The government recognised in 2008 that there were problems in the way services are provided for military personnel and their families. In part, this was because relationships between military establishments and local and regional civilian authorities were not well developed. The larger bases (‘super-garrisons’) that are emerging as a result of the current defence strategy have increased the importance of effective local relationships.

The issue

Introduction

Over the last two decades, the focus of British defence strategy has shifted from the maintenance of permanent garrisons overseas, using instead expeditionary forces deployed from bases in this country. In part, this reflects changes in the geo-political landscape and changes in military technology. But in addition, it reflects a recognition that the greater stability that results from this approach is less disruptive to family life and may therefore assist with recruitment and retention of staff.

The government recognised in 2008 that there were problems in the way services are provided for military personnel and their families. In part, this was because relationships between military establishments and local and regional civilian authorities were not well developed. The larger bases (‘super-garrisons’) that are emerging as a result of the current defence strategy have increased the importance of effective local relationships.

The key challenges

The demands made by military life – not just on serving personnel but also on their families – have not always been fully recognised by civilian service providers. The distinctive nature of service needs may not be understood; and there is an assumption that, where there are distinctive needs, these will be catered for by the armed services themselves.

The longer postings associated with home-based super-garrisons have brought with them greater stability for service families. However, there remain a range of challenges that arise from the nature of military life, for service providers as well as armed forces personnel.

Education – Where families are moving regularly, children’s education can be disrupted and there is some evidence that this can lead to poor educational outcomes. Depending on the timing of moves, parents’ choice of school may be limited. In some areas, a very high proportion of children in schools close to bases come from service families. Those schools therefore have to cope with constantly changing intakes.

Housing – Most service families live away from the base and are therefore competing with the local population for access to housing. Service personnel with severe injuries may require adapted housing or sheltered accommodation.

Health – The age profile of many service families may mean that high birth rates put pressure on local maternity services. Where personnel are involved in combat, the pressures on their families can create demands for local community mental health provision.

Employment – In some areas, there are concerns that relatively unskilled relatives of serving personnel will add pressures on labour markets.

Transport – Additional traffic, much of it very heavy, can place great strain on the roads infrastructure, especially in the kinds of rural locations where military bases are typically situated.

A recent consultation exercise conducted by Ministry of Defence (MoD) showed that a number of service personnel and their families did not know or understand what is available to them or how to get it. However, it is also increasingly recognised that military bases can bring great benefits to local areas, not least because of their substantial economic impact as employers and purchasers of services.

The policy context

In 2008, the MoD issued a command paper, ‘The Nation’s Commitment: cross-government support to our armed forces, their families and veterans’. The paper outlines plans to improve the level of support given to service personnel, their families and veterans. The strategy is based on the principle that, “…those who serve must not be disadvantaged by virtue of what they do�.

The paper argues that, in the modern world, the expectations of service personnel and their families have changed:

“Those who might join the armed forces have aspirations and expectations that are higher than ever. Their families are more complex and often find it harder to accept the demands of service life. Routinely moving our forces around makes it harder for them to achieve home ownership and exercise choice in their lives.�

More frequent moves can put service families at a disadvantage in the way they access public services, it continues: “…for example, in the allocation of school places, or provision for special educational needs for their children, and in access to benefits and core NHS services.�

The paper promises a range of special entitlements for service personnel and their families:

• Key worker status, giving access to affordable homes, is to be extended for a year after discharge
• Arrangements giving access to school places are being reviewed and special educational needs (SEN) support will be uninterrupted when families move
• There will be a duty on service providers to ensure availability of flexible and affordable childcare and family services
• There is a commitment to tackle disadvantage where service overseas makes it harder for spouses and civil partners to get paid employment and maintain a national insurance contribution record, which may affect their contribution record for basic state pension as well as their access to contribution-based working-age benefits
• The government has promised to ensure there are access routes for service leavers into public sector employment.

In addition to these specific guarantees, the government is keen to ensure that there is better communication locally between military establishments and the civilian authorities. The 2006 White Paper ‘Creating Strong, Safe and Prosperous Communities’ says that local authorities and local strategic partnerships (LSPs) “should consider consulting… representatives of service personnel�. The paper also promised that the government would identify how an appropriate MoD body can be added by the Department for Communities and Local Government (CLG) to the list of statutory bodies with whom local authorities must consult in the formulation of policy.

