Sunday, 8 April 2018

Going Dutch as Business Planning meets Family Planning

Once upon a time in the North West there was a Primary Care Trust (PCT). It was recognised as being the best in England. Indeed its replacement Care Commissioning Group (CCG) is also now recognised by NHS England as being ‘outstanding’. I think one of the reasons both the PCT and CCG achieved this recognition is the investment they made in their people. Education and training across the whole workforce, whether from a clinical or an administrative, background, was a good example of this investment. Some eight years ago I was privileged to facilitate a programme of Business Planning training.  

Over a few months everyone from Board level to Departmental managers took part in what was a two-day course. Day one explored some of the organisational and cultural aspects of bringing about change and the actual process of business planning. We considered everything from developing well-articulated aims and objectives; discovering the delights of net present value calculations; option appraisal scoring; and of course, agreeing evaluation criteria to measure success of the plan.  

Day two put the theory into practice and involved actually developing a business plan. Given the time available these were never going to be real, but they did allow for the process to be understood and individual assertions challenged by the rest of the group. A BBC news headline last week about teenagers preferring social media to sex brought one of these quasi business plans to mind. The business plan I remembered was about how to reduce the high rate of teenage pregnancies in the locality. The area had the eighth highest rate of teenage pregnancy in the UK. As I remember,r the number of girls aged 15 – 17 who became pregnant, was around 46%. Reducing this figure was high priority for the City Council and the PCT. 

There is a great deal of evidence that shows that those who have children at a young age can result in poor health and wellbeing for the mother. In addittion, the educational attainments and the possible career prospects of the children are reduced. Likewise the research suggests that children born to teenagers are more likely to experience a range of negative outcomes in later life. They are three times more likely to become a teenage parent themselves. The infant mortality rate for babies born to teenage mothers is 60% higher than for those babies born to mothers aged 20-39. Teenage mothers are more likely to smoke during pregnancy and less likely to breast feed. The XES ‘We can’t go backwards’ campaign (2013) showed that even with current sexual health and contraceptive services the cost of unintended pregnancy and sexually transmitted diseases between the years 2013 – 2020 could cost the UK anything between £84 - £127 billion.

Now I don’t know if that Business Plan was ever worked up into a full blown business case, but I do know that the teenage pregnancy rate for this part of Greater Manchester has fallen and last year, it stood at 31%. Which whilst still being the national average, is a great improvement. Indeed, over the last 20 years the teenage pregnancy rate in the UK has been more than halved. In 2016 birth rates for women over the age of 40 was at a higher level that for women aged under 20 – it is the first time this had happened since 1947. Thanks to strong and consistent political direction and integrated local health and care plans, such a reduction is one of the UK’s most successful public health programmes. 
So I was surprised when last week the BBC wondered if the fall was due to teenagers swapping social media for sex. The greatest drop in the rate of teenage pregnancy has occurred over the past 10 years, a time in which social media has transformed the way many of us socialise and connect with each other. Research by Ofcom found that on average 16 -24 year olds spend more than 27 hours a week online – this is almost three times the amount they did 10 years ago. It might be part of the reason, but there are other evidence-based interventions which are more likely to have had a bigger impact. For example, including parents in information prevention programmes is more likely to mean teenagers use contraception at first intercourse. Likewise having well a published, accessible and teenage-centred contraceptive and sexual health advice service will not only see a rise in contraception use, but will reinforce sexual health and sex education lessons provided at school. There are other factors of course that show a clear link to teenage pregnancy, many of which are the consequence of social inequalities, and these need to be tackled as well. 

Maybe we need to take a leaf out of the Netherlands book. The Netherlands have the lowest teenager pregnancy rate in Europe. Social attitudes to teenage sex and pregnancy are very different to those in the UK. In the Netherlands there is a degree of social stigma attached to teenagers getting pregnant, and all Dutch children are taught openly about sex both at home and at school. However, teenagers in the Netherlands are likely to start having sex at least a year later than in the UK. Personally, I think the biggest factor is trust. Teenagers need to trust their parents so that conversations can happen; and they need to trust services for advice that’s provided in a non-judgemental and young person-centred way. 

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