Bradford District Director of Public Health Annual Report 2023

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Foreword: Director of Public Health

Bradford District is the youngest in the UK with over a quarter of our population aged 18 or under. We have over 200 schools and colleges that support more than 100,000 children and young people in full time education as well as a wide range of early years provision.

Earlier in the year I attended two events where young people from across the district gave powerful presentations. A council Wellbeing Board meeting this February was attended by a team of 'Covid Young Ambassadors' from the Bradford Youth Service as well as the 'Youth Action Team' from Bradford Citizens. Both groups described to board members the different ways the pandemic and its continuing legacy had affected the mental health and wellbeing of children and young people and they shared ideas for how they felt our local systems could provide better early support and intervention.

Soon after this, I was invited to speak at the launch of the 'Young in Covid II: Routes to Recovery' film. This production was the outcome of a young people's voice and influence project commissioned by Public Health last year and has since been featured on BBC Radio 4 and Sky News. Supported by the fantastic Khidmat Centres, it gives a voice to young people from the district as they share how the legacy of the pandemic continues to affect their mental health and wellbeing. It is a powerful and moving message and we have included a link to the film within this report.

Feeling inspired by these young people, I wanted to use this years' annual report as an opportunity to highlight some of engagement work that has taken place with children and young people in Bradford District over the last year and to share the headline messages that we have been hearing from them.

Over the year ahead we will continue to work in partnership with children and young people to give them a voice and influence, to coproduce better services and to deliver better outcomes.

Sarah Muckle
Director of Public Health
June 2023

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Foreword: Portfolio Holder for Children and Families

We are a young district with 23% of our population aged under 16 and our children and young people are a big part of what makes this place special. It also means that many of the challenges they face nationally are reflected very clearly here in Bradford. I therefore warmly welcome this report, in particular the fact that the voice of children and young people is so evident throughout. This is vital as if we are to support them to fulfil their potential, then we must hear from them directly about their concerns and priorities.

As the council's political leadership, we are committed to putting the needs of children and young people at the heart of everything we do. That means investing in early help and prevention to avert problems before they emerge and tackling health inequalities so that every child and young person – whatever their background and wherever they live in the district – gets the best start in life.

In Bradford we are also renowned for our world leading health research which provides a solid evidence base to inform our work. We will continue to benefit from this resource as we build on our partnerships and share best practice with our health colleagues and VCS partners to realise our vision of a happier, healthier, kinder and more child-friendly district for every child and young person to grow up in.

The challenges that children and young people face around their mental health and wellbeing comes through strongly in this report, which comes as no surprise. They have been affected by the multiple challenges the country has faced over the past decade such as the impact of austerity cuts to public services, the life changing shock of the pandemic and the growing cost of living crisis.

Despite the challenges, these are also exciting times as we look ahead to our year as UK City of Culture 2025 - a brilliant opportunity for people of all ages. We are also delivering a series of regeneration projects designed to help build on that legacy and transform our city making it a better place to live, learn, work and play.

Councillor Sue Duffy
Portfolio Holder for Children and Families
June 2023

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An overview of the health and wellbeing of children and young people in Bradford District

The recently published Office for National Statistics (ONS) 2021 Census for England and Wales puts Bradford as the fifth largest local authority in England in terms of our population size after Birmingham, Leeds, Sheffield and Manchester. In 2021 it was estimated that there were 547,000 people living in Bradford District, an increase of 4.6% since the 2011 census.

"28.9% of under 16s living in absolute low-income families"

Our population is a young one with 154,801 people aged 19 and under and we have the fourth highest proportion of under 16-year-olds in England at 22.8%. Bradford District also has a higher proportion of babies, infants, children and young people than the average for England.

In addition, the proportion of the working age and older population is lower in Bradford than the national average.

Poverty affects the health and wellbeing of many of our families and we have the 6th highest rate in England of under 16- year-olds living in absolute low-income families at 28.9%. For relative low-income families, this figure jumps to 35.6% compared to the England average of 19.9%.

"Over 154,000 people aged 19 and under"

The 2021 census data also provides an overview on the perceptions of the general health of children and young people in the district. It shows that 95.6% of children and young people were described as in being in good health compared to the national average of 96.5% for England.

Public health data from the Office for Health Improvement and Disparities (OHID) gives us more detailed insight into children and young people's health around a range of key indicators and enables us to compare our outcomes to the national averages which we have included on the following page.

In addition, we are privileged to have one of the World's leading research studies into the lives of children and young people based here in Bradford. The Born in Bradford research study tracked the lives of over 13,500 children and their parents to find out what influences their health and wellbeing.

One of the key findings from the Born in Bradford research demonstrates the link between air quality and rates of Asthma. The OHID data tells us that our rates of Asthma admissions for 0 to 9 year olds is 279.1 per 100,000 compared to the England figure of 172.7.

