Agenda item

Report of the Director of Public Health

The Committee received a report to provide an overview of breastfeeding performance in Gateshead, support available for mums who wish to breastfeed and a tongue tie overview.

It is know that tongue-tie can prevent successful breastfeeding.  It is estimated that 10.7% of babies born are with tongue-tie.  In Gateshead 1900/2000 births, this would equate to about 200 babies.

Breastfeeding rates at 6 to 8 weeks had previously remained at around 35% to 36% in Gateshead for several years. The table below demonstrates the progress and improvements around breastfeeding rates since the contract for the 0-19 public health nursing service was award to Harrogate and District NHS Foundation Trust in July 2018 (note these figures include mothers who are fully breastfeeding and those who are partially breastfeeding).

Gateshead is 3^rd highest in the North East region for breastfeeding rates at 6 to 8 weeks.

The 0-19 public health nursing service (Growing Healthy Gateshead) received accreditation for stage 2 of the Unicef Baby Friendly Initiative (BFI) in September 2021. The baby friendly standards provide a roadmap for services to improve care and through the staged accreditation programme services are enabled to support all mothers with feeding and help parents build a close and loving relationship with their baby.

There are 3 stages to the accreditation programme as follows:

·         Stage 1          Building a firm foundation

·         Stage 2          An educated workforce

·         Stage 3          Parents experiences

There are a number of standards that have to be met at each stage to achieve accreditation. Services have to submit all of their evidence for each standard and this evidence is then assessed by Unicef. They also interveiw practitioners within the service to verify the evidence and to see how the standards are being implemented in practice.

The service achieved 100% in some of the standards and received excellent feedback about the team and their communication skills used in antenatal discussions and beyond.

An early year’s practitioner (EYP) in the service is also completing Unicef advocate training which will support families in Gateshead. This course is in the second intake and the cohort for the UK is only 8 members, so the EYP is really privileged to secure such a highly sought-after place.

During the pandemic the 0-19 service adapted and offered face to face, telephone and virtual support to clients and families with regards to infant feeding.  Proactive support is offered to all women in Gateshead to assist with infant feeding issues or provide encouragement and praise to women who choose to breastfeed. Daily pro-active telephone calls continue to be offered to breast feeding mothers during the first weeks after birth and these calls are continued as needed during the first 6 weeks based on each individual family’s needs and requirements.

Infant feeding cafes have been set up in partnership with the children’s centres at Elgin and Blaydon. These offer support around breastfeeding (positioning, blocked ducts, cluster feeds, attachment) and peer support from other mothers. The service also offers virtual ante natal sessions focusing on all aspects of infant feeding and the provision of realistic feeding expectations.

The North East and North Cumbria ICS Public Health Maternity Prevention Team worked with key delivery partners including peer supporters and parents/carers to develop a breastfeeding touchpoint pathway to improve the consistency and support across the North East.  This covers all the key contact points during pregnancy until the baby is 6 to 8 weeks old where practitioners can have discussions to support mothers who want to breastfeed or who are breastfeeding

The following table shows the tongue tie activity demand by Newcastle Gateshead CCG. As can be seen from the table below the pandemic impacted significantly on tongue tie activity demand and this was seen across the whole of the North East.

Currently there is inequity of service provision across the North East region with some limited access and time restraints for assessment and division. Infant Feeding Leads without local services historically referred to the RVI when tongue tie division clinics ran weekly. However, as this service is no longer routinely available at the RVI all referrals were being made to Sunderland and South Tyneside Foundation Trust. This service is commended for its rapid response to referrals, expert service provision and follow up communication; however, this has resulted in the following concerns:

·         Length of time until appointment - for out of area this can be 2-6 weeks

·         Sustainability for the large area currently supported by Sunderland and South Tyneside if the practitioner was to be absent or leave post

·         Travel requirements – access to transport and cost for out of area families

·         Parents who can afford costs are utilising private practitioners, whilst mothers who cannot are often left waiting for appointments. These appointments are not always communicated to Midwifery or Health Visiting services.

Frenulotomy can also be performed by tongue-tie practitioners in private practice. There are currently two private practitioners registered with the Association of tongue tie practitioners in the North East. Costs vary dependant on number of appointments, but division is around £225. Additional cranio-osteopathy may also be advised at an additional cost.

A paper written by the North East and North Cumbria (NENC) ICS Public Health Maternity and Prevention Team with considerations, options, and next steps was discussed at an inaugural meeting by NENC strategic Senior Leaders in June 2021. There was agreement that a joint regional approach to provision across the whole of the ICS footprint should be the standard.

However, the proposed work is on hold at present due to commissioning difficulties and access to Practitioners.

The Committee commented that all mums across the North East should have the same access.  It was noted that this is not a service that is commissioned by Public Health.

It was felt that the report didn’t cover the impact on new mums and there babies as it can be very difficult when your baby isn’t feeding and the baby can become very dehydrated and failing to thrive. 

It was commented that it isn’t right that parents should have to pay for the treatment and it is concerning that there potentially could be quite a number of children suffering.

It was queried when this would be picked up as giving a child the best start in life is part of the Council’s Performance Management Framework.

It was noted that the Integrated Care System is taking over and re-commissioning of services aren’t currently taking place.

It was suggested that this issue be referred to Health Scrutiny and that the North East and Cumbria team be spoken to about providing further information to the Committee.

It was noted that breastfeeding should be promoted, given current financial circumstances and the cost of formula there are issues with regards to the questions of who does the body belong to and who do the breasts belong to, irrespective of what mams say, how far can we go in terms of pushing the breastfeeding route.

It was noted that it is really difficult but breastfeeding is being promoted with lots of work ongoing to support and encourage mams but at the end of the day it is their choice.  It can be quite an emotive subject.

RESOLVED -               (i)      That the comments of the Committee be noted.        

                                      (ii)      That the matter of tongue-tie be referred to the Care

                                               Health and Wellbeing OSC

                                                                    (iii)     That a report be requested from the organisation who would commission the service to explain why the service can’t be commissioned.