More about Early Years Health and Wellbeing (BoNEE)


Over a quarter of Bristol children live in poverty (nearly 20,000)

The Bristol Network for Equality in Early Years Health and Wellbeing Health Integration Team (BoNEE HIT) is a team of academics, public health specialists, parent and community groups representatives. It aims to tackle the health inequalities that have a profound and lifelong impact on the health and wellbeing of children.

Deprivation in Bristol is higher than average for England, with nearly 20,000 children living in poverty. Around one in 13 children in Bristol have a chronic or potentially disabling condition which impacts on their daily lives. With a rising child population, Bristol needs a local evidence base along with staff and services that recognise and respond to inequalities in children's health.

Aims and objectives

The team has identified three priority areas, covering antenatal to children aged seven, which will be covered by working groups within the team:

  • Oral health
  • Early nutrition
  • Social and emotional wellbeing

These areas are underpinned by the cross-cutting themes of:

  • Involving people in solutions
  • Reducing the impact of poverty

Oral health

Dental decay is one of the most common and preventable of childhood diseases, causing pain, impeding quality of life, and requiring treatment. In 2003/2004 1,474 patients (mostly children) were treated under a general anaesthetic in the Bristol Dental Hospital, at considerable cost to both patients and health services. The inequalities in dental health within Bristol are clear; Ashley and Lawrence Hill experience more than 93 dental fillings per 1,000 under 5 year olds, compared to less than 33 per 1,000 in neighbouring Bishopston and Redland.

Dental fillings probably underestimate dental caries in these children, since decayed primary teeth may be lost without attending dental services. Links between parental awareness, low dental attendance, diet and oral health are well established. NICE guidance for local authority oral health improvement strategies are currently in development. This collaboration will work to refresh the City of Bristol oral health promotion strategy for young children.

Early nutrition

Socio-economic disparities in diet quality have life-long effects. Nutritional and material disadvantage during pregnancy are associated with poor outcomes for babies including pre-term birth and diet-related disease patterns in later life.

Mothers from the lowest income households are also less likely to initiate or maintain breastfeeding and are more likely to introduce solid food before 6 months of age. Breastfeeding initiation in Bristol is high (81.1 per cent in 2012, of those with feeding status recorded), but maintenance at 6-8 weeks falls as low as 20 per cent in some wards. Mothers who are younger or living in more deprived neighbourhoods are less likely to breastfeed.

Poor diet and disadvantage also contribute to childhood obesity, with severe health consequences. Current figures suggest prevalence of obesity (9.2 per cent) and overweight ( 12.7 per cent) among 4-5 year olds in Bristol, similar to the average in England (2012-2013 data).

Social and emotional wellbeing (SEWB)

Social and emotional wellbeing provides the building blocks for healthy behaviours, development, educational attainment, good mental health, positive family and peer relationships, and for the prevention of poor outcomes in later life.

Early speech and language development is essential to later development. Social and emotional wellbeing, particularly for children identified as 'vulnerable', is central to the work of Health and Wellbeing boards in addressing health inequalities.

Improvement in 'school readiness' is a key local authority indicator, and Bristol has a multiagency 'Emotional Health and Wellbeing Strategy for Children and Young People' to deliver this. By contributing to the development of indicators for SEWB and speech and language and to a better understanding of the emotional health of looked after children, this working group will influence service development in this field.

Involving people in solutions (IPIS)

Working with and through communities and families will be crucial to the delivery of both research and service outcomes for this HIT. This cross-cutting theme will contribute to, and inform the working groups through consultation and co-design. We have formed a standing IPIS advisory group comprising BoNEE members, community representatives and parents who meet at Wellspring Healthy Living Centre.

Reducing the impact of poverty

Associations between poverty and ill health are well-recognised and current welfare reforms and economic insecurity mean more families are at risk of income poverty. The aim of this theme is to ensure recognition of this in the efforts of all working groups.

Who's involved

The leading experts in child health inequality in Bristol are involved in the team. The HIT management team is made up of:

  • HIT Director: Patricia Lucas, Senior Lecturer, School for Policy Studies, University of Bristol
  • HIT Director: Jo Williams, Consultant in Child Public Health, Bristol City Council
  • Commissioning representative: Rebecca Cross, Service Manager Joint Commissioning (Children), Bristol City Council and Bristol Clinical Commissioning Group
  • Parent representative: Loula Hassan
  • Involving people in solutions working group lead: Rhian Loughlin, Head of Services, Wellspring Healthy Living Centre
  • Oral health working group lead: Katherine Walls, Senior Dental Officer, Oral Health Promotion & Epidemiology, UHBristol
  • Oral health working group: Sarah Bain, Director of DCP Training, University Hospitals Bristol,
  • Oral health working group: Andrea Waylen, Dental School, University of Bristol
  • Early nutrition working group lead: Jessica Williams, Senior Health Promotion Specialist, Early Years, Bristol City Council
  • Reducing the impact of poverty working group: Sally Jaeckle, Early Years Services Manager, Bristol City Council

Other organisations engaged in the work of the HIT include:

  • Barton Hill Settlement
  • Easton and Lawrence Hill Neighbourhood Management
  • NHS England
  • Public Health England (Devon, Cornwall and Somerset PHE Centre)
  • Single Parent Action Network
  • Wellspring Healthy Living Centre

How parents and the public are involved

The involving people in solutions working group, comprising parents, community representatives and HIT members, will make a significant contribution to involving parents, children and the public in the work of the HIT.

The working group will meet at least quarterly, and will oversee the patient and public involvement (PPI) delivery of this HIT and report to the management group. This work is led by a parent representative Loula Hassan and Rhian Loughlin, working group lead.

Projects and activities

There is no single pathway of care for babies and young children, they interact with health and public health services in multiple ways according to their age, stage of development and needs. The team has therefore taken a topic, rather than pathway approach to developing their strategy. Each working group has considered transformations in the short, medium and longer term.

This multiplicity demonstrates the value of this HIT, bringing together services across health, community health, CAMHS, SLT, education and community groups to consider efficiency and effectiveness of the services as a whole. For instance, the HIT has already linked groups across oral health and public health that had not previously been in contact.

Find out more about the projects and activities of BoNEE HIT.


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BoNEE at the HIT conference

The BoNEE HIT presented this poster (PDF) at the 2018 Bristol Health Partners Health Integration Team conference.

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