The “Born in Bradford: 10 Key Findings for Policy and Practice” 2019 report shows that 55% of the local population are exposed to levels of air pollution above EU exposure guidelines and that up to 38% of the total annual childhood asthma cases may be attributable to air pollution. As of September 2022, a Clean Air Zone has been introduced to help the district comply with legal limits for air quality and we will be closely monitoring its impact.

"55% of local population exposed to air pollution above EU limits"

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Office for Health Improvement and Disparities headline indicators

Indicator	Bradford	England	Recent trend (if available)	Period
Child mortality rate (1 to 17 years)	15.2 per 100,000	10.3 per 100,000	Not available	2018-20
Prevalence of obesity in school reception ages	11.4%	10.1%	Remains the same	2021-22
Prevalence of obesity in school year 6 ages	27%	23.4%	Increased	2021-22
Admissions for asthma (0 to 19 years)	222.7 per 100,000	131.5 per 100,000	Not available	2021-22
Admissions for diabetes (0 to 19 years)	39.9 per 100,000	37 per 100,000	Not available	2021-22
Admissions for epilepsy (0 to 19 years)	172.8 per 100,000	89.7 per 100,000	Not available	2021-22
Admissions for substance misuse (15 to 24 years)	109.5 per 100,000	81.2 per 100,000	Not available	2018-19 and 2020-21
Low birth weight of term babies	4.2%	2.8%	Remains the same	2021
Percentage of physically active children and young people	40.4%	47.2%	Not available	2021-22

Source: Office for Health Improvement and Disparities 'Fingertips' dashboard

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Child Friendly Bradford District: The voice and influence of children and young people

In both the 2021-2025 Council Plan and the District Plan we share our ambition to ensure that “The voice of the child is at the heart of all we do”.

In late 2022 we completed a successful foundational year working in partnership with UNICEF UK on their 'Child Friendly Cities and Communities' programme. Child Friendly Cities enables local government partnerships to develop the cultures and structures that enable children and young people to have a meaningful say in local decisions and services and to use their voice as a tool for service improvement and delivering better outcomes.

Over the course of this foundational year, over 100 members of the workforce attended UNICEF Children's Rights training and we were able to work with thousands of children, young people and families to ensure their priorities are reflected in our new Children and Young People's Strategy.

The event itself was co-planned and hosted by young people from the Healthy Minds Apprentices, was opened by Councillor Sue Duffy, the portfolio holder for Children and Families and was closed by the Leader of the Council, Councillor Susan Hinchcliffe. The event was also an opportunity to launch a music video we commissioned about being proud to grow up in Bradford District. The song and video were created and produced by the Healthy Minds Apprentices with support from All Star Ents.

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Children and young people's voice and influence projects

Across the district there are a range of existing groups, programmes and projects that help to give our children and young people more voice and influence over local services and systems. Some of these include:

• Bradford Citizens
• Children in Care Council
• Healthy Minds Apprentices
• Keighley Youth Forum
• School and College Councils
• West Yorkshire Police Youth Advisory group
• Young Covid ambassadors
• Young Dynamos Hospital forum
• Youth Voice Summits

In addition to these, this year we will be establishing a district wide youth forum specifically for young people with Special Educational Needs and Disabilities. We will be further embedding voice and influence into our joint commissioning arrangements with the recruitment of a new Engagement and Coproduction Manager role to further ensure we involve children and young people in the commissioning cycle.

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The national context of children and young people's voice and influence

The importance of giving children and young people a voice and influence over local decisions and services is set out nationally in a range of policies and documents.

In 2019, Public Health England and the Association for Directors of Public Health (ADPH) worked together to set out to create a set of overarching guiding principles for Children and Young People's Public Health in a report titled 'What Good Looks Like (PDF)'. Intended as a tool for sector-led improvement, the guidance focusses on a range of actions that local systems should take to ensure that all children and young people get the best start in life. It states that:

“Actions must be informed by the voice of children, young people, their parents and caregivers, and underpinned by collective system responsibility”

In 2015 the Department for Health and the Department for Education jointly published a set of statutory guidance in the form of the Special Education Needs and Disability (SEND) code of practice which sets out the following requirement: “Local Authorities must place children and young people at the centre of their planning and wok with them to develop co-ordinated approaches to securing better outcomes.”

Following the publication of the Health and Care Act 2022, the Public Participation Department at NHS England published their latest statutory guidance for health systems titled “Working in Partnership with People and Communities”.

This guidance sets out how NHS providers, including Integrated Care Boards, place-based partnerships and hospital trusts must meet the legal duties on public involvement. This includes making arrangements to ensure that people and communities are appropriately involved in planning, proposals and decisions regarding NHS services.

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What have we heard from children and young people in Bradford District?

