.6% higher than in 2016/17, in comparison with 3.5% decrease in England’s rate in the equivalent time period.
Children in care immunisations: In 2023, Richmond’s rate was 81.0% (n=61), which was the 13th highest in London, 1.2% lower than the England average and 9.0% higher than the London average. The latest Borough figure for 2023 was also 19.0% lower than in 2012, in comparison with 1.3% decrease in England’s rate in the equivalent time period.
A range of multi-agency services exist for children and young people that promote and encourage positive health and well-being outcomes. Many are referenced in other parts of this JSNA, but for the purpose of this chapter the key health related service to be focussed on is the 0–19 years Health Visiting and School Nursing Service.
The 0–19 years Health Visiting Service is commissioned to undertake interventions which result in the overall improvement of child health across Wandsworth and as such contribute to the achievement of the Child Health Measures as set out by the Department of Health and presented in table below 19.
This is achieved through adherence to all components of Department of Health’s 2009 Healthy Child Programme (HCP) 20 where a core universal service offer is balanced with effective and targeted responses to varying family needs, and accounts for the specific requirements of those with greater needs.
The HCP provides an evidence-based framework that identifies the necessary screening tests, immunisations, developmental reviews, information, and guidance necessary to support parenting and healthy choices to enable children to secure optimum health and well-being. Evidence shows that the HCP yields a good return on investment and that interventions are highly effective in securing healthy child development, positive future health and educational outcomes. This can reduce costs associated with dealing with problems such as mental ill-health and delayed learning, as well as child protection issues .
The 0–19 year service is currently commissioned by Central London Community Health (CLCH) and has the following objectives to:
The revised service model, presented below, is based on the 4-5-6 Model, DoH, 2015
Source: OHID, Overview of the 6 early years and school aged years high impact areas.
Four levels of support are offered to account for differing family needs including:
Additionally, in Richmond CLCH is commissioned to deliver the Family Nurse Partnership (FNP) which works with parents aged 24 years and under, partnering them with a specially trained family nurse who visits them regularly, from early pregnancy until their child is 2 years old. There are five contact points for the service: an antenatal contact, a home visit at 10–14 days, a home visit at 6–8 weeks, a home visit at 1 year (between 9–12 months) and a contact at 2- 2.5 years, presented in the table below 21.
The 0–19 years’ Service identifies and delivers clear evidenced pathways for delivering each of the high impact areas to all levels of family need across the four different levels of service at the five touch points, as shown below.
Child development: percentage of children achieving a good level of development at 2 to 2 and a half years: In 2022/23, Richmond’s rate was 30.7% (n=428), which was the 11th lowest in London, 61.3% lower than the England average and 55.8% lower than the London average. The latest Borough figure for 2022/23 was also 65.9% lower than in 2019/20, in comparison with 4.8% decrease in England’s rate in the equivalent time period.
The latest available published data reveals that in quarter 2 2019/20:
The overarching aim of the School Nursing Element of the 0–19 years’ Service is to develop and improve the emotional, physical and mental well-being of children and young people. Reducing the health inequalities across their life course and closing the health gap for children and young people identified as vulnerable or disadvantaged is a high priority.
The School Nursing Service includes these key components:
The School Nursing Service helps children and young people to develop the skills they need to manage the challenges they face in school, at home, in their personal lives or online. In Richmond, the service is provided by CLCH and focuses on:
In Richmond the School Nursing Service also provides the Family Start Programme for children who are:
The School Nursing Service builds on the evidence within cross-cutting policy and guidance, namely, but not exhaustively: * best start in life and beyond: Improving public health outcomes for young people and families (PHE March 2018) * maximising the School Nursing Team Contribution to the Public Health of School Age Children (DOH PHE 2014). * Healthy Lives, Healthy People: Improving Outcomes and Supporting Transparency, (DoH, 2010 and updates 2011, 2012), provides the outcomes framework for public health and recognise the importance of School Nursing in the promotion and delivery of the public health agenda as it includes children and young people. * ‘Getting it right for children, young people and families’ (DoH, 2012), sets out the vision and best practice model framework for the delivery by a School Nursing Service, of the Health Child Programme (HCP) * ‘The Children and Young People’s Health Outcome Forum’ (DoH, 2012), describes what children and young people consider to be the most important attributes of an effective school health service * New Relationships and Health Education in schools (DfE July 2018) draft guidance on the duty to provide relationships and sex education in schools * Transforming Children and Young People’s Mental Health – a Green Paper and Next Steps DHSC and DfE July 2018 which sets out proposals to increase the support for children’s mental health in schools.
Prior to the pandemic, work had commenced to ensure the outcomes for the school nursing services were captured within key performance data to ensure enhanced monitoring of the service. This work was put on hold during the pandemic following NHS COVID-19 directives. Some school nursing teams were re-deployed on an interim basis. Our local provider, however, retained a key focus on safeguarding while schools were closed. In March 2021 the government re-launched the Healthy Child Programme (replacing the 4,5,6 model) in order to focus on personalised assessments of need and provide interventions which are suitable for the children and families’ needs.
The new model aims to capture the full extent of both the health visitor and school nurse offer in recognition that local services were offering so much more than the 5 mandated contacts. It enables increased opportunities for further contacts to provide additional support, especially during the early years. The model includes two additional universal contacts at 3-4 months and 6 months. These will provide important opportunities to address key public health priorities including perinatal mental health, child development, breastfeeding, childhood obesity prevention, immunisation uptake, and safe sleep.
Commissioners and Public Health are currently working with the provider to ensure the service meets both universal and targeted needs of children, young people and families, re-starting contract variation and KPI discussions whilst embedding changes to the Healthy Child Model.
Children are assessed at various points, data from which can help inform both the education of individual children as well as planning services which bring benefit to larger groups in the community. As children come to the end of Reception, their readiness for school is assessed. School readiness indicators in Richmond are consistently above both London and England averages.
School readiness: percentage of children achieving a good level of development at the end of Reception: In 2022/23, Richmond’s rate was 75.6% (n=1750), which was the highest in London, 12.4% higher than the England average and 9.3% higher than the London average. The latest Borough figure for 2022/23 was also 1.6% higher than in 2021/22, in comparison with 3.1% increase in England’s rate in the equivalent time period.
There is local recognition that scores are beginning to plateau. Early Years teams are in the early stages of developing a cross borough Early Language Strategy in partnership with SALT services. In Richmond, plans are being developed to restructure the Early Years’ Service with a view to focusing on the gap in outcomes between disadvantaged children and their peers. Plans are under way to provide consistent support for children with SEND across the early years sector. The Borough is also working towards implementing the new Early Years Foundation Stage reforms that became statutory in September 2021.
Two of the key aims of these reforms are to:
Those working in Early Years and Childcare settings, headteachers and teachers have received briefings and will continue to have training and professional development to support these key aims.
Throughout the pandemic Health Visiting Services have been key to ensuring all children reach a good level of development. Health Visiting Services were reduced during the pandemic following NHS National Directives. The service was temporarily re-fined to focus attention on those with higher needs with the temporary suspension of some universal services. In response to the return to business as usual, the updated Healthy Child Programme and a significant national and local shortage of health visitors, CLCH worked in partnership with commissioners and public health teams to re-structuring their services across London. This review programme ‘Reimagining Health Visiting’, has been developed through consultation with staff, clients and commissioners, benchmarking with other 0-19 services, reviewing of commonalities across existing service specifications, and demand /capacity case modelling. It has also been informed by the NHS Long Term Plan for England, CQC inspection feedback, a review of caseload sizes, and improved and different ways of working as a response to COVID-19. Health visitors utilise Ages and Stages Questionnaires (ASQs) and 1 year checks to identify that children’s social-emotional development is on schedule, identifying cohorts most likely to fall behind. Health visitors have completed specialist speech and language training as part of a London wide initiative.
As has been found nationally, the current clinical model for health visiting has been inflexible and the data set does not reflect the totality of what is done across the service. The Re-imagining Programme essentially seeks to move toward utilising an ‘active’ and ‘inactive’ caseload model to increase capacity for those identified as the most in need or at risk. Health visitors will be supported by an increase in the recruitment and deployment of staff nurses to support families assessed as requiring universal services. The initial antenatal and new birth visits will continue to be carried out by health visitors as will support for vulnerable families assessed as requiring a universal plus or universal partnership plus services. Achieving for Children, with support from public health, have continued to progress the HEYL Awards for the Early Years’ setting, all be it at a lower profile given the temporary closure of some services.
Social Communication Intensive Packages (SCIPs) are run in Richmond for children going into Reception and continued for some children in Year 1. There will be 20 running from September 2021. Schools receive additional funding, outreach support and training for identified children in Early Years with social communication difficulties who are on the autism spectrum. Support continued virtually through COVID-19, but it is hoped that there will be a return to more face to face contact.
Despite Wandsworth’s high ranking for the overall school readiness for the reception year, the borough’s rank for the same indicator for children on FSM is the second lowest in London.
School Readiness: percentage of children with free school meal status achieving a good level of development at the end of Reception: In 2022/23, Richmond’s rate was 52.4% (n=97), which was the 6th lowest in London, 1.7% higher than the England average and 9.3% lower than the London average. The latest Borough figure for 2022/23 was also 12.5% higher than in 2021/22, in comparison with 5.0% increase in England’s rate in the equivalent time period.
