Too little progress in reducing child poverty in the capital

Despite the best efforts of the London Child Poverty Commission, not enough concrete progress has been made in tackling child poverty in the capital, London Councils warns today. The organisation has responded to the Commission’s report – Capital gains: one year on – by renewing its call on government to award councils greater freedoms around housing benefit and worklessness to respond to child poverty at a local level.
 
London Councils has praised the efforts of the Commission, especially in raising the issue of child poverty to the top of the capital’s policy agenda.  However, it is gravely concerned that the level of child poverty in the capital has remained as high as 41 per cent. In the current economic climate the fight against child poverty is more important than ever.
 
While London Councils expects various initiatives such as the Child Poverty pledge to have a greater impact in the coming year, it is also calling on the government to award the boroughs greater freedoms to respond to the challenge of child poverty.

In its response to the government’s 2009 Child Poverty Bill consultation, London Councils called for local authorities to be awarded greater freedoms to respond to child poverty locally, including:

Extending the housing benefit payment period once an individual moves into employment from four weeks to six months – which would increase the likelihood of them staying in work;

·         increased training opportunities to be made available to those in receipt of housing benefit;

·         successful pilots from the government’s Childcare Affordability Programme rolled out on a large scale in partnership with the boroughs to help more parents into work;

·         councils to have greater control over back to work programmes.
 
Copies of ‘Capital gains – one year on’ are available from www.londonchildpoverty.org.uk

Dutch study finds home birth is safe

The British Journal of Obstetricians and Gynaecologists (BJOG) published a study based in the Netherlands to compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care.  During a seven year study, a total of 529,688 low-risk women were in primary midwife-led care at the onset of labour. Of these, 321,307 (60.7%) intended to give birth at home, 163,261 (30.8%) planned to give birth in hospital and for 45,120 (8.5%) the intended place of birth was unknown.

The study found that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.

Research to investigate future of midwifery education

The University of Nottingham, in collaboration with the Universities of Glamorgan, Kingston/St Georges, Plymouth and Robert Gordon, have been awarded an important research project, funded by the NMC, that could have an impact on the future of midwifery education. The Midwives IN Teaching (MINT) research project will investigate:

• the various models for delivery of pre-registration midwifery education
• the specific contributions to practice learning made by midwife teachers
• how aspects of the curriculum, teaching and learning support affect the quality of care provided by newly qualified midwives
• the value brought to the care of families by midwife teachers

A specific project outcome will be the identification of measures that can be used to identify any added value that midwife teachers bring to the quality of newly registered midwives. The design of the study includes a UK wide survey, case study work in six universities and a prospective phase to follow a sample of newly qualified midwives into their first six months of practice.

The MINT project is being undertaken over 18 months, commencing in March 2009 and completing in September 2010.

NHS London completes ratings of higher education institutions

In December 2008 NHS London introduced a new way of measuring how universities and colleges ensure the next generation of healthcare professionals have the right skills to deliver world-class patient care. This process has now been completed and the last set of results, which are for Nursing and Midwifery, are now available.

The NHS in London invests over £1billion each year into the development of new and existing staff. This budget is used to commission education and training courses from Higher Education Institutions (HEIs) for a wide range of health care professions.

The new annual Quality Assurance (QA) ratings system measured HEIs against an agreed set of key performance indicators (KPIs). The QA system focused on value for money and the suitability of newly qualified professionals to perform the roles required to deliver the very best and appropriate healthcare possible in London. The system looked at how the NHS has worked with HEIs to market courses, recruit students and continually develop course content. It also looks at indicators such as drop-out rates and the proportion of students who complete courses on time, after taking account of unavoidable issues such as illness and maternity leave.

This is the first time there has been a standardised QA system for London measuring performance of HEIs. Information provided by the new system will be used to support decisions about where to place future education and training investment, rewarding high performing HEIs and providing intensive support for those not reaching the required standard in order to help them improve. The ratings compare information sent by HEIs against the KPIs. Results are then analysed and each HEI was given an annual report and a red, amber or green rating (RAG) based on their performance.

