Agenda item

To consider a report of the Director of Public Health and the Director of Human Resources, Performance & Communications (Item 4 attached) which provides an update on the 0-19 Service.

The Chair welcomed the following witnesses to the meeting:

• Julia Burrows, Director of Public Health, BMBC
• Alicia Marcroft, Head of Public Health, BMBC
• Carrie Abbott, Service Director, Public Health, BMBC
• Lisa Loach, Public Health Governance and Service Manager, BMBC
• Anita McCrum, Professional Lead 0-19 Service, Public Health, BMBC
• Councillor Jim Andrews, Deputy Leader of the Council & Cabinet Spokesperson for Public Health

Julia Burrows explained the 0-19 Service had previously been discussed at the Council’s Safeguarding Scrutiny Committee (SSC) in September 2015, and has subsequently been on quite a journey, meaning today it is now both in a different and better place. Local Authorities’ responsibility for commissioning the HCP, 5 to 19 years began in April 2013; this included School Nursing as well as the National Child Measurement Programme. The HCP 0 to 5 years, which includes Health Visiting, began on the 1 October 2015. Following the procurement process being unsuccessful, the 0-19 Service was brought ‘in house’. There have been challenges along the way; however a good service is being delivered with strong leadership and a service review is currently being undertaken.

Members proceeded to ask the following questions:

1. What are the rules for public procurement, and as detailed in the report why was there conflict?

Members were advised the last time the service went out to procurement with a new specification, there was only one bid received, which was outside the financial envelope, culminating in the process being ended. Cabinet agreed the proposal to form a partnership arrangement with South West Yorkshire NHS Partnership Foundation Trust (SWYPFT) however were unable to get a joint service. Public Health therefore went back to Cabinet for permission to bring the service ‘in house’ and there was subsequently a six month transition period to transfer staff to BMBC, which was successfully completed by 1^st October 2016.

2. What have been the key challenges; what services will be delivered with the new service model; and are effective performance management and infrastructure in place to ensue appropriate clinical governance?

The committee were advised the new model is to be re-designed by the end of March 2017; it involves a number of partners but is being led by the 0-19 service. Appropriate governance structures were ensured pre-transfer and the service is looking to enhance this in terms of the new delivery model. The transfer period allowed the delivery model to be embedded, including the transfer of the service manager who has been working to embed good practice such as Care Quality Commission (CQC) and quality marker requirements.

One of the key challenges has been ensuring a safe transition and modernisation of the service to ensure it is fit for purpose and delivers future council outcomes. Other challenges have been estates and data transfer. Colleagues have been working hard on these, including to turn data into intelligence.

3. Regarding the HCP, how often are families visited and where do these visits take place?

Members were advised for 0-5 year olds these visits are mandatory; including an antenatal health promoting visit; a review following the birth of the baby, a six to eight                    week assessment of mum and baby; a 1 year assessment and finally a 2 to 2.5 year assessment enabling planning for any future support. Additional visits are carried out with children aged 10-11 years old as they transition to secondary school. The service needs to ensure set visits are kept and are working with partners to ensure this. There is universal provision as well as tiered support for those who may need more intervention.

    iv.          The report advises the new model will be in place by September 2017 therefore please can the Committee receive an update either via a report or attendance at a meeting regarding the new model, its implementation and how effective it is operating?

The committee were advised the service would welcome the opportunity to provide an update.

     v.          The 0-19 service states that it will engage with those aged up to 25 if they have a disability; is there much take-up of these services from older customers?

The group were advised there is not much take-up from the older age group; previously the service was 0-18 however even after age 16 services did not have much input, therefore are now looking at how they can target this older age group.

    vi.          What plans are in place to engage with people up to the age of 25?

Members were advised there are plans within the Special Educational Needs (SEND) strategy; engagement with other partners within BMBC is currently being undertaken to support their transition across services.

  vii.          Initially there was some dissatisfaction from staff regarding their transfer from SWYPFT to BMBC, have these issues been amicably resolved with the trade unions and how many employees have left during this process?