There has been no discernible downward trend in the percentage of children receiving FSM achieving the expected level in the Phonics Screening Check in Year 1 since 2015/16. The level has remained around 71% in comparison to 87% for those not receiving FSM. Richmond ranks within the bottom quintile of all London Boroughs for those on FSM (the figure below).
By the end of Year 6, however, the percentage of disadvantaged children reaching the expected standard drops to 57% compared to other children at 85%. The inequality in Richmond is greater than that seen in both London and England (the figure below).
Achievement for those in Black, Asian and Minority Ethnic Groups (74%), is almost 10% lower than in all other children (83%) and will perpetuate health inequalities through the life-course (the figure below).
Children who do not develop good oral language in early life are at greater risk of experiencing problems with literacy later, potentially impairing their ability to reach their academic potential. As the National Institute for Health and Care Excellence (NICE) explains: “Children and young people with communication difficulties are at increased risk of social, emotional and behavioural difficulties and mental health problems. So, identifying their speech and language needs early is crucial for their health and well-being. Many young children whose needs are identified early do catch up with their peers” 22.
Early identification and intervention ensure children start school in a position to flourish and minimises the development of gaps which can have a lasting detrimental impact. Research has shown that “children who had poor language skills at age five were about six times less likely to reach the expected standard in English and about 11 times less likely to reach the expected standard in maths at age 11” 23. In addition, only 15% of pupils with identified speech, language and communication needs achieve the expected standard reading, writing and maths at the end of primary school, compared with 61% of all pupils. As the government’s national plan to improve social mobility through education states: “Children who arrive at school in a strong position will find it easier to learn, while those already behind will face a growing challenge: early advantage accumulates, but so too does early disadvantage” 24.
Since 2011/12 there has been a steady increase in:
School readiness: percentage of children achieving at least the expected level of development in communication, language and literacy skills at the end of Reception: In 2022/23, Richmond’s rate was 77.4% (n=1793), which was the highest in London, 12.5% higher than the England average and 9.9% higher than the London average. The latest Borough figure for 2022/23 was also 1.2% higher than in 2021/22, in comparison with 2.6% increase in England’s rate in the equivalent time period.
Unintentional injuries form a major burden of disease in children and young people and are a major cause of inequality. In 2014/15, there were 19.6 million Accident and Emergency (A&E) attendances recorded at major A&E departments, single specialty A&E Departments, Walk-in Centres and Minor Injury Units in England. More than one quarter (25.9%) of attendances were made by children and young people aged0–19 years. A&E admissions in Richmond have seen a worrying upward trend across all age groups in 0–19 year olds and are statistically worse than the England averages. Furthermore, Richmond has the third highest emergency admissions for falls in children aged 0–4 years of all London Boroughs.The inclusion of this indicator within Public Health Profiles as one of the five most common causes of childhood injury admissions is key for cross-sectoral and partnership working to reduce injuries and improve child safeguarding. Local Authorities and CCGs can use this indicator to inform child safety campaigns and service provision which may be evidence of the hidden safeguarding concerns prevalent within more affluent areas.
Hospital admissions caused by unintentional and deliberate injuries in children (aged 0 to 4 years): In 2022/23, Richmond’s rate was 83.7 per 10,000 (n=90), which was the 10th highest in London, 9.0% lower than the England average and 12.0% higher than the London average. The latest Borough figure for 2022/23 was also 4.6% lower than in 2010/11, in comparison with 35.9% decrease in England’s rate in the equivalent time period.
Hospital admissions caused by unintentional and deliberate injuries in children (aged 0 to 14 years): In 2022/23, Richmond’s rate was 59.6 per 10,000 (n=220), which was the 15th highest in London, 20.9% lower than the England average and 0.9% lower than the London average. The latest Borough figure for 2022/23 was also 32.4% lower than in 2010/11, in comparison with 34.6% decrease in England’s rate in the equivalent time period.
Hospital admissions caused by unintentional and deliberate injuries in young people (aged 15 to 24 years): In 2022/23, Richmond’s rate was 90.5 per 10,000 (n=170), which was the 3rd highest in London, 3.8% lower than the England average and 32.9% higher than the London average. The latest Borough figure for 2022/23 was also 12.6% lower than in 2010/11, in comparison with 39.2% decrease in England’s rate in the equivalent time period.
OHID expects that most of the lower respiratory tract Infections in toddlers should be managed outside of hospital. Primary care has an important role in advising and managing infections at home, as well as encouraging a healthy diet and high levels of hygiene. High rate of hospitalisation might indicate that the system for supporting predominantly young parents with managing child’s lower respiratory infections has been inefficient 25.
Admissions for lower respiratory tract infections (2 to 4 years): In 2022/23, Richmond’s rate was 67.4 per 10,000 (n=45), which was the 7th highest in London, 57.1% higher than the England average and 46.3% higher than the London average. The latest Borough figure for 2022/23 was also 176.1% higher than in 2011/12, in comparison with 67.9% increase in England’s rate in the equivalent time period. Missing time series data for Richmond have been estimated using linear interpolation.
Admissions for asthma (0 to 9 years): In 2022/23, Richmond’s rate was 106.9 per 100,000 (n=25), which was the 4th lowest in London, 30.9% lower than the England average and 34.0% lower than the London average. The latest Borough figure for 2022/23 was also 37.3% lower than in 2010/11, in comparison with 50.4% decrease in England’s rate in the equivalent time period.
Admissions for epilepsy (0 to 9 years): In 2022/23, Richmond’s rate was 85.5 per 100,000 (n=20), which was the 13th highest in London, 8.0% lower than the England average and 6.8% higher than the London average. The latest Borough figure for 2022/23 was also 110.5% higher than in 2010/11, in comparison with 3.5% decrease in England’s rate in the equivalent time period. Missing time series data for Richmond have been estimated using linear interpolation.
In 2018/19 in Wandsworth there were virtually no admissions for diabetes in children under 10 years old. PHE has suppressed the borough’s numbers and the rates have not been calculated for Wandsworth. However, diabetes admissions data is available for all under 19 year olds, including young people aged 10-18 years.
Admissions for diabetes (under 19 years): In 2022/23, Richmond’s rate was 43.3 per 100,000 (n=20), which was the 16th highest in London, 17.4% lower than the England average and 2.1% lower than the London average. The latest Borough figure for 2022/23 was also 32.5% lower than in 2010/11, in comparison with 18.2% decrease in England’s rate in the equivalent time period.
Childhood obesity is defined as abnormal or excessive fat accumulation that presents a risk to health and is one of the most serious public health challenges of the 21st century 26. However, obesity is a complex issue and there is no singular solution. The UK is now ranked among the worst in Western Europe for childhood obesity rates and is one of the biggest health problems the country faces. Nationally, two thirds of adults, a third of 11–15 year olds, and a quarter of 2–10 year olds are overweight or obese.
The UK is now ranked among the worst in Western Europe for childhood obesity rates and it is one of the biggest health problems the country faces. Nationally, two thirds of adults, a third of 11–15 year olds and a quarter of 2–10 year olds are overweight or obese.
Obesity and overweight disproportionately affects those from more deprived areas. This is seen most strongly in children with obesity prevalence, in the most deprived decile twice as high as those in the least deprived decile. Prevalence of obesity is also higher amongst children from particular ethnic minorities – boys in Year 6 from all Black Asian and Minority Ethnic groups are more likely to be obese than White British boys, and girls in Year 6 are more likely to be obese if they are from Black or Black African ethnic groups. Children with learning disabilities are also more likely to be overweight or obese.
In childhood, obesity is associated with several health risks, such as the development of eating disorders, musculoskeletal problems, respiratory problems and type 2 diabetes, which until recently was considered a health issue that only effected adults. Excess weight also has a significant impact on psychological well-being, with many children developing negative self-image and low self-esteem issues.
Obesity is most likely to be a result of diet and eating patterns and research indicates that 40% to 60% of obese school-age children become obese adults 27 and dietary behaviours established in childhood have been found to continue into adolescence and adulthood 28.
A roundtable event by LSE entitled, “Tackling Obesity in London and Beyond – Nudge and Trade” identified the importance of locally-led solutions in relation to tackling public health challenges such as obesity. Learning from France and the Netherlands shows that Local Authorities, working with local stakeholders, such as parents, schools, community groups, businesses and the media, can have a modest effect on stopping childhood obesity. There is evidence of intergenerational transmission of obesity which highlights the importance of considering the whole family when tackling child obesity. Parental obesity increases obesity in adolescence. This link is even stronger when both parents are obese and is stronger for school age girls. It is recommended that consideration is given to how to improve access to and encourage use of green space; as well as an increased focus on cooking to improve health 29.
We must put our children’s health first and act now to improve child health and well-being. In working together across society, we can improve our children’s health and several strategies to achieve this are recommended and have been incorporated into the government’s action plan to counteract the rise in childhood obesity 30. The plan includes improving the nutritional content of the food and drink our children consume, strengthening the information available to parents and the general public about nutritional content of foods and drinks (and those that should be limited). Changing the way that unhealthy food and sugary drinks are promoted, for example, removing offers for ‘Buy One Get One Free’ on foods high in sugar must be challenged.
These actions are important to reduce the increasing financial burden that the obesity epidemic is having on the NHS; obesity-related health conditions are estimated to cost the NHS (and therefore UK taxpayers) £6.1 billion per year.