Results have been published on a phased basis since December 2008 by profession rather than HEI. The final set of results is for Nursing and Midwifery and are as follows:

Ranking and RAG Ratings for Midwifery

HEI	Rank	RAG rating
LSBU	1	AMBER
University of Hertfordshire	2	AMBER
Kingston & St Georges	3	AMBER
University of Greenwich	4	AMBER
Middlesex University	5	AMBER
Kings College London	6	AMBER
Thames Valley University	7	AMBER
City University	8	AMBER

Ranking and RAG Ratings for Nursing

HEI	Rank	RAG rating
Bucks New University	1	AMBER
University of Greenwich	2	AMBER
LSBU	3	AMBER
University of Hertfordshire	4	AMBER
Kingston & St Georges	5	AMBER
Middlesex University	6	AMBER
Kings College London	7	AMBER
Thames Valley University	8	AMBER
City University	9	AMBER

Following the completion of the QA process no HEI or course has been red rated. Those rated amber have shown some areas of concern where improvements need to be made and a green rating means there are no significant areas of concern. An HEI not rated green does not mean that the overall standard of education is poor. Instead, it could mean that the course content has not been developed in partnership with the NHS which could lead to students completing the course not having the relevant experience of working in particular NHS environments.

This is a new process and NHS London will be working closely with any HEIs that are red rated to improve performance over the next 12 months.

BJOG release: Women value safety over choice

New research to be published in BJOG: An International Journal of Obstetrics and Gynaecology suggests that ‘choice’ may not be the best way to understand women’s decision-making about birth method. The results of the study question the current focus on choice in UK maternity care policy, and challenge prevailing notions about caesarean delivery for maternal request. The Royal College of Obstetricians and Gynaecologists (RCOG) note that choice has been established as a central theme in maternity care policy in the UK and that current guidelines highlight the role of women’s preferences in choosing between birth methods such as vaginal birth and caesarean section.

Caesarean delivery on maternal request (CDMR) is a subset of elective caesarean section, performed not by medical necessity, but on request of the pregnant woman. CDMR is perceived as a leading reason for increasing caesarean section rates. In this study, researchers tracked 454 women at the Liverpool Women’s Foundation NHS Trust. The study aimed to explore the views and experiences of women accessing NHS maternity care for the first time, to identify how they report decision-making surrounding birth method. This is the first longitudinal study of women’s views of CDMR in the UK to follow the same cohort of women from their antenatal booking appointment to 12 months after birth.

The key findings indicate that while most women felt that vaginal birth might be preferable, they accepted that their actual birth method would be determined by the circumstances of their pregnancy, the position of the baby, the course of their labour, and the practices of midwives and obstetricians they encountered. The researchers found that women’s preferences changed throughout the course of their pregnancies. By late pregnancy the proportion of women expressing a preference for CDMR had declined to 2%, while those reporting a preference for vaginal birth increased to 80%. The findings stress that choice until the moment of birth is neither static nor final.

Moreover, women felt that health concerns should take precedence in decision-making and entrusted health professionals to act appropriately. Any personal preference, such as convenience, was viewed as secondary to maintaining the safety of the baby.

The study found that the percentage of women who expressed a preference for planned caesarean section was very low. None of the women interviewed thought that they could request planned caesarean section ‘on the NHS’. This was viewed as available only to women with the ability to pay for the operation or women who had experienced a previous traumatic birth.

The authors recommend that for women who do want choice, transparency of actual birth options is paramount. Both women and clinicians should revisit these options at multiple time-points.

Announcement of new support teams to tackle infant mortality – Tackling inequalities from the ground up

A new support team to tackle infant mortality was launched this week by Public Health Minister Dawn Primarolo, who said it would help turn the tide on health inequalities. The new National Support Team will visit 43 areas with the highest rate of infant mortality in the routine and manual group, to deliver intensive four-day programmes of interviews and workshops and tailored support to local areas.

The team will help local health teams to deal with maternal obesity, smoking, teenage pregnancy, housing and child poverty all which have significant roles to play in the life expectancy of an infant. Other related factors include ensuring that all women have a health and social care needs assessment by 12 weeks of pregnancy. Ethnicity, immunisation, management of the unwell infant, and infant nutrition can also have an impact. A national target to reduce the ‘gap’ between infant mortality rates in the routine and manual group and the population as whole will be met if recent trends continue. However, this remains a challenging target.

A national health inequalities target was set in 2001 and updated in 2004. The overall target, which includes the infant mortality objective, is:

By 2010 to reduce inequalities in health outcomes by 10 per cent as measured by infant mortality and life expectancy at birth.  The target is underpinned by two more detailed objectives:

* Starting with children under one year, by 2010 to reduce by at least 10 per cent the gap in mortality between routine and manual groups and the population as a whole.

* Starting with local authorities, by 2010 to reduce by at least 10 per cent the gap in life expectancy between the fifth of areas with the worst health and deprivation indicators (the Spearhead Group) and the population as a whole.

Budget 2009: Building Britain’s future

The Chancellor, Alistair Darling, this week announced the 2009 Budget. It was announced in the face of a steep and synchronised global downturn.  It was aimed at delivering a comprehensive and coherent package of targeted support to continue to help households and businesses, while implementing a strategy to support a strong and sustainable recovery.