What works

Catterick Garrison

In 2005, the MoD announced a £1 billion programme of major developments at Catterick Garrison in North Yorkshire, to be spent over 15 years. This would make what is already the British Army’s biggest base (home to about 18,500 people including dependants and non military personnel) into the country’s first super-garrison, with a population of around 25,000 by 2020. The local demographic mix is unusual, with a large proportion in the 17-55 age group, including many young single men and young families. The key issue was how to plan and manage this growth in a way that brought the least disruption and the most benefits to both army personnel and their families and to service providers.

Although increases in numbers of military personnel and their families create pressures for local service providers, there are also potential benefits to the local community:

• A number of MoD sites have been identified for release to the local council for housing development
• The garrison offers a pool of highly-skilled labour among those leaving the services
• Its purchasing power provides major opportunities for local businesses if local supply chains can be established.

Although there have been regular liaison meetings between the garrison and the local authority, it was only in 2005 that the base recognised the need for a more strategic and comprehensive approach. Its ‘Catterick Forward’ programme served as a vehicle for opening and extending discussions with local and regional partners. Reinforced by the 2008 command paper, the result has been rebranded the ‘Military Civilian Integration’ (MCI) pilot initiative.

The aims of the MCI are to ensure that servicemen, women and families have equal access to key services as laid down in the command paper and are enabled to play a full part as citizens in their communities. The MCI is managed through two main mechanisms:

• The MCI main board: This board, chaired by the garrison commanding officer, brings together the chief executives of the councils and main public agencies involved, including the Learning and Skills Council, police, fire and rescue services, LSPs and the Tees Valley joint strategy unit. Meeting every six months, the main board has adopted a thematic approach following the six work streams of the local area agreement (LAA), but also reporting against the main sub-headings of the command paper.
• The military stakeholder board: Partners in the past have found it difficult communicating with the variety of military players in each region. The army-led military stakeholder board has tackled this by bringing together a number of army and RAF sites throughout Yorkshire (also every six months) in order to present a common voice to its civilian stakeholders at the main board.

As a result of the new cooperation, partners are undertaking a variety of detailed reviews of the implications of the military presence.

• Yorkshire Forward (the regional development agency) is leading on a study of the economic impact of the defence presence locally
• An in-depth survey of traffic will also enable the partners to plan ahead and avoid congestion problems when the expansion begins
• Yorkshire Forward is also keen to develop a better understanding of the MoD’s role as a significant employer, inward investor and buyer.

The army has also looked for ways in which it can share its resources with the local community as it starts to emerge from its traditional position ’behind the wire‘.

• There is joint working with the primary care trust (PCT) – covering future delivery of primary health care provision and welfare and health support to young dependants in the garrison. They are also exploring how to give local hospital trusts access to military outpatient facilities
• The commanding officer at the garrison is on the board of governors of the local secondary school
• The Department for Farming and Rural Affairs (Defra) is talking to the garrison about sourcing more food from local producers.
• North Yorkshire Police are discussing a joint custody facility in Catterick
• Leisure facilities in the garrison are to be opened up for use by the wider community.

Project BORONA

Project BORONA, established by the MoD in 2006, was set up to oversee the relocation of military units from Germany to the UK. Its initial effort has been to transfer a NATO unit to Gloucestershire. During 2010, some 1,000 soldiers and their families from the Allied Rapid Reaction Corps (HQ ARRC) in Germany will move to Innsworth, near Gloucester. This operation involves the re-settlement of a large number of soldiers and their dependants, of whom more than a quarter will be non-British. This has required continuing engagement with local agencies to plan the necessary services, including housing, health, education, welfare and local transport.

The unit will be located at a former RAF base that closed in 2006, which offers much of the essential infrastructure for the incoming families. Indeed the relocation has meant that some services (including primary schools) threatened with closure will remain. Additional housing will be needed and there are longer-term plans to build new accommodation at Innsworth if funding becomes available. In the meantime, some families will be housed at two new developments outside the area where provision has already been made for schooling and healthcare.

The re-settlement process is overseen by the BORONA project team, consisting of 14 military and civilian personnel, one of whose role is to engage with local agencies to facilitate service planning. Since 2006, the BORONA team has built contact with the council and PCT at several levels:

• High level support has come from the chief executive of Gloucestershire County Council following a meeting with the officer commanding HQ ARRC.
• There has been regular contact between BORONA and local authority officers, including schools, early years and race equality and diversity.
• There have been visits to the two primary schools and regular contact has been maintained with the head teachers.
• The BORONA team has met with the deputy director of commissioning at the PCT and is in regular contact with the member of the PCT staff who has responsibility for day-to-day liaison with BORONA.