More than 1 in 5 children in England are obese or overweight by the time they start primary school, and this rises to one third by the time they are 11 years old . In England, the National Child Measurement Programme (NCMP) measures the weight and height of children within state maintained Primary Schools in Reception Class (aged 4 to 5 years) and Year 6 (aged 10 to 11 years). Their figures are based on large numbers of measurements and provide a robust assessment of obesity in children . However, the NMCP does not include children in the independent sector so the overall measurement of school children in Reception and Year 6 aged 4–5 years is incomplete.
Reception prevalence of obesity (including severe obesity): In 2022/23, Richmond’s rate was 5.7% (n=100), which was the lowest in London, 38.1% lower than the England average and 39.2% lower than the London average. The latest Borough figure for 2022/23 was also 4.8% higher than in 2008/09, in comparison with 4.7% decrease in England’s rate in the equivalent time period. Missing time series data for Richmond have been estimated using linear interpolation.
Reception prevalence of overweight (including obesity): In 2022/23, Richmond’s rate was 15.0% (n=265), which was the lowest in London, 29.5% lower than the England average and 25.0% lower than the London average. The latest Borough figure for 2022/23 was also 10.7% lower than in 2008/09, in comparison with 6.5% decrease in England’s rate in the equivalent time period. Missing time series data for Richmond have been estimated using linear interpolation.
By the time a child reaches Year 6 the percentage of obese children has increased two-fold.
Year 6 prevalence of overweight (including obesity): In 2022/23, Richmond’s rate was 23.3% (n=445), which was the lowest in London, 36.3% lower than the England average and 40.0% lower than the London average. The latest Borough figure for 2022/23 was also 2.9% lower than in 2008/09, in comparison with 12.0% increase in England’s rate in the equivalent time period. Missing time series data for Richmond have been estimated using linear interpolation.
Childhood obesity prevalence changes with age and ethnic group. In Richmond (and nationally) the prevalence of obesity is the highest in Black Ethnic groups and the lowest in White Ethnic groups; the prevalence in Asian Ethnic groups was somewhere in the middle. Interestingly, the pace of increase in obesity prevalence between Reception and Year 6 varies even more substantially. for Black ethnicities, the prevalence in Year 6 is 181% higher than in Reception, in comparison with a 261% increase in White ethnicities and 316% increase in Asian ethnicities (the figures below).
The causes of obesity and being overweight are multi-factorial as no one single factor can be attributed to it. The Obesity Systems Map outlines the main areas that contain variables which are considered to affect the outcome of obesity directly or indirectly: environmental, societal and individual themes 31. These include variables such as an individual’s psychology and physiology, and their food and activity environment.
A growing body of evidence suggests that a whole systems approach could help tackle complex problems, such as obesity. The recent Public Health England document ‘Whole Systems Approach to Obesity: A Guide to Support Local Approaches to Promoting a Healthy Weight’ is a professional resource that is designed to support local action to address Obesity. The guide describes a how to process, which can enable Local Authorities, and their partners, to create their own local whole systems approaches to reducing obesity and promoting a healthy weight, as it is understood that there is no one singular solution; causes of obesity exist in the places where we live, work and play. The guide does not specify which specific policies, interventions or actions local areas should include in a whole systems approach; this is an important part of the approach, which needs to be agreed collectively by local stakeholders to reflect the local context 32.
In 2019 the London Child Obesity Taskforce launched their ‘Every Child a Healthy Weight’ campaign, which outlines 10 ambitions on areas that are understood to reduce the risk of lifelong ill health for children. These ambitions have been chosen to reflect the circumstances in which children may live which makes it difficult for them to eat healthy food, drink water and be physically active 33. Some examples of these ambitions include, ending child poverty, supporting women to breastfeed for longer, ensuring all nurseries and schools are enabling health for life, making free water available everywhere, creating more active, playful streets and public spaces, and stopping unhealthy marketing which influences what children eat.
At its simplest, excess weight in children is caused by an energy (calorie) imbalance and consuming too much energy compared with an expenditure. Children in the UK have diets that are too high in energy-dense foods, saturated fat and free sugars (sugars that are added to our food), all of which contribute to this imbalance. Children also consume too little fibre, fruit and vegetables 34 which counteract the overconsumption of calorie-dense foods by filling us up more than processed, sugary foods.
The adoption of a healthy diet from as young an age as possible is recommended 35. In general, a healthy diet is rich in fruit and vegetables, wholegrains, legumes and nuts, and low in foods high in saturated fat, salt and sugar. It is recommended that at least 400 grams (equivalent to approximately five portions of 80 grams) of fruit and vegetables per day (excluding starchy root vegetables) are consumed from two years of age 36.
The Public Health England Eatwell Guide 37 and the Department of Health ‘5 A Day’ Campaign aim to improve diet and nutrition in the general population and have been promoted widely. Nevertheless, only 18% of 5-15 year olds eat the recommended ‘5 A Day’ 38.
Research has indicated that over the last 20 years there has been a dramatic reduction intake in key nutrients in children, such as vitamin A, folate, calcium, zinc, iron and iodine 39, all of which are available in a healthy, nutrient-rich diet 40.
The implications of this are children from a young age do not have the required nutrients to support growth and development including the formation of healthy teeth, bones, body tissues and normal nerve function 41.
Risk factors begin from birth, starting with an increased risk of obesity for children who are not breastfed 42:
In Richmond the number of children being breastfed continues to increase. Richmond has seen an overall improvement in 6–8 weeks prevalence rates between 2018 to 2019 from 26% in Q1 to 79% in Q4. The overall total for the year is 56% which is higher than the England average of 42.7% 43.
To stay healthy or to improve health, young people aged 5–18 years need to do three types of physical activity each week; aerobic exercise, exercises to strengthen bones, and exercises to strengthen muscles 44. Data on physical activity in children and young people in Wandsworth is scarce. The latest available borough’s data comes from Active Lives Children and Young People Survey, Sport England for year 2020/21.
This age group should be encouraged to do at least 60 minutes of physical activity every day and up to several hours a week. This should range from moderate activities such as walking, cycling and playground activities, to vigorous activities causing heavier and faster breathing and an increase in heart rate, such as football, rugby or tennis. It is recommended that on three days a week, these activities should involve exercises to strengthen muscles and exercises to strengthen bones. Examples would be a child lifting their own body weight or working against a resistance, such as push-ups, rope climbing, and sports like gymnastics and rugby. Bone strengthening activities could include running, dancing, or martial arts which promote bone growth and strength by producing an impact or tension force on the bones.
Children and young people should reduce the amount of time they spend on sedentary activities, for example watching TV and playing computer games. It is encouraged to travel by foot or bicycle as opposed to being a passenger in a car where possible.
School nurses conduct the NCMP and measure all children at Reception and Year 6. Children who are identified as overweight or obese are provided with appropriate support and advice and referred to the Health4Life Child Weight Management Service. This is run by CLCH and provides a family-based approach covering nutrition and physical activity. Children are followed up and referred to this service.
The Family Weight Management Service is also available for children aged 2–5 years (pre-school) with weight more than 2 centiles above height centile (using the UK-WHO: 0–4 Growth Charts in the Red Book); and women who have given birth in the previous 2 years who are obese (BMI ≥30), also run by CLCH as part of the 0–19 service.
Richmond is also part of the Healthy Early Years London (HEYL) Award Scheme. It is funded by the Mayor of London for all Early Years settings and child minders. It supports and recognizes achievements in child health, well-being, and development in early years settings. The HEYL Award builds on from the success of Healthy Schools London and compliments the statutory Early Years Foundation Stage Framework adding to the focus on children, families and staff health and well-being. The award is focused on a whole setting approach by involving children, parents, and the local community to create a healthy learning environment across 12 themes which are:
There are 4 levels of the HEYL award: First Steps, Bronze, Silver and Gold. At present 57 settings have registered, 41 settings are on First Steps, 5 settings have achieved Bronze, 1 setting has achieved Silver and no school is yet on Gold.
There is local recognition that the impact of the response to COVID-19 further restricted children and young people’s level of physical activity, both in the respect of lockdown and due to the closure of schools, and disproportionately affecting those already disadvantaged. While Child Weight Management services are run by the School Health Services in Richmond there is acknowledgment that further support is required to increase physical activity for targeted groups least likely to access extra-curricular sporting activities. Public health is currently planning to conduct a validated Health and Related Behaviour Survey across all schools. This will gather comparative data in respect of physical activity and inform multi-agency partnership responses.
The percentage of Richmond’s Reception Year children that are a healthy weight has remained relatively stable in the last decade.
Reception prevalence of healthy weight: In 2022/23, Richmond’s rate was 84.1% (n=1485), which was the highest in London, 8.5% higher than the England average and 7.7% higher than the London average. The latest Borough figure for 2022/23 was also 1.9% higher than in 2008/09, in comparison with 1.7% increase in England’s rate in the equivalent time period. Missing time series data for Richmond have been estimated using linear interpolation.
Year 6 prevalence of healthy weight: In 2022/23, Richmond’s rate was 74.6% (n=1425), which was the highest in London, 20.6% higher than the England average and 26.1% higher than the London average. The latest Borough figure for 2022/23 was also 0.4% lower than in 2008/09, in comparison with 6.3% decrease in England’s rate in the equivalent time period. Missing time series data for Richmond have been estimated using linear interpolation.