Building on the strategy set out at the 2008 Pre-Budget Report, the Budget announces targeted discretionary support for the economy, while continuing sustained fiscal consolidation from 2010-11 when the economy is expected to be recovering and able to support a reduction in borrowing.

The 2008 Pre-Budget Report set out the following increases in financial support, which families are now receiving:

• the bringing forward of increases to Child Benefit, worth over £22 on average to families, between January 2009 and April 2009, to support all families across the UK;
• the bringing forward of the Government’s commitment to increase the child element of the Child Tax Credit by £25 above indexation from April 2010 to April 2009, so that the child element increased by £150 a year in April 2009; and
• the introduction in April 2009 of the Health in Pregnancy Grant, worth £190 for all women after the 25th week of pregnancy, which is expected to benefit 780,000 families a year.

 

The 2009 budget announced the following:

 

Tax Credits

 

To help low-to-middle-income families, the child element of the Child Tax Credit will increase by an additional £20 a year above indexation from April 2010 providing valuable support to families with children.

• the Government announces that grandparents and other adult family members who care for their grandchildren or other members of their family aged 12 or younger for 20 hours or more a week will be able to gain National Insurance credits toward the basic State Pension from April 2011.

• an increase to the child element of the Child Tax Credit of an additional £20 a year above indexation from April 2010, providing valuable support to families with children;

 

As a result of personal tax and benefit measures introduced since 1997 by April 2011:

• households will be £1,550 per year better off, on average; and
• households with children will be £2,350 per year better off, on average, and those in the poorest fifth of the population £4,750 per year better off, on average.

 

Child poverty

Budget 2009 reiterates the Government’s commitment to the sustainable eradication of child poverty and announces further targeted support for vulnerable households including:

·         increasing the child element of the Child Tax Credit by an additional £20 a year above indexation from April 2010, providing valuable support to families with children;

·         amending the law to make clear that the current 4-week run-on in the Working Tax Credit extends to the childcare element, including for couples when only one partner falls out of work, helping to minimise disruption to children during these difficult changes; worth on average £68 per week.

·         taking further steps to help low-income households gain access to the support they are entitled to, such as the extra tax credits available to people suffering a fall in income (already helping 355,000 people by an average of £35 per week)

The Child Poverty Bill will be introduced later this year and will:

• create a clear definition of success in primary legislation. Legislation will set child poverty targets using relative low income; persistent poverty; and material deprivation combined with low income indicators. In addition, reflecting the views of many respondents, legislation will reflect the need to make progress on absolute low income;
• create a clear and transparent accountability framework. Legislation will require the Government to publish a child poverty strategy, to be refreshed every three years, evaluating progress towards the 2020 vision and setting milestones for future action across a wide range of policy areas. In recognition of stakeholders’ views, legislation will also require the Government to have regard to advice published by an expert commission ahead of each three-year strategy; and
• improve partnership working and collaboration to tackle child poverty at a local level. Legislation will require local authorities and delivery partners to work together to tackle child poverty and to set out the contribution that they will make in their local areas.

 

Help for Charities

 

Budget 2009 announces the launch of new £20 million Hardship Fund to provide grant support to third sector organisations, delivering front-line services to the most vulnerable and disadvantaged in society, that have been affected by the recession, with demonstrable resource constraints due to cash-flow difficulties of increased demand.

 

 

In other areas the Chancellor announced:

• support for employment, including for Jobcentre Plus and the Flexible New Deal, and the offer a guaranteed job, training or work placement for all 18-24 year olds who reach 12 months unemployed;
• extending the enhanced loss relief for an additional year and expanding HMRC’s Business Payment Support Service, increasing capital allowances for new investment to 40 per cent for one year, and establishing a £750 million Strategic Investment Fund to support advanced industrial projects of strategic importance;
• an increase in the annual investment limit for Individual Savings Accounts (ISAs) to £10,200, up to £5,100 of which can be saved in cash; an additional payment alongside the Winter Fuel Payment worth £100 for households with someone aged over 80 and £50 for households with someone aged over 60;
• a £600 million funding package of measures to build more homes through unlocking sites currently sitting as dormant, and an extension of the stamp duty holiday for all houses costing up to £175,000 until the end of the year;
• the world’s first carbon budgets and measures to encourage energy efficiency and low-carbon growth.

 

The Budget also announces:

·         from April 2010, an additional rate of income tax of 50 per cent will apply to income over £150,000, and the income tax personal allowance will be restricted for those with income over £100,000;

·         from April 2011, tax relief on pensions contributions will be restricted for those with incomes of £150,000 and over, and tapered down until it is 20 per cent;

·         fuel duty will increase by 2 pence per litre on 1 September 2009, and by 1 penny per litre in real terms each year from 2010 to 2013;

·         £5 billion recoverable value for money savings in 2011-11 raising the 2007 Comprehensive Spending Review target from £30 billion to £35 billion, and in the next Spending Review period, additional efficiencies to help support the economy and front-line services, rising to £9 billion by 2013-14.