Identifying demand has been essential for service planning. One of the team’s tasks is to collect data and determine population trends – particularly on pupil intake in local schools. A number of initiatives have catered for the needs of non-British families, including English language support and medical care.

The team’s presence and the intelligence it has collected have already made a difference to the services available:

• Planning school provision and entry – The team has estimated the number of school places (at each stage) that will be needed from 2010 and the local authority is using the data to help plan relevant schools’ intake in 2010.
• Identifying non-British children – The team has also estimated the number of non-British children entering local schools. This information should help to identify where English language support may be needed.
• Schools admission – There is a special schools admission form enabling families to apply directly from Germany. Gloucestershire maintains selective secondary education, so children can sit grammar school admissions exams in Germany.
• Planning healthcare services – At present, the PCT does not anticipate that substantial additional services will be needed for ARRC dependants, apart from NHS dental services.
• Signposting and language support – The PCT aims to ensure that British families know what health services are available and that non-British families understand the NHS and how it works. This may require some language translation services for non-British personnel accessing health care.
• Nursery places – The BORONA team and the council’s early years officer have identified the need for a nursery for under-fives at Innsworth. As a result, the MoD is building a 50-place nursery to be contracted out to a specialist nursery provider.

MCI programme, Tidworth, Wiltshire

One of the new super-garrisons under development is on Salisbury Plain. The garrison is designed to “improve the way of life for those working and living within it and the community at large. It will not only create a strong sense of military community, but will also encourage closer integration with the civilian community.�

The garrison already constitutes a major presence in the area. There are around 15,000 military personnel and some 6,000 dependants in Wiltshire. Additional ‘defence dependent’ jobs (agency staff, civil servants and contractors) make the military the largest employer in the county. Two further influxes of personnel are expected in 2009 and 2010.

Until recently, service provision for army personnel and their families was not entirely satisfactory. Examples included a lack of housing and affordable houses to buy, poorly coordinated education, poor dental facilities, patchy uneven medical facilities, limited employment options for partners and poor facilities. The MCI programme was set up to help improve these services.

The programme is designed to maximise the economic and social benefits of the military presence in the county and has five main objectives:

• to identify the changing military ‘footprint’ in the county
• to measure the economic contribution of the military to the county and the south-west region
• to enable the realignment of service provision to meet the changing needs of the military and their dependants
• to spot opportunities for regeneration and building sustainable communities in the Salisbury Plain area
• to ensure Wiltshire continues to be an attractive location for long-term investment by the MoD.

A partnership led by Wiltshire Council is delivering the programme. It includes Headquarters 43 (Wessex) Brigade, Defence Estates, South West Regional Development Agency (SWRDA), council representatives at cabinet member and chief executive level and representatives from the Wessex Association of Chambers of Commerce (private sector) and Community First (voluntary sector) in Wiltshire. The programme is managed by a coordinator (a permanent MoD civil service post), supported by a programme manager and researcher.

A study in 2008 explored the demands that the military presence made on council services and how these might change in the future. A report in 2009 identified the threats and opportunities afforded by the military presence.

Some threats:

• There could be more people with low skill levels and low economic activity rates as the number of dependants in the garrison area increases.
• Service leavers will now be entitled to affordable housing in Wiltshire, which may increase demand.
• Demands for mental health and social care services could increase because of high levels of military deployments.
• The military presence could lead to a risk of increased teenage conceptions in the area, partly because of the age of some soldiers’ wives.

Some opportunities:

• Increased demand for further and higher education (HE) from service leavers could support a ’University Challenge‘ bid to increase provision in Wiltshire.
• There is scope for increased local procurement of food by military bases
• The increase in the number of service leavers in the area will increase the skilled workforce in the area
• A larger and more stable military presence should make public transport services more sustainable and easier to plan
• Defence Estates have identified MoD land that may be released for development and therefore extra housing provision.

It was previously difficult for some service areas to see how the military presence was relevant to them; the analysis now provides a valuable tool for both the council and the MoD.

• It helps ensure that relevant service delivery plans and actions take account of the military presence and expected changes
• It is easier for all partners to strengthen military civilian integration in the county
• It provides the opportunity to share information with regional partners, such as the Government Office South West and SWRDA, through the Wiltshire Council website.