The committee were advised during the transition the service worked closely with Human Resources and the Trade Unions and there was individual and collective dialogue with every member of the service. The service advised 24 of 156 staff (approximately 15%) left the service during transition. Some employees did not want to leave employment with the NHS and others moved to roles in neighbouring areas. The service was mindful of and monitored which staff left to ensure there was coverage and continuation of services. Those employees who have joined the Council are very positive and looking forward to contributing to what the service needs to look like in the future.

 viii.          Were staff happy in relation to TUPE (Transfer of Undertaking [Protection of Employment]) and regarding the transfer in general?

The group were advised that many of the staff transferred with NHS terms and conditions, whereas some opted to move to a Council pension. Staff have been much happier compared with the previous tender as they have been engaged and enthused by being involved. As staff moved to the Council the service was clear in telling them what they could expect and made sure the service did what it said it would to ensure staff continued to be engaged. The service has recently advertised for 6 additional bank staff so that employees can be involved in the service re-design; the 6 people that have been taken on previously left the service but have decided to come back.

    ix.          In relation to the planned workshops, have all staff attended and how many more sessions are due to be held?

Members were advised the third of 3 workshops is due to be held this week. So far 105 out of 120 employees have attended. Different locations have been used to enable as many staff as possible to attend and the service has also established a closed Facebook group to continue the dialogue. The service will also be holding an additional ‘mop-up’ session for those who were unable to attend the other sessions.

     x.          Has there been the implementation of new practices; if so, has there been any feedback on these?

The committee were advised there have been no changes; it has been business as usual. There has been no increase in negative feedback and the service is working with Healthwatch to look at service user feedback. Problems identified have been in relation to the administration of the single point of access (SPA) however the service is working on its review to address these.

11. How do you ensure effective targeted intervention takes place amongst vulnerable, hard to reach groups?

The group were advised there have been no changes to the services that are being provided. Universal provision is now accessed in group sessions rather than one to one but this has been the only change. Through the HCP there are mandated contacts, and for each contact an individual assessment and pathway is completed. Regarding vulnerable families, it is about what they need and how this can be strengthened in the delivery model.

An example of a pathway would be an antenatal contact which would be a pregnant mum seen by a midwife. If there were concerns, a Health Visitor could then initiate the mental health pathway and also infant feeding support and join up with the midwifery service. The person would also be invited to sign up to an information sharing agreement and could be signposted to our Family Centres.

12. Are there instances where people could ‘slip through the net’?

Members were advised there are core contacts which are mandated which enables the service to see people at critical times and also in-between if appropriate. If someone is seen by another service e.g. a GP could refer someone into the service who had low mood. Visits would be made as appropriate and clients could either be e.g. referred to mental health services or have low level interventions in relation to mood if there was a long waiting list.

13. Regarding the 0-19 service; are there any ages where people tend to face more challenges or where the service has to focus, such as young children/teenagers?

The committee were advised the first year of a child’s life is the most important; as they are being set up for life, such as their bonds and early nutrition. It is also however about enabling children to be school-ready as well as at senior school to avoid risky behaviours and ensure they have good self-esteem.

The service advised that there has not been much work done with those aged 16-19 years, therefore this is something they are currently looking to improve.

14. Will resources be allocated to the more deprived areas within the borough?

The group were advised the cost of the transition was carefully managed and undertaken within the budget envelope. It was important for the service to protect the front-line which it continues to be committed to and has therefore reduced costs such as those for estates. The service is now in a strong position to consider its next steps. Staff across the borough are working to normalise support in parenthood.

15. Is there any use of the Third Sector or volunteers to deliver services?

Members were advised the service would like to consider a community parenting model which has been used in Derbyshire. Research has shown that service users are more accepting of delivery within the Third Sector. Community parenting has been done in some areas of our Borough, for example Home Start has worked. Also, peer support in infant feeding is already being utilised.

The Chair thanked all the witnesses for their attendance and helpful contribution, and declared this item closed.