Tax cuts deliver extra help for families

The Government this week implemented tax cuts and increased benefits to provide help for families and individuals in dealing with the effects of the global economic downturn. A number of important changes for families and individuals have come into effect with the start of the new tax year.

The changes include:
* Increased personal tax allowances, which will benefit 22 million basic rate taxpayers;
* Increased child tax credits and working tax credits, benefiting over 4 million families;
* Increases in the Basic State Pension for 12 million pensioners, and Pension Credit increases that benefit over 2 million pensioner households;
* A new £190 grant for mums-to-be payable at the 25th week of pregnancy;
* Since 5th January, over 7 million families have been benefiting from the increase in Child Benefit that was brought forward from April.

Personal tax allowance increase
To provide additional help for low to middle income families the Government has increased the personal allowance by £130 above indexation for 2009-10. This is on top of the £600 increase announced in May for 2008-09, which has now been made permanent. Together the changes mean that 22 million basic rate taxpayers under 65 will pay £145 less tax in real terms in 2009-10.

Tax Credit increases
The Government remains firmly committed to eradicating child poverty and will continue to build upon the substantial progress made since 1997. The 2008 Pre-Budget Report set out further steps to reduce child poverty including changes to the Child Tax Credit and Working Tax Credit and bringing forward its commitment to increase the child element of the child tax credit by £25 above indexation in April 2010 to April 2009. The child element of Child Tax Credit has therefore been increased by £150 in total to £2,235, helping 3.9 million families. In addition 7.5 million families are already befitting from the over indexation increase in child benefit for the first child which now stands at £20 per week. The Government brought forward the increase from April to January to provide real support for families during these difficult times.

Support for Pensioners
The Government has increased the basic State Pension by 5%, in line with prices, with the level of a basic full State Pension rising from £90.70 to £95.25 a week; this will benefit 12million pensioners. The Government also confirms an above-indexation increase of 4.8% in Pension Credit’s minimum income guarantee from £124.05 to £130.00 for single pensioners and from £189.35 to £198.45 for couples in 2009-10, which will support 2.1 million pensioner households.

Health in Pregnancy Grant
The Health in Pregnancy Grant is a new £190 grant for all pregnant women, available from their 25th week of pregnancy. The grant is tax-free and disregarded for the purpose of income-related benefits. This will help 780,000 women to invest in their individual needs during pregnancy, whilst giving them flexibility to choose how they budget and where they spend this money.

Help for Job seekers
6.3% in income support, job seekers allowance, employment and support allowance, and incapacity benefit, significantly above inflation, and will be of real benefit to individuals and families across the UK.

Weight management following childbirth: Draft scope

The National Institute for Health and Clinical Excellence (NICE) has launched a consultation regarding weight management following childbirth.

The Department of Health has asked NICE to develop guidance on public health interventions aimed at helping mothers to achieve and maintain a healthy weight after childbirth. The draft scope of the consultation covers mothers who have had a baby in the past two years and those planning another pregnancy. NICE intends to address post-natal weight management, community interventions, media campaigns and incentives. Comments are invited on issues including the most effective dietary and physical activity interventions for helping mothers achieve a healthy weight after childbirth, and the role of breastfeeding in weight management.

The consultation closes on May 11 2009.

Please click here to view the consultation.

Mothers-to-be can now claim a tax-free cash bonus of £190

The new Health in Pregnancy Grant (HiPG) is a one-off payment intended to help pregnant mothers stay fit and healthy in the run up to the birth, and help meet some of the costs as the big day approaches.

The money can be claimed from the 25th week of pregnancy, after receiving health advice from a midwife or other health professional. Expectant mums will be given a claim form to sign and send off, which they must do within 31 days. When the claim is approved, the money is paid directly into a bank or building society account.

Pregnant women can get more information at http://www.direct.gov.uk/money4mum2be or by downloading a free podcast at http://www.hmrc.gov.uk/podcasts

Janet Fyle, Professional Policy Advisor at the Royal College of Midwives, said:

“This is a commendable initiative from the Government, and one that demonstrates that we value and want to support mothers-to-be. Midwives have a crucial role to play in assisting and enabling all women to access the grant. They are often a woman’s first, and in some cases, only contact with the health service.

“Midwives will be there to give objective advice and information to women about the grant, because they know an investment in women is an investment towards a healthier woman and a healthier baby.”