RAF Marham

RAF Marham is one of the largest and busiest stations in the RAF, employing almost 5,000 people, with an annual wage bill of around £85 million. In an otherwise largely rural district, the station exercises considerable influence on the local economy and on the demand for, and provision of, services. The base is valued not just as an employer, but also for the spending power it brings to the local economy, the business opportunities it offers to local firms, and also as a source of recruitment – many of the local council’s employees are the partners of service personnel at the base.

The station’s child population indicates its significance locally. It has an average of 100 births a year, half the local total. It is unlikely that maternity facilities at the local hospital would be maintained without this level of births. More than 90 per cent of the children at the village junior and infants’ school are connected to families on the base.

Until recently, the station’s links to the wider community were limited to ceremonial occasions. Few on the station understood the opportunities local service provision offered. A variety of service provision is available on station, but it is not exhaustive and was not well integrated with what is available through the mainstream. This led to both gaps in provision and duplication. For example, a children’s centre on the base has not been able to secure support from or involvement with the local SureStart.

As with all military establishments, RAF Marham makes a payment as the equivalent of council tax – but until recently they had no idea what services that payment entitled them to. For example, they handled their own rubbish bin collection – unaware of their rights from the council.

A combination of tactical necessity and RAF culture erected barriers between the base and the local area, residents and agencies. Security requirements imposed through the cold war and then the threats of IRA terrorism meant that the base and its personnel had to keep a low profile. Three years ago, one of the senior officers on the base initiated a systematic programme of cooperation between the base and the local community. Among other things, this included a seat on the West Norfolk Partnership, the district LSP.

RAF Marham’s presence on the LSP has helped both the base and the LSP. It has injected expertise into the LSP and helped the base develop bilateral relationships with, among others, the local college, the PCT, police and local authorities.

This reflects the two key principles underlying the station’s approach:

• There is recognition that involvement with the local community is a two-way street: RAF Marham must invest in the local community if it is to benefit from what the community has to offer
• Building productive relationships requires a community development approach.

The base has organised a ‘Pride in Marham’ campaign to help develop positive relationships between the station and the local community. Some of the activities generated by the campaign have included community clean ups and environmental education projects.

The borough is also trying to ensure that it takes into account the needs and aspirations of people associated with the base. Its second ‘Quality of Life’ survey, set for October 2009, sees a plan to increase the sample size in Marham to ensure the survey captures the views of service personnel and their families. Since the first survey in 2007, Marham’s community development team have been helping the LSP with their response to the issues raised.

There have already been a number of tangible impacts:

• RAF Marham has been granted honorary Freedom of Norwich
• The Borough of Kings Lynn and West Norfolk launched a ‘Heroes Welcome’ campaign which offers benefits to service personnel and their families through free access to a number of council amenities and discounts from a growing range of local traders.
• Access to information: the borough maintains an information point on the base to signpost personnel and their families to local services.
• Partnership officers provide a signpost to the right people to talk to about services.
• A mobile library provided by the county now visits the base – a far better option than the very limited library facilities provided on-site before.
• Improvements to the road system on the base have benefited all aspects of the business
• Minor improvements to the pavements and kerbs around the base have brought huge benefits to families.

Lessons and challenges

One of the main lessons from all this experience is the importance of reciprocity: if military bases are to benefit from links with their local community they must also invest in them.

From the perspective of local public sector agencies, the key issue is to ensure continuity. Very often the strength of the relationship between a base and the wider community is a result of the enthusiasm and commitment of one officer. A key lesson, therefore, is to ensure that the engagement of military bases with the LSP continues despite any personnel changes. The relationship needs to be institutional rather than individual.

But the impact of relatively high turnover goes beyond the contribution of individual officers. Even with the greater stability of the new garrison, service personnel may still have variety of different postings during their career. So local councils and other service providers need to undertake continuous re-marketing.

Both military and civilian partners may need persuading of the value of cooperation. This works best where there is demonstrable commitment from senior leadership – chief executives and commanding officers.

Effective joint working creates wider opportunities for economic development and regeneration and creating more balanced and stable communities in the long term. MoD may be able to identify areas of land managed by Defence Estates that could be freed into the local development framework and realise funds. Partners could plan together to resolve shortages, for example, for housing or business units, but this needs to be addressed within the regional spatial strategy.

Finally, having a post within the base liaising with service providers helps give credibility to the planning process. It also helps military personnel develop a better understanding of the opportunities (and limitations) of civilian service provision.