Richmond’s prevalence of underweight in 2019/20 (BMI less than 2nd centile of the UK90 growth reference 45) among children in Reception Year was 0.7%.
Reception prevalence of underweight: In 2022/23, Richmond’s rate was 0.8% (n=15), which was the 2nd lowest in London, 26.5% lower than the England average and 53.2% lower than the London average. The latest Borough figure for 2022/23 was also 5.7% lower than in 2008/09, in comparison with 14.6% increase in England’s rate in the equivalent time period. Missing time series data for Richmond have been estimated using linear interpolation.
Year 6 prevalence of underweight: In 2022/23, Richmond’s rate was 2.1% (n=40), which was the 13th highest in London, 34.0% higher than the England average and 3.0% higher than the London average. The latest Borough figure for 2022/23 was also 41.9% higher than in 2008/09, in comparison with 20.3% increase in England’s rate in the equivalent time period. Missing time series data for Richmond have been estimated using linear interpolation.
The data in the table below has been obtained from the North East London Commissioning Support Unit. It shows the number of child eating (ED) disorder contacts at CAMHS for the months of April to July 2021/22.
Source: NEL Commissioning Support Unit
Currently, there are no available data to fully explore the impact of eating disorders on Richmond’s children and young people.
Data reported in the figure below are taken from the most recent national study carried out by NHS Digital. The 2017 Mental Health in Children and Young People Survey identified that 0.4% of 5-19 year olds surveyed had an eating disorder ^[[NHS Digital. Mental Health of Children and Young People in England, 2017]. The figure below shows that they were more common in girls (0.7%) than boys (0.1%); and in older age groups than younger ones (0.1% of 5-10 year olds; 0.6% of 11-16 year olds; 0.8% of 17-19 year olds). Rates of eating disorder were higher in girls aged 17-19 year olds (1.6%) than in other demographic groups. While the pattern of association between presence of eating disorder and age group looks different between girls and boys, this was not statistically significant.
Source: NHS Digital. Mental Health in Children and Young People Survey. 2017
This survey confirms an expected profile for eating disorders that while it can affect boys, it is primarily a disorder experienced by girls. The findings also confirm the established pattern that vulnerability to eating disorder increases with age. The survey found a prevalence of 1 in 60 girls aged 17 to 19 years old equivalent to one case in every two classes. However, eating disorders in younger girls aged 11-16 years old were evident in 1 in 100. These figures should be viewed as estimates, due to the few positive cases identified in the sample. They should be considered underestimates.
Public Health is conducting a comprehensive Mental Health Needs Assessment (MHNA) 2021/2022. This needs assessment will incorporate an in-depth review of the latest data available to identify the estimated prevalence of mental disorder in Wandsworth and will include eating disorders. The MHNA will use the NHS Digital national study Mental Health in Children and Young People 2017 (MHCYP, 2017) to estimate the number of girls and boys that we would expect to have an eating disorder. The MHNA will also examine service demand and utilisation for a more complete picture of need.
Percentage of physically active children and young people: In 2022/23, Richmond’s rate was 56.2%, which was the 3rd highest in London, 19.6% higher than the England average and 23.0% higher than the London average. The latest Borough figure for 2022/23 was also 25.1% higher than in 2017/18, in comparison with 8.7% increase in England’s rate in the equivalent time period. Missing time series data for Richmond have been estimated using linear interpolation.
dmft (decayed, missing or filled teeth) in five year olds: In 2018/19, Richmond’s rate was 0.4 mean dmft per child, which was the 3rd lowest in London, 49.2% lower than the England average and 56.2% lower than the London average. The latest Borough figure for 2018/19 was also 14.9% lower than in 2014/15, in comparison with 5.2% decrease in England’s rate in the equivalent time period.
Percentage of 5 year olds with experience of visually obvious dental decay: In 2021/22, Richmond’s rate was 16.1%, which was the 3rd lowest in London, 32.0% lower than the England average and 37.6% lower than the London average. The latest Borough figure for 2021/22 was also 19.1% lower than in 2007/08, in comparison with 23.4% decrease in England’s rate in the equivalent time period.
The percentage of all school pupils with social, emotional and mental health needs in Richmond is 1.91% which is significantly lower than both the London and England Levels at 2.41% and 2.39% respectively 46. This masks the disparity in outcomes and the challenges felt by secondary school aged pupils in Richmond with the percentage of secondary school aged pupils with social, emotional and mental health needs rising to 2.67% and is significantly higher than levels seen across England.
School aged Children with Significant Social, Emotional and Mental Health Needs is an indicator from PHE Public Health Profiles. The data represents the number of school children with Special Education Needs (SEN) who are identified as having social, emotional and mental health as the primary type of need, expressed as a percentage of all school pupils.
The most recent data available using the Mental Health in Children and Young People Survey 2017 identifies an estimated 3,849 children and young people in aged 5-17 years with a mental disorder. This includes emotional disorders, behavioural disorders, hyperactivity disorders, and autism spectrum, eating and other less common disorders.
The figure below provide a comparison across the 32 London Boroughs of estimated number of children and young people with mental disorders in Richmond.
Source: Mental Health in Children and Young People Survey 2017
School pupils with social, emotional and mental health needs: % of school pupils with social, emotional and mental health needs: In 2022/23, Richmond’s rate was 2.1% (n=357), which was the 8th lowest in London, 25.0% lower than the England average and 12.5% lower than the London average. The latest Borough figure for 2022/23 was also 36.9% higher than in 2015/16, in comparison with 34.4% increase in England’s rate in the equivalent time period.
School pupils with social, emotional and mental health needs: % of school pupils with social, emotional and mental health needs: In 2022/23, Richmond’s rate was 4.2% (n=501), which was the 7th highest in London, 20.0% higher than the England average and 31.2% higher than the London average. The latest Borough figure for 2022/23 was also 17.4% higher than in 2015/16, in comparison with 48.5% increase in England’s rate in the equivalent time period.
Looking at presentations to accident and emergency, 125 children and young people attended Accident and Emergency requiring a Mental Health Assessment in 2017/18. This was up from 19 children and young people in 2015/16. Of the 125 children, 71 (57%) were aged 11–15 years and 88 (70%) were female.
There is an estimated 2008 children and young people in Richmond with a mental health disorder (the table below).
Source: Children and Young People Needs Assessment (CYPNA)
44 young people were in treatment for eating disorders in 2017/18, which has been a steady trend since 2015/6. 95% of those in treatment were female, while 71% were between 11–15 years of age.
Hospital admissions as a result of self-harm: In 2022/23, Richmond’s rate was 73.8 per 100,000 (n=10), which was the 6th lowest in London, 70.6% lower than the England average and 40.6% lower than the London average. The latest Borough figure for 2022/23 was also 51.5% lower than in 2011/12, in comparison with 102.8% increase in England’s rate in the equivalent time period.
Hospital admissions as a result of self-harm: In 2022/23, Richmond’s rate was 281.2 per 100,000 (n=30), which was the 10th highest in London, 39.9% lower than the England average and 9.6% higher than the London average. The latest Borough figure for 2022/23 was also 26.4% lower than in 2011/12, in comparison with 0.8% decrease in England’s rate in the equivalent time period.
Adolescence is a critical time in development. It is a period when life-long behaviours are set, long-term conditions emerge, and risk-taking behaviours begin (including sexual activity and experimentation with alcohol and drugs).
Nationally, recent trends have seen improvements in some areas of adolescent health including a reduction in young people’s health risk-taking behaviour 47. Young people’s rates of smoking, alcohol consumptions and teenage pregnancy rates have been on the decline over the past decade.
National evidence demonstrates that young people’s substance misuse is a causal factor of and contributor to a wide range of other serious problems. Substance misuse can exacerbate and be a consequence of falling behind in school, involvement in crime, anti-social behaviour and becoming a victim of crime. Alcohol and substance misuse can contribute to unplanned teenage pregnancy and sexually transmitted infections. Substance misuse is also a response to or a causal factor of mental health problems. This may be a contributing factor to episodes of missing from home and is strongly linked to the exploitation of young people such as through county lines and/or child sexual exploitation (CSE) 48. Furthermore, it can exacerbate problems relating to employment, housing and family life.
Nationally, recent trends have seen improvements in some areas of adolescent health including young people’s health risk-taking behaviour 49. Young people’s rates of smoking, alcohol consumption, and teenage pregnancy rates have been on the decline over the past decade.
Smoking prevalence at age 15 - regular smokers (WAY survey): In 2014/15, Richmond’s rate was 6.7%, which was the highest in London, 22.2% higher than the England average and 94.0% higher than the London average. Time series data were not available for this indicator.
Percentage who have ever tried cannabis at age 15: In 2014/15, Richmond’s rate was 18.6%, which was the highest in London, 73.8% higher than the England average and 70.6% higher than the London average. Time series data were not available for this indicator.
For 2018/19 there were 144 new referrals into the Young Persons Substance Misuse Service, a reduction from 226 in 2017/18. The top three referral routes were via Children’s Services, followed by A&E and Education Providers. Primary substance use reported during 2018/19 was linked to cannabis 33%, followed by alcohol 12%, others such as Benzodiazepines and MDMA were less than 2%. The ages of those referred to the service were mainly 15-16 years (40%), followed by those who were 17-18 years (27%) and 13-14 years (21%). In terms of gender, 40% were female and 60% male. With regards to ethnicity 37% were White, 6% Mixed, 3% Black, and 1% Asian with 51% did not state their ethnicity.
