Consultations in East Sussex

East Sussex County Council and its partners are working together to reduce and prevent childhood unintentional injuries. In East Sussex, the rate of hospital admissions due to unintentional and deliberate injuries in children aged 0-4 years continues to remain significantly higher than the England average, with Hastings and Rother having some of the highest admission rates in the South East. Often, we think of ‘accidents’ as events that are unintended, or things that just happen and therefore there is nothing we can do about them. However, the reality is that accidents are predictable events and are frequently preventable.

As part of our programme of work to reduce unintentional injuries in the under 5s within the home, we carried out a survey with local parents, asking them how they receive and access information about child safety. The survey has a range of questions which were designed to help us understand this topic further.

Survey responders were required to state what parenting and family topics they thought about the most. The top two were ‘my role as a parent’ and ‘my child’s development’. Interestingly, ‘reducing child accidents in the home’, although important, was slightly less important compared to other topics.

Respondents stated and/or agreed with the following:

• They receive information and advice about child safety from a very wide range of sources, including NHS professionals and family members.
• Health Visitors were stated as their preferred source of child safety information, followed by parenting websites and other family members.
• Parents don’t routinely, or only rarely, look for accident prevention and child safety information online.

Responders also stated and were more likely to agree with the following:

• They want to learn about dangers in their home which could lead to accidents and unintentional injuries.
• They want to understand how they can prevent accidents and unintentional injuries at home.
• They want to look for practical advice on how to make their homes a safer environment for children.
• They want to understand what their children are capable of at their age and stage of development.

Who took part

98 parents completed the survey. 90% were female and over 70% of responders had one child under 5 years old. 25% of responders had attended hospital with their child because they had an accident. 87% were White British, 5% were from other White backgrounds, and 3% didn’t answer the question. 93% were heterosexual and 3% were bisexual. 23% of responders stated they had physical or mental health conditions or illnesses lasting or expected to last 12 months or more.

We have learnt several key insights relating to how parents receive and access information relating to child safety in the home. We will use some of these insights, alongside the published evidence, to further develop our programmes to support families to reduce child accidents. This may include updating our child safety campaigns, and promoting the Start for life website and its free email subscription service.

One You East Sussex helps residents to eat well, manage their weight, move more, quit smoking and drink less. The contract for the service ends in March 2024. We asked what you thought about our plans to change the service model in future. 

The majority who took part agreed with the proposed change. You said that targeting those most in need is sensible and that the proposed approach is cost effective.

For the third of people who disagreed there were some clear themes when it came to your concerns, some of which were also shared by those who agreed or were neutral. The main feedback was:

• It is vital to have a range of contact methods.  
• Retain some flexibility around the type of support offered irrespective of whether an individual is in the target groups for the service.
• Those who cannot access online will be excluded.
• The approach should be led by individual need.

You also provided feedback on how we spend any budget saved from the changes and which programmes you think are most important. Your top choice for any money freed up by making the change was for it to be reinvested in providing mental health support that aids health-related behaviour change, while being more physically active and mental health to aid behaviour change were the programmes that were most important to you.

The proposed change to the service has been approved and will apply from 1 April 2024 when the new contract starts. All your comments and feedback have been reviewed and we have identified a number of requirements we can add to the new contract to address your main concerns and feedback.

It was always our plan that the provider would be able to be flexible in how they worked with people. In response to your feedback, we will make this clearer in the service model by making personalised care to meet an individual’s identified need one of the key principles of the service. The provider would also be expected to review decisions made about people’s support needs in the early stages to ensure they were correct. This would allow the provider to be flexible around contact methods, how support is offered and meeting people’s individual needs. It’s important to note though that people’s needs might be different to their preferences.

We will include a requirement for the new provider to help tackle digital inclusion, both through the work they do directly with people and through putting people in touch with other providers. This might include offering skills training, helping people to access technology and tackling barriers to digital inclusion such as motivation, trust and useability. 

The new service will include a focus on helping people to make behaviour changes by offering mental wellbeing support to those experiencing low to moderate anxiety, stress and depression. When it comes to physical activity, we will expect the service to develop a good knowledge of local health and wellbeing opportunities. This will mean that its staff can tell people about local opportunities that will help them to make and sustain changes to their behaviour.