The military presence can make exceptional demands on district council capacity, particularly in relation to planning, LDF preparation and issues that cross district and sometimes regional borders. In some cases the additional support and understanding from regional partners, MoD and Defence Estates has been both necessary and welcome.

References and further reading

MoD (2008): ‘The Nation’s Commitment: cross-government support to our armed forces, their families and veterans’

For further information on the MCI programme and to see the research reports:

For information about SWRDA and its investment plans – highlighting joint work in the Military Civilian Integration programme and shows the MoD in Wiltshire:

The Wiltshire research, ‘Envisioning the Future’ – published in July 2009, is on the Wiltshire Council website

This case study shows how Hounslow Council used the children and young people scrutiny review process to tackle teenage pregnancy locally and also scrutinise partners involved in meeting the local strategic partnership (LSP) target on teenage pregnancy. The review brought about renewed corporate drive at senior level to reach this stretching target by 2010. It also resulted in a teenage pregnancy (TP) action plan with a detailed programme of measures for 2006-08.

A series of recommendations for action by the council and its partners was agreed based on conversations with witnesses, the evidence gathered and best practice in other local authorities. These included looking at:

• structures – the make-up of the TP partnership board; location of the TP coordinator’s post
• processes – monitoring spending of the TP grant
• better data collection
• better signposting of services for young people
• practitioners
• a higher corporate profile for children’s safeguarding information – across the whole spectrum of safeguarding including substance abuse, mental health and sexual health.

The issue

National

In 1999, the Social Exclusion Unit published its teenage pregnancy (TP) report which highlighted concerns about the poverty trap and poor outcomes for teenage parents and their children. The government’s Every Child Matters agenda also sets out a number of reasons why reducing teenage pregnancy is important. The evidence shows that children born to teenagers are much more likely to have a variety of negative outcomes in later life, for example:

• Teenage mothers are less likely to finish their education and more likely to bring up their child alone and in poverty. Their children have a higher risk of poverty, low educational attainment, poor housing and health, and lower rates of economic activity in adult life.
• Teenage mothers are more likely to smoke during pregnancy and less likely to breastfeed. Infant mortality rates are higher and low birth weight babies are more common.
• Teenage mothers have three times the rate of post-natal depression of older mothers and a higher risk of poor mental health for three years after the birth. Half of all teenage conceptions end with an abortion with all the damage and trauma to the mother and others that this can cause.
• Rates of teenage pregnancy are highest among deprived communities.

In addition, government estimates suggest that every £1 spent on preventative measures saves at least £4 required to deal with the impact and issues relating to a teenage pregnancy over a period of five years.

Hounslow

Hounslow’s teenage conception rate in 1998 was 49.6 per 1,000 under-18-year-olds. The borough needed to reduce this by half to 24.8 per 1,000 to meet the government’s national target. Some councils made significant progress towards this target, including Hammersmith and Fulham, Kensington and Chelsea and two of Hounslow’s closest statistical neighbours.

The conception statistics – onthe Every Chlid Matters website

However, in 2004, Hounslow’s conception rate had increased to 52.2 per 1,000 15 to 17-year-olds (203 conceptions). This meant Hounslow’s rate was the ninth highest of the 32 London boroughs and 19th highest of the 148 upper-tier authorities in England. The council had ‘red’ status on the so-called ‘traffic light’ monitoring system by the then Department for Education and Skills (DfES). In real terms it meant that, of the 203 conceptions, there were 104 abortions and 99 births.(Ward data suggested that the problem was concentrated at the western end of the borough).

The Hounslow Strategic Partnership and Children’s Partnership Board had set milestones for achieving the 50 per cent reduction by 2010 in their local area agreement (LAA) 2006-09. However, they had only achieved half the target reduction for 2005 and progress had not been consistent. The scrutiny review found that there had been a lack of leadership on this issue. Money earmarked for reducing teenage pregnancy had not been spent and work between agencies had not been well coordinated.

In addition, it is the director of children’s services in each council who is accountable for the improvement (or not) of teenage pregnancy rates, even though they do not directly manage all the relevant services. At the time of the scrutiny review, the TP coordinator was located in community services.

Hounslow’s LAA included references to national indicators:

• NI 112 Under 18 conception rate PSA 14
• NI 117 16 to 18-year-olds who are not in education, training or employment (NEET)
• NI 123 16+ current smoking rate prevalence.