Hospital admissions due to substance misuse (15 to 24 years): In 2020/21 - 22/23, Richmond’s rate was 64.3 per 100,000 (n=35), which was the 6th highest in London, 10.4% higher than the England average and 28.9% higher than the London average. The latest Borough figure for 2020/21 - 22/23 was also 14.4% lower than in 2008/09 - 10/11, in comparison with 8.2% decrease in England’s rate in the equivalent time period.
Adolescence is a crucial time for physical, emotional and social development. It is also a time of intense learning, both in terms of formal education and informally from family and peers. Alcohol and drug abuse affects, impairs, interrupts or hinders physical, emotional, social or academic development.
The Smoking, Drinking and Drug use among Young People in England surveys pupils in all secondary schools every two years to provide national estimates and information on the smoking, drinking and drug use behaviours of young people aged 11 – 15 years. The latest publications Statistics on Drug Misuse (England, 2019) 50 and Statistics on Alcohol (England, 2018) 51 show that 44% of 11-15 year old pupils have had an alcoholic drink, 19% have smoked cigarettes, and 24% have taken drugs.
Data from young people’s specialist substance misuse services indicate young people who need drug and alcohol treatment have a range of vulnerabilities, the majority present with poly-drug use.
The most recent national treatment data (2019-2021) 52 shows that cannabis and alcohol are two most required services. However young people also come to treatment services using a range of substances including ecstasy (Methylenedioxymethamphetamine, MDMA), new psychoactive substances and cocaine. A very small minority will present with heroin use. Benzodiazepine use has doubled since 2016-2017.
The latest Crime Survey for England and Wales (2018-2019) shows that younger adults aged 16-24 years have a higher proportion of people who have taken a drug in the last year (20.3%), compared to adults aged 16-59 years (9.4%). Young adults aged 16-24 years were more likely to be frequent drug users and consume higher proportion of Class A drugs (8.7%) than any other age group (3.7%).
The Sexual Health Framework (2013) 53 highlights alcohol consumption and being drunk can result in lower inhibitions and poor judgements regarding sexual activity, vulnerability and risky sexual behaviour, such as not using contraception or condoms. Reducing smoking, alcohol and drug related harm is linked to the priorities of a smoke free society, better mental health, and the best start in life outlined in the Public Health England’s Strategy 2020-2025.
Young people who use recreational drugs run the risk of damage to mental health including suicide, depression and disruptive behaviour disorders. Regular use of cannabis or other drugs can also lead to dependence.
Admission episodes for alcohol specific conditions in Richmond for under 18-year-olds between 2017/18 and 2019/20 is 33.0 per 100,000 and has been on an upward trend since 2015/16 . This is equivalent to 45 admissions, 10 of which were males and 35 females. Richmond has the highest amongst all of London boroughs and has a higher rate than London (15.4) and England (30.7) 54.
In 2017/18, there were 40 hospital admissions due to substance misuse in 15–24 year olds in Richmond, a rate of 75.1 per 100,000. This rate is higher than London (55.6 per 100,000) but lower than England (84.7 per 100,000).
The rate of hospital admissions caused by unintentional and deliberate injuries in young people aged between 15–24 is 119.9 per 10,000, which is equivalent to 215 admissions in 2019/20. This rate is higher than London (94.8 per 10,000) but lower than England (132.1 per 10,000).Unintentional and deliberate Injuries are a leading cause of hospitalisation and represent a major cause of premature mortality for children and young people. They are also a source of long-term health issues, including mental health related to experiences. This can put young people at risk of turning to substances as a coping mechanism.
This section highlights key performance information about young people (under the age of 18 years) accessing specialist substance misuse interventions provided by the YPSMS. The data is taken from the National Drug Treatment Monitoring System (NDTMS) which reflects specialist treatment activity reported for young people with problems around alcohol and drug misuse. For the purposes of this report and to uphold the confidentiality of all young people’s data being used, the specific age and gender categories of young people in treatment have not been outlined. A more generalised trend analysis has been provided.
Among 10–15 year olds, an increased likelihood of drug use is linked to a range of adverse experiences and behaviour, including truancy, exclusion from school, homelessness, time in care, and serious or frequent offending.
The table below shows the totals for the number of young people in treatment in Richmond each year since 2016/17 Q4 up until 2020/21 Q2. Data from 2020/21 Q2 was the most recent data available at the time when this review was being conducted.
The data highlights a marked increase in young people accessing specialist substance misuse interventions over the last two years when compared to previous years.
Source: NDTMS
In Richmond, the most common age of young people accessing treatment with most referrals coming through amongst young people were aged 15–16. In 2019/20, the highest age group was 15 and in Q2 202/21, the highest was 16. This could mean that there is a specific cohort of users that are ageing and are clients in service. Across both years, there were significantly more males than females accessing treatment, with more than 60% males in treatment in both years.
The most used substance amongst young people accessing treatment was cannabis. This was followed by alcohol, and in 2019/20 this was followed by nicotine. All other substances were used at a frequency less than 5 or not at all (the table below).
*-Numbers smaller than 5 are suppressed to protect confidentiality of service users Source: NDTMS
Referral pathways into young people’s substance misuse services in Richmond, across both years (to date), come predominantly via Children and Family services, followed by Youth Justice Services, Education Services, Health & Mental Health Services, and Accident and Emergency. No referrals have been made via other sources (the table below).
Numbers smaller than 5 are suppressed to protect confidentiality of service users Source: NDTMS
During 2020/21 (to date), a greater proportion of treatments delivered fell into the 0–12 weeks and 13–26 weeks treatment window compared to the year before, with the largest rise observed in treatments lasting on average between 0–12 weeks (now 46% compared to 28%). The overall average length of time in services in 2019/20 was 22.62 weeks, compared to 19.82 in 2020/21 (a decrease of 2.8 weeks).
The proportion of treatments lasting 13–26 weeks has decreased from 41% in 2019/20 to 18% by Q2 of 2020/21, (the figure below).
Those with treatment length greater than 52 weeks also decreased from 8% to 0%.
An individual may receive more than one intervention during their time in treatment so percentages may add up to more than 100%. In Richmond during the full year of 2019/20 and mid-year of 2020/, psychosocial interventions are the most commonly used in treatment. Young People Harm Reduction and Young People Multi Agency interventions are the second and third most commonly used interventions, respectively (the table below).
Percentage who have been drunk in the last 4 weeks at age 15: In 2014/15, Richmond’s rate was 24.5%, which was the highest in London, 67.8% higher than the England average and 175.3% higher than the London average. Time series data were not available for this indicator.
Excess alcohol is attributable to a diverse range of conditions. Alcohol misuse is estimated to cost the NHS £3.5 billion per year and society £21 billion annually. In Richmond, trends in hospital admissions for alcohol-specific conditions in the under 18 year olds, where the primary diagnosis or any of the secondary diagnoses are an alcohol-specific condition, have seen an upward turn in recent years.
Admission episodes for alcohol-specific conditions - Under 18s: In 2020/21 - 22/23, Richmond’s rate was 22.7 per 100,000 (n=30), which was the 5th highest in London, 13.0% lower than the England average and 52.4% higher than the London average. The latest Borough figure for 2020/21 - 22/23 was also 15.7% higher than in 2012/13 - 14/15, in comparison with 33.5% decrease in England’s rate in the equivalent time period.
Percentage with 3 or more risky behaviours at age 15: In 2014/15, Richmond’s rate was 21.5%, which was the highest in London, 35.2% higher than the England average and 112.9% higher than the London average. Time series data were not available for this indicator.
in 2020/21 41.8% of Richmond’s A-level students achieved grades AAB or better, higher than the London and England averages.
Source: LG Inform/DfE, 2015/16 - 2020/21
*A level facilitating subjects are biology, chemistry, physics, Maths, further Maths, geography, history, English literature, modern and Classical languages.
Richmond has seen a steady decrease in numbers of young people who are classified as Not in Education, Employment, Training or Unknown (NEET). The data shows the number and proportion of 16 and 17 year olds recorded as in education, employment or training in each local authority area and an estimate of the proportion and number of 16 and 17 year olds who are recorded as NEET or whose activity is ‘not known’.
16 to 17 year olds not in education, employment or training (NEET) or whose activity is not known: In 2022/23, Richmond’s rate was 1.9% (n=64), which was the 5th lowest in London, 63.2% lower than the England average and 43.8% lower than the London average. The latest Borough figure for 2022/23 was also 53.6% lower than in 2016/17, in comparison with 13.6% decrease in England’s rate in the equivalent time period.