Bradford Youth Service Localities Survey

The Bradford Youth Service were able to engage with children and young people from every postcode area of the district through their localities survey, which was completed in Spring 2022. Youth workers across the district worked with 4467 people aged 8 to 18 to help them take part through a series of face-to-face interviews. Amongst a range of questions, respondents were asked to comment on their mental health and wellbeing with the specific question “Do you feel healthy in your mind?”.

In total, nearly 1 in 5 of the participants (19%) shared that they didn't feel healthy in their mind with a further 27% neither agreeing nor disagreeing with the statement. Just over half of participants (54%) felt they agreed with the statement. Participants also had the opportunity of leaving additional information and some these comments included:

“I am stressed and anxious a lot of the time”
“School and coronavirus have a depressing effect”
“More mindfulness classes would be helpful”
“I feel unhealthy and insecure about my health and my image”

Respondents were also asked to comment on their physical health with the specific question “Do you have a healthy body?”

In total, 13% of participants shared that they didn't feel that they have a healthy body (disagree and strongly disagree) with a further 28% neither agreeing nor disagreeing with the statement. 60% felt they agreed with the statement that they have a healthy body. Participants also had the opportunity of leaving additional information about their selected answer and some these comments included:

“I eat healthy foods like Fruit and Vegetables”
“I play lots of sport in school”
“I'm not in best fitness on account of there not being many places that people my age can go to for general exercise and fun”
“I eat a lot of junk food”

Bradford Citizens

During the autumn term of 2022 Bradford Citizens, who are a part of Citizens UK, worked with over 10,000 students from 24 schools in the district. Children and young people took part in listening activities through individual discussions or through small group sessions in form time. A Youth Summit event was held in November with 135 students attending.

At the event, participants were able to collectively reflect on the listening activities that had taken place in their individual schools and then worked together to discuss and agree a set of priority issues.

The top three issues that they felt children and young people in Bradford District needed more support for were:

• Cost of living crisis and its impact
• Mental health and wellbeing
• Tackling discrimination

As well as Mental Health and Wellbeing coming out as a priority issue in and of itself, the impacts of the cost-of-living crisis and of discrimination both contribute negatively to children and young people's mental health and wellbeing. The young people also made the following suggestions for areas where they would like to see specific improvements:

Mental Health and Wellbeing

• Trained staff and mental health ambassadors in schools. Teachers could be mental health ambassadors and children as wellbeing ambassadors
• To tell stories and to promote good mental health as part of the City of Culture 2025.

Dealing with the cost of living crisis

• We are asking for the development of food hubs in every community: breakfast clubs and community kitchens supported by supermarket vouchers
• We are asking for community hubs to work with schools to provide internet access and other learning resources (e.g., revision guides, access to computers and calculators) in the community
• Late clubs in every school where children can stay longer for learning and curriculum extension

Tackling discrimination

• Celebrate culture through music and festivals / cultural days led by and involving different cultures and build as an annual programme which is accessible to all
• Education in schools through for example through virtual media/apps and radio shows and organisations coming into schools to deliver workshops
• Provision of Safe Spaces if you are experiencing problems and review of safe provision of changing rooms and toilets
• Staff training (including on language, behaviour and responding)

Source: Bradford Citizens listening events autumn 2022

Born in Bradford Age of Wonder: Mental Health and Wellbeing Pilot

From March to July 2022, 1122 participants from 4 schools piloted a new Born in Bradford Age of Wonder Mental Health and Wellbeing survey that will be rolled out to further schools over the next 3 years.

The 4 pilot schools are generally representative of the Bradford population. However, it should be noted that within this pilot data, there are a higher proportion of participants with an Asian / Asian British ethnicity than in Bradford as a whole, and a lower proportion of children with a White ethnicity, because two of the schools were from areas of the district with a higher population of people from Asian backgrounds than the Bradford average. Moreover, year 9s (ages 13 -14) are disproportionately represented as this age group were specifically investigated for additional health measures.

Under the category of 'Depression and Anxiety', the data shows a marked increase in reported depression in young people since the pandemic.

Bradford mirrors the nation, with girls (23.3%) more likely to report problems than boys (9.1%). Bradford boys are 1.68 times more likely and girls 1.22 more likely to meet the clinical threshold than their peers nationally (19.1% and 5.4% respectively).

There were some minor differences in reported overall levels of depression and anxiety between different ethnic groups on the pilot. While, once again, girls were more likely to report problems than boys for all ethnic groups, white girls (22.4%) and boys (12.2%) were more likely to report difficulties than their Asian or Asian British peers (17.7% and 7.9% respectively).

The Young in Covid project

Public Health commissioned the Khidmat Centres in BD7 to work with a group of young people to produce a follow-up to their award-winning 2021 film “Young in Covid - The Silent Pandemic” which has now had over 5,000 views.