What they did

Fresh energy came from the new management team within children’s services and lifelong learning and a DfES-led event with other councils in London in January 2007. Hounslow had to attend – having got a ‘red traffic light’ rating for the 2004 figures – and completed a self-assessment ahead of this meeting with a review of action to date and a set of actions for the next six to 12 months.

The children and young people’s strategic partnership (CYPSP) agreed terms of reference that guided the scrutiny review panel’s work:

• to examine the causes for the rise in teenage pregnancy levels and understand the data and in-borough variations
• to understand the choices and circumstances that can lead to becoming a teenage parent
• to examine the extent to which young people are shaping the delivery of services to reduce teenage conception
• to learn about good practice models in other boroughs in the UK regarding staffing structures and policy implementation
• to look at current policies, staffing structures and funding across the council and local NHS regarding reducing teenage conceptions.

The panel explored and challenged a number of assumptions and preconceptions about teenage pregnancy. Mainly because of population changes since the 2001 Census, it used primary care trust (PCT) data, which suggested that teenage mothers were much more likely to be white and with lower educational achievement when compared with borough population average figures.

Review panel’s series of recommendations

The Teenage Pregnancy Partnership Board (TPPB) needed to improve the recording and sharing of statistics and all relevant information between all partners in Hounslow – particularly to target key risk and vulnerable groups. The TP grant had been underspent every year, suggesting poor monitoring and missed opportunities. It recommended regular monitoring by the TPPB.

The review panel met teenage mothers at young mothers’ hostels and at the young mothers’ group at West Middlesex University Hospital and found little evidence to back up the popular belief that becoming pregnant was a calculated move to get on the fast-track for the housing register or to live on benefits. All the mothers interviewed said that their pregnancy was not planned and hospital statistics suggested almost two-thirds were taking no contraceptive measures.

Statistics showed that 41 per cent of teenage mothers were smokers, compared with about 30 per cent in the borough’s female 16-24 population as a whole.

The review panel adopted the recommendation of the Deep Dive study (2006) published by the DfES, ‘Teenage Pregnancy Next Steps: guidance for local authorities and primary care trusts on effective delivery of local strategies’, that the council and PCT should:

• note the poor outcomes experienced by young mothers and their children
• ensure that senior managers through to frontline professionals understand that reducing teenage pregnancy is a priority
• recognise that actions to reduce teenage pregnancy represent an important ‘invest to save’ measure.

The Deep Dive study compared three councils that were performing well against three that were not. Seven key best practice factors emerged, many of which became part of the borough’s TP Forward Action Plan 2006-08, which the TPPB approved and was brought to the CYPSP in October 2006. Based on the evidence the review gathered, these seven points shaped the panel’s observations and recommendations.

1. Active engagement of all the key partners in health, education, social services and youth support services

In line with the London regional teenage pregnancy (LRTP) coordinator, the panel recommended:

• “TPPB should be a high-level strategic steering group, chaired by a council or PCT representative who is senior (at least assistant director level) and with organisational and personal influence to ensure that work is sustained.� This was the only way that aims would become organisational commitments and unlock funding streams and overcome high-level obstacles.
• The CYPSP should get an annual update (six-monthly update in the first year) on progress on teenage pregnancy and the panel should review the TPPB’s performance and effectiveness.
• Acknowledging the important management role that schools can play, the panel recommended that the TPPB should include at least one secondary and one primary headteacher representative – possibly from different ends of the borough.

Acknowledging lead officers’ heavy workloads, the review panel recommended administrative resources to support the various leads of the working groups. The LRTP coordinator favoured the TP coordinator post being located where it could exert strategic influence, so the panel recommended that it be moved from public health to the children’s services and lifelong learning directorate.

2. Strong senior champion for tackling teenage pregnancy

According to the LRTP coordinator, the local TP champion(s) could be drawn from either the elected membership or officers, or both – they needed to be accountable, driven and have clout and control over budgets. The review welcomed the director of children’s services and lifelong learning as Hounslow’s local champion.

3. Well-publicised, young people-centred contraceptive and sexual health advice service

Every effort should be made to have drop-in centres in all schools wanting to have one. Pilot drop-ins had been set up and initial reports suggested that young men were making very good use of them.

In addition, there were several recommendations about revising and publicising children’s signposting information.