Youth Offending (YO) and Serious Youth Violence (SYV) affect us all and particularly affects the most disadvantaged groups in society. It is a complex and challenging issue, however, can be preventable. Taking a public health approach to tackling youth offending and serious youth offending examines the root causes of crime and uses a whole-system approach informed by data and intelligence. Collaboration and leadership across the system is critical. To reduce youth offending and serious youth offending one must, in partnership, tackle drugs, the criminal and sexual exploitation of children, and gang related violence. Shifting the narrative from one of criminality to vulnerability and a ‘child first’ approach is important if we are to understand and tackle the root causes of crime. Early identification and consideration of needs include:
Serious youth violence is a multi-faceted complex issue. To address this, innovative action is taking place in Richmond including the work of the Evolve Adolescent Exploitation Team, the Multi-Agency Risk Vulnerability Exploitation (MARVE) Panel, the Community Safety Local Knife Crime Forum, and the targeted detached work being delivered by the Youth Service. These are local examples of collaboration, active intelligence gathering, partnership and community engagement, working to intervene and support some of the most vulnerable children and communities. Children’s Services are also working towards further integration of Vulnerable Adolescent Services to improve coordination of partnership support and to develop effective early responses to further reduce and prevent risk.
Further work is required to improve and embed the needs and experiences of local children into the development of services if we want to say we are truly child centred and put children first.
In addition to this, three specific areas of partnership working are identified for development that will improve the support and offer available for those at risk of encountering the Youth Justice System:
Richmond is a safe place to live. In 2018/19 it had the third lowest crime rate in London and in 2017/18. The rate of children cautioned or sentenced was the lowest in London. However, total crime has risen by 20% since 2014, similar to the London increase of 23%. Since 2016/17, there has also been a 20% rise in crimes with a victim aged 1–17 years, compared to an 11% increase in all other ages. Knife crime is now more likely to involve a victim or suspect under the age of 18 years. These changes have been influenced by a rise in knife-related robberies involving young people.
Young people are more likely victims of assault (37%), robbery (16%) or sexual offences (11%) than victims of any age (17%, 3% and 3%, respectively). Young people are more likely to be suspects of robbery (14.5%) than suspects of any age (4.1%).
Of all crimes recorded and where age data was captured, 6.7% of victims and 12.8% of suspects during 2018/19 were 10–17 years old, the table below. Though they can be affected, crimes that occur in higher volumes, such as burglary and vehicle crime rarely count a young person as a victim. Conversely, young people are disproportionally affected by crimes that occur in lower volumes but pose a higher risk to safety, such as knife and gang grime, or sexual exploitation. As a result, the 6.7% is not fully reflective of the impact crime may have on the development and well-being of young people.
Source: Metropolitan Police Crime Data, June 2019
Since 2016/17, the percentage of male victims has increased from 48% to 60%, whilst the percentage of suspects from Black Ethnic, Asian Ethnic or Minority groups has increased from 22% to 28%, the table below.
Compared to other areas in London and across England, fewer local young people enter the Criminal Justice System. There were 19 First Time Entrants (FTEs) in 2017/18, a reduction from 37 in 2016/17. The rate was 90 per 100,000 population in 2017/18 and this has been decreasing over the past several years. This is lower than our statistical neighbour’s rate of 169.1 per 100,000 and the England rate of 238.5 per 100,000 population.
36% of 15–17 year old offenders in 2015/16 went onto re-offend over the following 12 months, a reduction from 45.7% for the 2014/15 cohort. Less than 5 young people were sentenced to custody for each of the last two years. The use of custody rate for 10–17 year olds in 2016/17 fell to 0.03 per 1,000, from 0.16 per 1,000 population in 2014/15. This is lower than the national rate of 0.41 per 1,000 population.
Reported levels of knife crime have been increasing over the past 2–3 years, with young people increasingly affected, whether as victims or perpetrators. In Richmond, recorded knife crime offences affecting all ages has increased from 81 offences in 2016/17 to 158 offences in 2018/19 (+95%). However, the rate is the 4th lowest in London. The percentage of knife crime events with a victim or suspect under the age of 18 years has increased from 31% (2016/17) to 55% (2018/19). This is an increase from 20 to 58 events and is closely linked to a rise in robberies where the suspect(s) are in possession of a knife. However, violent crime (assaults) involving knives remains very low in Richmond.
First time entrants to the youth justice system: In 2022, Richmond’s rate was 84.3 per 100,000 (n=17), which was the 3rd lowest in London, 43.4% lower than the England average and 49.3% lower than the London average. The latest Borough figure for 2022 was also 71.9% lower than in 2012, in comparison with 73.3% decrease in England’s rate in the equivalent time period. Missing time series data for Richmond have been estimated using linear interpolation.
Teenage parents and their children experience poorer health, educational and economic outcomes, and inequality 55. There is a strong relationship between teenage conceptions and deprivation, and poor education and economic outcomes. High rates of teenage pregnancy are most often associated with low educational attainment, disengagement from school, economic deprivation, and poor mental health. Young people at increased risk of early parenthood and teenage pregnancy include:
Other significant risk factors include:
Nationally, recent trends have seen improvements in some areas of adolescent health including young people’s health risk-taking behaviour 56. Young people’s rates of teenage pregnancy rates have been on the decline over the past decade.
Under 18s conception rate / 1,000: In 2021, Richmond’s rate was 8.6 per 1,000 (n=29), which was the 14th lowest in London, 34.5% lower than the England average and 9.5% lower than the London average. The latest Borough figure for 2021 was also 62.9% lower than in 1998, in comparison with 72.0% decrease in England’s rate in the equivalent time period.
Under 16s conception rate / 1,000: In 2021, Richmond’s rate was 1.4 per 1,000 (n=5), which was the 16th highest in London, 35.4% lower than the England average and 7.9% lower than the London average. The latest Borough figure for 2021 was also 58.9% lower than in 2009, in comparison with 71.0% decrease in England’s rate in the equivalent time period.
Most teenage conceptions are unintended, and the data suggests that access to contraception for young women in Richmond must continue to be strengthened to reduce abortion rates.
Under 18s conceptions leading to abortion (%): In 2021, Richmond’s rate was 69.0% (n=20), which was the 11th highest in London, 29.1% higher than the England average and 11.0% higher than the London average. The latest Borough figure for 2021 was also 0.2% higher than in 1998, in comparison with 25.9% increase in England’s rate in the equivalent time period.
This indicator can help to monitor the awareness of available postpartum contraception at the local level.
Office for Health Improvement & Disparities recommends local authorities work towards achieving a chlamydia detection rate of above 2,300 per 100,000 population aged 15 to 24 years; the recommended level was set at a high level to encourage an increase in volume of screening and diagnoses. The PHE expectation is that increased level of screening is likely to result in a continued chlamydia prevalence reduction.
Chlamydia detection rate per 100,000 aged 15 to 24: In 2023, Richmond’s rate was 1187.3 per 100,000 (n=223), which was the 7th lowest in London, 23.2% lower than the England average and 31.7% lower than the London average. The latest Borough figure for 2023 was also 12.4% lower than in 2012, in comparison with 26.2% decrease in England’s rate in the equivalent time period.
Chlamydia proportion of females aged 15 to 24 screened: In 2023, Richmond’s rate was 22.2% (n=2054), which was the 15th lowest in London, 8.8% higher than the England average and 8.6% lower than the London average. The latest Borough figure for 2023 was also 0.9% higher than in 2021, in comparison with 4.7% decrease in England’s rate in the equivalent time period.
There are no published non-chlamydia STI indicators for young people aged 15–24 years old. The only non-chlamydia STI indicator is for the 15–64 years age group. Based on the national data, the impact of STIs remains greatest in young people aged 15-24 years old, with most of STIs diagnosed in people aged under 35 years old. The rates of STIs are the highest in under 25 year olds, hence it is fitting to report on this indicator in this section.
New STI diagnoses (excluding chlamydia aged under 25) per 100,000: In 2023, Richmond’s rate was 534.6 per 100,000 (n=1042), which was the 7th lowest in London, 2.8% higher than the England average and 56.5% lower than the London average. The latest Borough figure for 2023 was also 5.2% lower than in 2012, in comparison with 8.5% decrease in England’s rate in the equivalent time period.
When family relationships breakdown or circumstances are concerning, it may be necessary for children to become ‘looked after’ by the local authority to ensure they are safeguarded and protected. A decision to take a child into care is not one that is made lightly. Key factors such as risk of harm, the child’s health and well-being are all considered holistically before a decision to provide statutory care is taken. This is because evidence shows that longer term outcomes (including education, health and employability) for children who do not remain at home are usually poor. This makes looked after children (LAC) one of the most vulnerable groups in society.
The journey of a child into becoming looked after by the Local Authority starts with a referral to Children’s Social Care Services. Following the referral, an initial assessment can identify the child as needing Social Care Services input.
Children in need In 2021, Richmond’s rate was 199.8 Rate per 10,000 children aged <18 (n=915), which is the 3rd lowest rate in London, 37.8% lower than the England average and 41.0% lower than the London average. The latest Borough figure was also 6.4% higher than in 2013, in comparison with 2.9% decrease in England’s rate in the equivalent time period.
Source: ONS: Children in need statistics, 2021
A looked after child can be aged between 0–18 years. A child stops being looked after when they are adopted, return home or turn 18 years old. However, Local Authorities are required to support children leaving care at 18 years until they are 21 years old.
The definition of looked after children and duties of the local authority towards them are set out in the Children Act 1989. Local Authorities also have duties towards young people leaving care or care leavers, governed by the Children (Leaving Care) Act 2000.
Children considered looked after can be broken down into three main groups:
Children and young people come into the care of the local authority when it is necessary. Decisions are based on clear, effective, comprehensive and risk-based assessments that include input from the professionals working with the family.