We consulted between September and October 2021 with both registered and non-registered users of the East Sussex Health Promotion Resources Service on stopping the provision of hard copy health promotion resources. A total of 15 people took part in the consultation, with the majority having a mixed or negative view on the proposal. The main concerns centred on future access to only downloadable resources, and  we have been working since the consultation closed to explore the impact of our proposal in more detail through the completion of an Equality Impact Assessment (EqIA). This was discussed at the Inclusion Advisory Group and shared with the Senior Management Team. They made the decision to go ahead with our plan, due to the resource implications of continuing to provide hard copy resources that are infrequently ordered and have limited use. 

What we were proposing

Before 1 April 2022, registered users of the East Sussex Health Promotion Resource Service (HPRS) have been able to order free hard copy health promotion resources across a range of subject areas for delivery.

Our proposal was that, from that date, we stop offering hard copy health promotion resources to registered users, and instead only offer resources in online access or download formats – with exceptions for hard copies of locally produced fuel poverty resources, as these continue to be ordered in large numbers. 

These proposals were based on:

• changes in how society accesses information and resources since the HPRS was introduced in 2014;
• increased use by health promotion professionals of signposting to online information, downloadable resources, and social media;
• a consistent decrease, since 2018/19, in the number of registered users placing orders and the number of hard copy resources they have ordered; and
• the ongoing challenge of hosting a hard copy health promotion catalogue whose resources are kept up-to-date as national guidance and evidence changes.

A public consultation on the proposed changes was conducted in September 2021. Of the 15 responses received, most (12) were submitted by registered Health Promotion Access Catalogue (HPAC) users.

Although the number of respondents was small, it was clear that people’s preferences were varied. Asked how they typically shared health promotion information and resources with the people they worked with, the most common method selected by respondents was to ‘give or post them hard copy resources’. However, ‘signposting by email to online/downloadable resources’ was the respondents’ preferred method of sharing health promotion information with people.

Things were similarly mixed when people were asked about the proposal itself. Of 15 who answered, 3 were positive, 5 had mixed views, 6 viewed it negatively, and 1 was neutral. In addition, opinion was split evenly between those who felt their health promotion work would be affected either negatively by the proposal, and those who had mixed views or felt neutral.

Concerns from current service users centred on how easy it would be to share resources with clients or patients who may have limited or no digital access, including older people and those with disabilities. Positive comments reflected how some services had already changed the way they share health promotion information by not giving out hard copy leaflets, working in a much more ‘online-focused’ way. Should they need to, these services could download and print off downloadable material for specific individuals.

The consultation findings were shared in December 2021 with the Inclusion Advisory Group (IAG). In doing so, it was noted that 12 HPAC users took part (out of a total of 225 individually registered who were invited). The IAG summary report also noted a consistent decrease in the number of registered users placing orders, and in the number of hard copy resources being ordered (other than for locally produced fuel poverty resources). Mitigating actions were included in relation to the potential impact on older people, those with a disability, those whose first language is not English, and those who may have limited or no digital access.  IAG did not raise any direct concerns and endorsed the proposal.

Following the IAG meeting a paper was presented to the Senior Management Team and the decision made to move ahead with the proposed service changes, including the mitigating actions   

Since 1 April 2022, ordering of hard copy resources has stopped for registered HPAC users., with the exception of locally produced fuel poverty resources, and a small selection of leaflets aimed at older people which are still available to order via the HPAC website.

The HPRS catalogue has been reviewed and appropriate validated downloadable resources have been added as alternatives to replace the removed hard copy resources. The catalogue will continue to list a collection of high quality, validated, health promotion resources in download or web access format to support health promotion work.

To address the concerns raised in the consultation, our Equality Impact Assessment recommended that we:

• Encourage HPACT users to continue placing orders for hard copy health promotion resources up until 31 March 2022. Subject to availability, additional orders could be placed during this period.
• Ensure HPAC catalogue listings will include (where available from validated sources) current, evidence-based resources suitable for people with disabilities, including British Sign Language, links to audio books, videos, podcasts, and easy read downloads. 
• Provide descriptions of downloadable or web accessible resources on HPAC to indicate whether the information is available in other accessible formats or languages.
• Retain a small selection of the top 3 resources listed and ordered from HPAC which particularly focus on topics/issues specific to older people. Monitor the orders (by organisation and volume) over a period of 3 months to determine the level of demand for these resources and whether there is a viable business case to continue their provision.