4. Priority on PHSE and comprehensive programmes of sexual and relationships education (SRE) in schools

Some panel members observed a Year 9 PHSE SRE lesson. They found variations in the extent to which secondary schools consulted their pupils about the content of SRE and there were also many variations in the way SRE was delivered. Some had specialist PSHE teachers, but not all of these had attended training. Others had form tutors who regularly attended training teach SRE, but sometimes only a third of secondary schools attended borough PSHE coordinator meetings.

In Tower Hamlets and Slough, the preference was for form tutors to do SRE teaching, rather than specialists. That way the whole issue was mainstreamed into the life of the school community. Form tutors are often best placed to pick up on safeguarding issues (from eating disorders to abuse and mental and sexual health) which can have a link with SRE. But the pupil survey showed that young people preferred high quality, experiential SRE teaching, adding weight to the argument for specialists. So the review recommended that secondary schools should:

• set up specialist PSHE teaching teams
• make sure all those teaching sex and relationships education had regular training
• consider inviting health professionals to be part of the SRE quality assurance process.

The review panel were impressed by Tower Hamlets Council’s two-year exercise to draw up SRE guidelines for schools. They had successfully engaged with all faith groups, and indeed all stakeholders, to produce guidelines on which everyone could agree.

The panel wanted the council to start and facilitate a borough-wide debate among all stakeholders (pupils, parents, governors, teachers, faith groups, council, voluntary sector and healthcare professionals) on SRE teaching and advice in primary and secondary schools, the college and youth clubs. They could do this by revisiting and renewing the council’s SRE policy. Some useful steps would include a policy for SRE for SEN pupils and for looked after children.

The SRE policy could also include:

• a list of ‘approved’ external organisations to deliver additional SRE in schools and youth clubs
• an updated list of recommended teaching materials and list of useful materials for parents
• revised and clearer templates for individual schools’ SRE policies (building on practice the panel observed in Ealing) and templates for letters to parents about SRE teaching
• a brief signposting document with all relevant contact points on children’s safeguarding issues, including on sex and relationships.

Drawing on lessons from Ealing, the panel suggested that a Hounslow school might work with the council to host an SRE teaching resource centre. They also encouraged schools to make use of the council’s offer of a systematic review of schools’ SRE policies as well as their PSHE curriculum. When this had been done in Slough gaps were often identified, as well as help to improve coordination of SRE teaching in the PSHE and science curricula.

5. Targeted interventions with young people at greatest risk of teenage pregnancy, in particular with looked after children

Looked after children are a key risk group, but no local figures were available. The panel wanted to explore Ealing’s approach, developing a specific “personal relationships and sexual health policy for looked after children and care leavers�.

Young mothers need help and support after the birth of their first child. When the review team met some of them it was clear they were not getting the advice and support they needed – sometimes getting incorrect advice from JobCentre Plus workers and conflicting messages. The panel recommended a review of coordination between agencies of the information and advice they give parents after the birth of their first child to make sure they have full and easy access to the correct and consistent information.

It also recommended:

• The TPPB (or sub-group) should discuss the most effective and appropriate support for young men and fathers, perhaps building on Richmond’s experience.
• Hounslow should keep piloting and evaluating interventions for vulnerable teenagers based on analysis of need.
• No 16 or 17-year-old should be in unsupported temporary accommodation, as had previously been the case.
• Couples could be supported to stay together, wherever possible.
• The TP coordinator should work closely with the area committees – in particular in the West Area Committee, where teenage pregnancies were concentrated.
• As in Ealing, parents of SEN children might want help in discussing sex and relationships with their children and supporting them. This should be reflected in the SRE strategy.

6. SRE training for professionals in partner organisations working with the most vulnerable young people

This formed part of the action plan 2006-08. Multi-agency training could be a chance to promote better integration of working practices between agencies, including schools.

7. Well-resourced youth service with a clear focus on addressing key social issues affecting young people, such as sexual health and substance misuse

Given the success of the borough’s Detached and Outreach Teams (DOT) in reaching vulnerable young people, the review panel saw scope to engage a part-time health worker to work alongside the DOTs.

The impact

The review panel came to the view that the most important thing was choice for the young people concerned. It also made the point that efforts to reduce teenage pregnancy do not just benefit the few. Better SRE and better access to advice and support benefit all Hounslow’s children and young people.