Children in care: In 2022/23, Richmond’s rate was 30.0 per 10,000 (n=130), which was the 3rd lowest in London, 57.7% lower than the England average and 41.2% lower than the London average. The latest Borough figure for 2022/23 was also 15.4% higher than in 2018/19, in comparison with 7.6% increase in England’s rate in the equivalent time period.
There were 115 looked after children on 31st March 2019, this was taken as a snapshot. Of this group approximately 60% were male, while 51% were White and 49% were from a Black, Asian and Minority Ethnic group. Most looked after children were over the age of 16 years (approximately 44%), 28% were aged 13–15 years and 15% were aged 0–4 years old. The number of looked after children is projected to reduce slightly by 2022 to 111, with a consistent projected rate of 24 per 10,000 of the under-18 population. This is notably less than the 2018 rate in Kingston of 33 and the 2018 national rate of 64 per 10,000 of under-18 population. In 2018 47% of looked after children have an EHCP for SEND compared to 26.5% nationally. Conversely 17.6% of looked after children have SEND but are without an EHCP compared to 29% nationally.
In 2019 32% of looked after children were living in 38 in-house foster placements, and 24% in independent foster placements (Kingston 45%).
16% of looked after children went missing from care in Richmond compared to 11% nationally. Local data shows there were 99 episodes of children missing from care between October to December 2018. There were 27 episodes of children missing from home during the same period.
There were 794 children in need as measured on 31st March 2019, a rate of 174 per 10,000 under-18 population. This compares to 907 in Kingston, a rate of 233 per 10,000 under-18 population. The national rate in 2019 was 334 per 10,000 under 18 population. Locally, there is projected to be an increase of children in need to 840 by 2022.
There were 96 children subject to Child Protection Plans in 2019. This equates to a rate of 21.1 children for every 10,000 within Richmond and is notably less than the outer London rate of 37 and national rate of 43.7. Children and young people in Richmond have a lower likelihood of becoming subject to a plan for a second time at 15.9% compared to Kingston at 25% and nationally at 20%.
In 2018, 47.1% of looked after children had an EHCP, more than the national average of 26.5%. In 2018 17.6% of looked after children have SEND support (but not an EHCP) compared with 29% nationally. In 2017, 27.8% of school age children in need received SEND support compared with 25.3% nationally.
Data from services treating dependent adults in 2018/19 suggest that there were 24 households where children were living with alcohol misusing adults and 32 households with children living with substance misusing adults. In 2018/19 there were 220 households with children living with adults with mental health problems.
Below are the estimated prevalence rates of children living with adults with mental health concerns:
In 2018/19 there were 17 looked after children in Richmond that scored 17 or over on the Strength and Difficulties Questionnaire (SDQ). Such high scores indicated a substantial cause of concern for the emotional well-being of those children.
Percentage of looked after children whose emotional wellbeing is a cause for concern: In 2021/22, Richmond’s rate was 49.0% (n=20), which was the highest in London, 32.4% higher than the England average and 48.5% higher than the London average. The latest Borough figure for 2021/22 was also 14.0% higher than in 2014/15, in comparison with 0.0% increase in England’s rate in the equivalent time period. Missing time series data for Richmond have been estimated using linear interpolation.
The placement stability of children is of critical importance for their long-term, emotional and social well-being. There has been a decrease in the number of three or more placement moves across the year bringing us more in line with London average, at 11%. The primary reason for placement changes is due to behavioural issues of the child. A review is underway to understand how we can better support children and young people, as well as carers, in managing behavioural issues. A Foster Carer survey aimed at understanding the challenges during the lockdown will help us design and implement the right packages of support.
Multiple placement moves have an impact on the consistency of care for children. While some of these moves are positive, to secure permanency for example, a high proportion have been placement breakdowns driven by behavioural issues. Placement moves are considered with caution and collectively at the care panel and the monthly monitoring meetings for children at risk. This ensures moves are only undertaken when absolutely necessary.
Children looked after 3 or more placements during the year In 2021, Richmond’s rate was 11.0 % (rounded) (n=15), which is the 6th highest rate in London, 22.2% higher than the England average and 22.2% higher than the London average. The latest Borough figure for 2021 was also 37.5% higher than in 2018, in comparison with 18.2% decrease in England’s rate in the equivalent time period.
Source: ONS: Children looked after in England including adoptions, 2021
A child or young person has Special Educational Needs and Disabilities (SEND) if they have a learning difficulty or disability which calls for special educational provision to be made for him/her. According to the 2019 School Census, 12.4% of the pupil population (3,442) with SEND live or were educated in the Borough. Of the 0–19 year old population, Hampton North ward had the highest percentage of pupils with SEND at 17.3% (203) followed by Heathfield ward, 16% (224). In March 2019, there were 1381 children and young people with an Education and Health Care Plan (EHCP) in the Borough; it is estimated that this number will increase to at least 1,596 in 2022.
The largest percentage of children with EHCPs are 9–11 year olds followed by 15–17 year olds, with higher percentages seen amongst boys than girls. Generally, there are more children living in Richmond wards with SEND compared to those with an EHCP 57.
Pupils with special educational needs (SEN): % of school pupils with special educational needs: In 2022/23, Richmond’s rate was 14.2% (n=5622), which was the 6th lowest in London, 17.9% lower than the England average and 14.5% lower than the London average. The latest Borough figure for 2022/23 was also 13.6% higher than in 2015/16, in comparison with 20.1% increase in England’s rate in the equivalent time period.
12.4% of the pupil population, 3,442 pupils with SEND live in or are educated in the Borough 58. In all Richmond wards in 2018 more children have SEND support than an EHCP:
In 2018 47.1% of looked after children had an EHCP, more than the national average of 26.5%. In 2018 17.6% of looked after children had SEND support but not an EHCP compared with 29% nationally. In 2017, 27.8% of school age children in need receive SEND support compared with 25.3% nationally.
On 31 March 2019, 1,381 children and young people had EHCPs, an increase from 1040 in 2014. It is estimated that this will increase to at least 1,596 in 2022. The largest percentage of children with EHCPS are 9-11 year olds (286 individuals) followed by 15–17 year olds (275). In all age groups more boys than girls have EHCPs.
The main needs addressed in local EHCPs are:
Learning disabilities at 44.2% and autism spectrum conditions at 32.5% are the most prevalent disabilities in children in need. This is in line with national averages.
In March 2019, 71.2% of EHCPs were issued within 20 weeks compared to 60.2% nationally. The rate of SEND registered appeals per 10,000 school population in 2017 was 8.14%, which was almost twice the national rate at 5.45%. On March 2019, 48 children and young people with SEND were in residential placements.
Of the 1381 children with EHCPs in 2019, 45% children and young people with SEND were in mainstream Schools (626 children), followed by special maintained and academies at 17% (231 children). 13% of 16 years + were in College (178) with 13% (174) in independent and non-maintained placements. 323 pupils access SEND transport, 271 of these were of statutory school age (aged 5–16 years).
97% of children over 16 years remained looked after until their 18th birthday, compared with 71% nationally. 170 young people were supported by Leaving Care Services at March 2019. This is an increase from 131 in 2014 and has been impacted by the extended duty to provide services until 25 years of age.
In 2019 92% of children leaving care lived in suitable accommodation and 52% were in education, training or employment. This is the same or better than the national average.
The KRSCP priorities for 2020–2022 are:
There are strong links between poverty, children living at risk of significant harm, and those being taken into local authority Care. 268 children aged under 16 years were living in temporary accommodation compared to 347 in 2018/19.
In Richmond, there are several Indices of Deprivation which affect our local children in some areas of need. 15% of Richmond children were living in low-income families in 2016. The Children’s Commissioner highlighted the following local vulnerabilities, which often affect those who live in poverty:
The Children’s Commissioner estimates there are 18,220 children aged under 18 years old living in Kingston and Richmond where an adult in their household has one of the three serious vulnerabilities, putting the child at greater risk of harm, the table below.
Source: Richmond Council
There are other hidden harms that affect children and young people, many of which have been exacerbated by the Covid-19 Pandemic, including:
All these factors put children at greater risk of hidden harm because there are no obvious physical signs of harm.
Source: MARAC
Approximately 51% of children and young people accessing the Youth Resilience Services (YRS) are from Black, Asian and Minority Ethnic groups in Kingston and Richmond. This is an inequality within the Youth Justice cohort for Richmond and it has been agreed as a strategic priority for the next 3 years for the Youth Offending Service (YOS) Management Board and Partnership. There are small numbers of young people and young people from a Black, Asian and Minority Ethnic Groups across the Youth Justice cohort, however the outcomes within this cohort are often poor and require a specific focus going forward. Achieving for Children (AfC),a recent thematic audit into knife crime offences in 2019/20 further highlighted concerns regarding disproportionality. In Richmond, 7 in 10 knife crime offences involved young people from a Black, Asian and Minority Ethnic groups.
In 2021, Kingston and Richmond Safeguarding Children Partnership (KRSCP) will be completing a Local Child Safeguarding Practice Review with learning around perinatal mental health for all agencies including supervision, pre-birth risk assessments, staff confidence in working with families, and information sharing.
The table below shows the category of abuse for child protection plans in Richmond 2016 onwards.
Source: AfC
The table below shows annual numbers of unborn children and children under the age of 1 that are on Child Protection Plan.