The young people involved in the first film wanted their sequel to look at how they and their peers continue to live with the effects of the pandemic. They particularly wanted to explore the toll it has taken on their mental health and wellbeing and some of the wider problems this has caused in their communities. Therefore, the sequel, “Young in Covid II: Routes to Recovery” collects and shares a series of personal stories from young people representing a range of communities and perspectives.

On 20 March 2023 at the launch event for the film, the young people spoke to over 100 civic leaders and local decision makers about the need to improve access to mental health and wellbeing support – a message echoed at the 28 February Wellbeing Board meeting which was attended by young people from the Bradford Citizens and Bradford Youth Service projects referenced above.

Children and Young People in Care

To support children and young people who are living in care, the Bradford Children and Families Trust deliver a Children in Care Council to enable care experienced young people to meet in a safe and inclusive environment and discuss issues that are important to them.

The top three issues that group members feel are the most important to children and young people in care are:

Family contact
They would like more opportunities to see their families, and within this they would also like to be given a better understanding of the decision making processes around "contact".

Placement inconsistencies
They would like to see a reduction in the inconsistencies between the experience of being placed in children's homes, foster care and kinship care.

Consistent Social Workers
They would like consistent social workers who stick around and who do what they say they're going to do.

Children and Young People with SEND
A Participation Officer specifically for Children and Young People with SEND has recently been recruited. Over the coming year they will be working in partnership with special schools and resourced provisions to establish a SEND Youth Forum for Bradford District. Engagement activity over the previous year has given us insight into the three priority areas for young people with SEND:

• Provision in the area needs to be accessible to all needs and this includes consideration of the time and location of the support that is available.
• Travel is a barrier to attendance at events and other opportunities. Consideration of how children and young people with SEND will get to and from a location is crucial.
• Children and young people with SEND want to be supported with advice but allowed to make the decision on what is best for them.

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Conclusions

Across the variety of highlighted engagement activities we can see that a clear message from children and young people in the district is that mental health and wellbeing is their top priority. This message was reinforced at the February meeting of the Bradford Metropolitan District Council Wellbeing Board where young people from Bradford Citizens and Bradford Youth Service gave impassioned presentations on the subject.
This priority is reflected in our new Children and Young People's Strategy for the district. This has been produced following extensive engagement with stakeholders – including children, young people and families. Mental Health and Wellbeing is one of the four priority areas within the strategy and the voice and influence of children, young people and families is included as a key enabler across all four of the priority areas.
In 2015 the Government set up the Children and Young People's Mental Health and Wellbeing Taskforce which went on the publish a detailed report and a set of recommendations known as 'Future in Mind: improving mental health services for young people'.

One of the recommendations contained within Future in Mind specifically references the importance of children and young people's voice and influence when designing and delivering services:“the best mental health care and support must involve children, young people and those who care for them in making choices about what they regard as key priorities, these need to be offered in ways they find acceptable, accessible and useful.”

As we have described in this report, there are a range of platforms for children and young people to have a voice and influence here in Bradford District and a growing culture within our organisations to enable this.

We have invited young people to attend our most senior governance boards and have commissioned films and projects to give them new ways of having a voice. We have an ambition to become a more Child Friendly district and co-producing solutions with our children and young people is key to this.

Over the year ahead we will continue to develop more ways to enable children and young people to further inform how we design, deliver and communicate our services in the district. We will do this by working in partnership with providers, education settings and of course, children, young people and their parents, carers and families.

We have heard that early intervention and support for mental health and wellbeing in our schools and settings is paramount for children and young people in the district. Our current Healthy Minds Schools offer includes:

• Mental health school champions in schools
• Educational psychology support to the champions
• Youth workers in schools and hospital and apprentice schemes
• Digital tools for support
• Increased therapeutic models of support delivered in the community

The Healthy Minds Schools offer is based on the Thrive Framework – which aligns the mental health and wellbeing needs of children, young people and families into five needs based groups:

Thriving: prevention and promotion to maintain wellbeing
Getting Advice: signposting and advice
Getting Help: goals-based focussed support
Getting More Help: specialised goals-based support
Getting Risk Support: – in contact with urgent help

With the publication of the new Children and Young People's Strategy for Bradford District and as a result of what we have heard from children and young people, there are several changes planned for the system-wide Healthy Minds Offer, that will better support the mental health and wellbeing of children and young people in Bradford District:

• More joined up and effective planning and resource allocation.
• Continued work with academic partners and with the new Health Determinants Research Collaboration to further build on and embed an evidence based
  approach to interventions.
• Further developing our voice and influence work with children and young people – working with the Child Friendly Bradford District initiative.
• Direct work with communities, schools, settings and families to improve the mental health and wellbeing of children and young people.
• Establishing a new multi-agency Children and Young People's Mental Health strategic leadership group.