Following the scrutiny review there was a borough-wide audit of how sexual health services were delivered both for adults and young people. This brought changes to the way services were delivered. Some were decommissioned where it was felt GPs could deliver them better; others were expanded – in particular the sexual health services for younger people in the areas of greatest need in the west and central parts of Hounslow. Anecdotal evidence is that even before the launch, take-up of this service was very good as the location was right. The launch itself in the west of the borough was very successful and well coordinated by youth services

The school-based drop-in has been expanded to two further schools and there is a new TP project development officer post. There is a new sessional worker to deliver SRE in schools and to model good SRE, and the new development officer will also deliver SRE. All requests from schools for SRE external input are now coordinated by the authority, which is leading to a more consistent message on SRE. Speakeasy training has begun and around 20 family support workers, youth workers and health professionals have been through the training.

One of the main hostels for young women is going to be refurbished so that living conditions are safer for young women and their babies.

Most importantly, there have been changes to leadership in this area. The TP coordinator post became the ‘children’s public health manager’ post located in children’s services and the post-holder changed. There is now much greater dynamism and coordination of activities, although the figures do not yet reflect that, partly because they take time to come through.

The latest figures are from 2007 and they showed an increase on 2006 from 44.4 per 1,000 in 2006 to 46.9 in 2007. In real terms there were nine more conceptions in 2007 than 2006. Members understand that it is too early to make a judgement on the effectiveness of measures that were put in place in 2007-09. They understand the difficulty of obtaining up-to-date figures and know that they have to take the long view on impact. In general terms, the level of debate between the politicians has been more mature and informed than it was prior to the scrutiny review. They are key stakeholders in debate in the public arena. It was useful to dispel some of the myths – particularly in the west of the borough – about the reasons a young woman might become pregnant.

Challenges, barriers and lessons

The scrutiny process was a good reminder of how important and powerful it is to speak with users. There are many myths about teenage mothers and so it was useful to bring politicians into direct contact with young parents. The review panel made arrangements sensitively, ensuring that the midwives who knew the young people were in attendance. Despite fears and misgivings from various quarters, the council just wanted members to be trusted to do what they do best and understand the human stories behind the figures and the stereotypes. This also seemed helpful in building cross-party consensus.

The review process drew in some of the teenage mothers’ own mothers, who had their own stories to tell. In Hounslow’s experience it has always been beneficial for members to see and hear these things for themselves. It can be time-consuming to set up in a way that is comfortable for everyone, but it has always proven beneficial.

In the follow-up work with the teenage parents (and their parents), members made further recommendations about the contract monitoring of the hostels. One of these is now being completely refurbished to make it safer for the young women and their babies.

SRE in schools has remained a difficult nut to crack. While there have been some definite improvements as a result of the review, such as a new SRE facilitator, SRE in schools is a big piece of work on its own, demanding a very long preparation time. It is about changing attitudes in schools and in the community in a highly sensitive area. The results of the consultation on whether PSHE should be compulsory are due to be published in Autumn 2009. There remain questions about the quality of delivery on the ground and scrutiny can still have a role in monitoring this.

Data and intelligence sharing

One of the greatest frustrations for members was the lack of good, up-to-date local data both from national and borough sources. Ward data from the Office for National Statistics comes out with a 24-month delay. Members identified a historic lack of coordination at the centre on this issue. Agencies are now talking more to each other and a concerted effort is being made to pull all the available data together.

The gaps were numerous and covered both data and intelligence about specific individuals – where they are, what their needs are, how they are being supported and which are the most vulnerable. Hounslow’s young parents are known to the various agencies, but there had not been the same joined-up approach as in some other boroughs.

• There was no effective data to identify which schools had the highest need.
• There had been a lack of data from hostels and information sharing with them and no coordination of statistics from the maternity unit at West Mid or other hospitals where Hounslow residents gave birth.
• There was no evidence of GPs being better involved in information exchange, no evidence of good information exchange with the temporary accommodation unit at the council, no numbers for pregnant looked after children and no useful statistics on ethnicity or drug use.
• Most of this information was already collected by the different organisations – or could be fairly easily if they were asked to, for example, if midwives were asked to record which schools young mothers attended. Across the TPPB, moves have been made to improve data capture and sharing and to establish protocols and SLAs, as well as proposals to explore the use of the existing Connexions database to manage the information. The increased used of the common assessment framework should also help.
• Since the scrutiny review, data sharing has improved between the council and the PCT, which is informing commissioning decisions.

Further information

Jonathan Hill Brown
Scrutiny Officer
London Borough of Hounslow
scrutiny@hounslow.gov.uk

Hounslow Council website.