Other Indicators include:
London Borough of Richmond. Children and Young People Needs Assessment (CYPNA). 2019↩︎
Indicator is defined as percentage of children aged under 16 living in families in receipt of Child Tax Credit whose reported income is less than 60 per cent of the median income or in receipt of Income Support or (Income-Based) Job Seeker’s Allowance.↩︎
Inskip HM, Crozier SR, Godfrey KM, Borland SE, Cooper C, Robinson SM. Women’s compliance with nutrition and lifestyle recommendations before pregnancy: general population cohort study. BMJ. 2009 Feb 12;338:b481.↩︎
World Health Organization. Policy Brief: Preconception Care – Maximising the gains for maternal and child health. 2013. URL: https://www.who.int/publications/i/item/9789241505000 ↩︎
Office for National Statistics. Child mortality in England and Wales: 2016. URL: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/childhoodinfantandperinatalmortalityinenglandandwales/2021 ↩︎
OHID Public Health Profiles. Under 18s conception rate. URL: https://fingertips.phe.org.uk/search/conception%20rate#page/4/gid/1/pat/6/par/E12000007/ati/402/are/E09000032/iid/20401/age/173/sex/2/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0 ↩︎
Office for National Statistics. Conception and Fertility Rates. 2021. URL: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/conceptionandfertilityrates/bulletins/conceptionstatistics/2021#age-at-conception ↩︎
Royal College of Physicians. Passive smoking and children. 2010.↩︎
Measured as percentage of mothers who give their babies breast milk in the first 48 hours after delivery↩︎
McAndrew F, Thompson J, Fellows L, et al. Infant Feeding Survey 2010. NHS Health and Social Care Information Centre. 2012.↩︎
Public Health England (2017) giving every child the best start in life: LGA Early Years Conference↩︎
UNICEF. Baby Friendly Initiative. 2021. URL: https://www.unicef.org.uk/babyfriendly/about/breastfeeding-in-the-uk/ ↩︎
UNICEF(2019). A Call to Action on Infant Feeding in the UK.↩︎
NHS. Hearing tests for children. 2021. URL: https://www.nhs.uk/conditions/hearing-tests-children/ ↩︎
NHS The routine immunisation schedule↩︎
NHS. HPV vaccine overview. 2021. URL: https://www.nhs.uk/conditions/vaccinations/hpv-human-papillomavirus-vaccine ↩︎
MenACWY vaccine NHS overview. URL: https://www.nhs.uk/conditions/vaccinations/men-acwy-vaccine ↩︎
PHOF, Guide to Early Years Profile (2014); NHSOF; Early Intervention Foundation - The Best Start at Home (March 2015); NICE QS115 (2016); and Working Together to Safeguard Children (2015).↩︎
Department of Health and Social Care. Healthy Child Programme: Pregnancy and the First 5 Years of Life. 2009. URL: https://www.gov.uk/government/publications/healthy-child-programme-pregnancy-and-the-first-5-years-of-life ↩︎
Cowley et al. Why Health Visiting? A review of the literature about key health visitor interventions, processes and outcomes for children and families. 2013. URL: https://www.researchgate.net/publication/236134248_Why_Health_Visiting_A_review_of_the_literature_about_key_health_visitor_interventions_processes_and_outcomes_for_children_and_families_Department_of_Health_Policy_Research_Programme_King's_College_Lon ↩︎
NICE: Early years: promoting health and wellbeing in under 5s. URL: https://www.nice.org.uk/guidance/qs128/chapter/quality-statement-2-speech-and-language ↩︎
National Literacy Trust. Language unlocks reading: supporting early language and reading for every child. 2018. URL: https://cdn.literacytrust.org.uk/media/documents/Language_unlocks_reading.pdf ↩︎
OHID. Public Health Profiles – indicator definition. 2021.↩︎
WHO. Noncommunicable diseases: Childhood overweight and obesity. 2020. URL: https://www.who.int/news-room/questions-and-answers/item/noncommunicable-diseases-childhood-overweight-and-obesity ↩︎
Office for Standards in Education. Children’s Services and Skills – Obesity, healthy eating and physical activity in primary schools. 2018. URL: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/726114/Obesity__healthy_eating_and_physical_activity_in_primary_schools_170718.pdf ↩︎
Northstone K & Emmett PM. Are dietary patterns stable throughout early and mid-childhood? A birth cohort study. The British Journal of Nutrition, 100(5), 1069–1076. 2018↩︎
Tackling Obesity in London and Beyond – Nudge and Trade LSE Policy Roundtable Write-Up: 29th June 2021. The Obesity Challenge and the Need for Locally Led Solutions (and Funding)↩︎
Department of Health. Childhood Obesity: a plan for action. 2018↩︎
GOV.UK. Obesity map. 2021↩︎
Public Health England (PHE). Health matters: whole systems approach to Obesity. 2019.↩︎
The London Child Obesity Taskforce. Every Child A Healthy Weight. Ten Ambitions for London. 2019.↩︎
The London Child Obesity Taskforce. Every Child A Healthy Weight. Ten Ambitions for London. 2019. URL: https://www.london.gov.uk/sites/default/files/every_child_a_healthy_weight.pdf ↩︎
Delgado-Noguera, M., Tort, S., Martínez-Zapata, M. J., & Bonfill, M. J. (2011). Primary school interventions to promote fruit and vegetable consumption: a systematic review and meta-analysis. Preventative Medicine, 53(1-2), 3-9; Bull, C. J., & Northstone, K. (2016). Childhood dietary patterns and cardiovascular risk factors in adolescence: results from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Public Health Nutrition19(18), 3369-3377; Holley, C. E., Farrow, C., & Haycraft, E. (2017). A Systematic Review of Methods for Increasing Vegetable Consumption in Early Childhood. Current Nutrition Reports, 6, 157-170↩︎
World Health Organization. Healthy Diet. 2023. URL: https://www.who.int/news-room/fact-sheets/detail/healthy-diet ↩︎
PHE. The Eatwell Guide: Helping you eat a healthy, balanced diet. 2018. URL: https://www.gov.uk/government/publications/the-eatwell-guide ↩︎
NHS. Health Survey for England 2018 [NS]. 2018. URL: https://files.digital.nhs.uk/78/A85200/HSE18-Child-Health-rep.pdf ↩︎
Roberts, C., Steer, T., Maplethorpe, N., Cox, L., Meadows, S., Nicholson, S., Swan, G. National Diet and Nutrition Survey. 2018.↩︎
British Nutrition Foundation. Minerals and trace elements. 2021. URL: https://www.nutrition.org.uk/healthy-sustainable-diets/vitamins-and-minerals ↩︎
Victora CG, Bahl R, Barros AJD, Franca GVA, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC (2016) Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet Series: Breastfeeding 1. Volume 387, No. 10017, p475–490, 30 January↩︎
Richmond has seen an overall improvement in 6–8 weeks prevalence rates between 2018 to 2019 from 26% in Q1 to 79% in Q4 . The overall total for the year is 56% which is higher than the England average↩︎
PHE. Everybody active, every day: framework for physical activity. 2019. URL: https://www.gov.uk/government/publications/everybody-active-every-day-a-framework-to-embed-physical-activity-into-daily-life ↩︎
NHS Digital. National Child Measurement Programme 2016/17. URL: https://digital.nhs.uk/data-and-information/publications/statistical/national-child-measurement-programme/2016-17-school-year ↩︎
Department for Education. SEN statistics. 2020.↩︎
Hagell A and Shah R (2019) Key Data on Young People 2019. London: Association for Young People’s Health.↩︎
Alcohol also increases the risk of sexual aggression, sexual violence and sexual victimisation of women.↩︎
NHS Digital (2019). Statistics on Drug Misuse: Part 4- Drug use among young people. URL: https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-drug-misuse/2019/part-4-drug-use-among-young-people ↩︎
NHS Digital (2018). Statistics on Alcohol: Part 5- Drinking behaviours among children. URL: https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-alcohol/2018/part-5 ↩︎
Home Office (2019). National Statistics – Drug misuse: findings from the 2018 to 2019 CSEW. URL: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/832533/drug-misuse-2019-hosb2119.pdf ↩︎
DoH. A Framework for Sexual Health Improvement in England. URL: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/142592/9287-2900714-TSO-SexualHealthPolicyNW_ACCESSIBLE.pdf ↩︎
The Government has said that everyone has a role to play in reducing the harmful use of alcohol - this indicator is one of the key contributions by the Government (and the Department of Health) to promote measurable, evidence-based prevention activities at a local level, and supports the national ambitions to reduce harm set out in the Government’s Alcohol Strategy. Alcohol-related admissions can be reduced through local interventions to reduce alcohol misuse and harm.↩︎
Public Health England. A framework for supporting teenage mother & young fathers. 2019, URL: https://www.gov.uk/government/publications/teenage-mothers-and-young-fathers-support-framework ↩︎
Hagell A and Shah R. Key Data on Young People 2019. London: Association for Young People’s Health. 2019.↩︎
Richmond’s Children and Young People Needs Assessment.↩︎
School CENSUS 2019.↩︎
AfC SEND futures Plan.↩︎
Source: Richmond Carers Centre.↩︎
Up to: Joint Strategic Needs Assessment (JSNA)
Updated: 08 July 2024
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