Agenda item

10:20

This item covers the following (JHO6):

·         the impact of changes to children’s centres on provision of health visiting service;

·         scrutiny of the newly commissioned service for 0 – 5 years health visiting services;

·         the impact of school health nurses in secondary schools and future service plans;

·         the recommissioned services.

The Committee welcomed the following representatives from the Health Visitor and School Nursing services in Public Health, OCC:

Val Messenger – Deputy Director of Public Health

Donna Husband – Lead Commissioner,

Emma Leaver – Service Director

Pauline Nicklin – Head of Service

Nicky Taylor – Operational Manager, Health Visiting

Angela Smith – Operational Manager, Health Visiting

Helen Lambourne – Family Nurse Partnership Supervisor

Margaret Fallon – Operational Manager, School Health Nursing

Each presented their part in a series of slides as attached to the Agenda at JHO6.

Questions asked by members of the Committee, and responses received, were as follows:

-       How is performance measured? -  There are key performance indicators included in the contracts, performance of which is managed by Health and the Performance Scrutiny Committee, OCC. There is a Public Health Outcomes Framework which is broken down into various categories. Sometimes the issues are hard to link to a specific activity and therefore not in contract management;

-       How are inequalities tackled? -  Equal access to all is offered, the service adapts to the needs of individuals, for example, health visitors offer the service where it is most suitable and convenient for the user and it offers a delivery of the service in the home itself, particularly in rural areas. It also uses interpreters where needed;

-       Where are the nine centres for Health Visitors located? -  the county is divided into 9 localities and within each there are 7 teams. For example, West Oxfordshire has teams in central Witney, Carterton and Chipping Norton. Additional services are also provided in Charlbury;

-       How do Health Visitors connect with people? – They establish good therapeutic relationships with people early, in order for relationships to be built. For example, if there are concerns regarding a person’s mental health during their ante-natal period, the health visitor may do the liaison work and carry out joint visiting with other professional to assist that person in their transition to another service;

-       How does the service support children with a fluidity of gender? -  The service is experiencing a growing need in this sphere and it has trained nurses to both help the children and also to assist teachers with how to respond to it;

-       What about the people that are not being seen – 73% of mothers attend antenatal classes, but what about the other 27%? – The service is offered to all people working with midwives. Some mothers feel that they do not require the service and there is an element of choice in that. There is a system in place for health visitors to work with midwives to identify those mothers they are most concerned about and they do endeavour to track them down. There is also contact with primary care colleagues. Thus, included within the 73% of antenatal contacts are some for whom there is some concern;

-       Up to 63% of women breastfeed their babies until they are 6 weeks old. Compared to other countries this is low – how can numbers be raised, given that many mothers are returning to work earlier? -  If one compares Oxfordshire with the national figure (47%), Oxfordshire is exceeding this. Those mothers who are still feeding at 6 weeks tend to continue until 6 months (6 - 8 weeks statistics includes combination and exclusive feeding). Work is ongoing with employers to encourage them to provide the right facilities to enable mothers to continue doing so. The Oxfordshire Midwifery Team is also supporting baby-friendly initiatives. The Committee requested a break-down of the statistics in order to ascertain how many mothers were exclusively breastfeeding rather than combination feeding;

-       A member asked if there was a set of national standards and any external accreditation where assessors could talk to the mothers?  -  there is very little evidence of health promotion as it is not possible to do randomised control trials. The tendency is to work with the users themselves to ensure that any messages go out. The service does its best to evaluate this to ensure that groups are targeted. It is also ensured that clients are directed to accredited websites for information;

-       A committee member pointed out that there was no mention of drugs and alcohol education included within the work the school health nurses carried out in schools? – It is better to glean this kind of knowledge when working on a one to one basis with the child. OCC’s Drugs and Alcohol Team work closely with schools and delivered training to school nurses;

-       What is the difference between school health nurse support workers and school health nurse assistants? Is there a difference in where they are being used? – SHN assistants is a new support role, at NHS/Agenda for change a band 3 support worker is responsible for height and weight measuring, for example – and they do not do any follow up on the results. They will also lead on the health education side. School Health nurses are a band 5, and qualified School Health Nurses are qualified nurses with enhanced training;

-       What is the strength of partnership with Children’s Social Care? – There is a very good relationship with social care colleagues, at all levels. Health Visitors and School Health Nurses have a separate but very clear role and work very closely with Children’s social workers, both at leadership team level and with social workers on the ground. Looked After Children (LAC) are top priority - and school nurses know who the vulnerable children were. Social workers are also linked with schools;

-       If a child suffered from, for example, epilepsy, how were transitions dealt with?  - whose role was it to lead with the Education Health Plan?  - Multi-professional teams worked around the family and the child is tracked and monitored, so that the child can achieve its aspirations. All LAC Children have compulsory, six monthly assessments completed on them.  The school health nurses hand over to secondary school nurses on transition. Strong links are forged with specialist nurses (with epilepsy/allergy clinics, for example) and with OUH, in order to ensure a close working relationship between all nurses. SEND holds all to account and provides a link and knowledge base;

-       The Committee asked if there was anything the Committee could assist with in respect of supporting the continuation of funding for the training of school health nurses? – Health Education England allows the organisations to train. Notification has been received that 15 School Health Nurses and Health Visitors can be put forward for training but it is not sure if it would be possible to do the same next year. The service was moving to an apprenticeship model for Health Visitors from 2020.  Good staff were being developed in Oxfordshire and innovative work was in train to keep staff developed. The Committee will be approached for assistance in maintaining the movement forward with the apprenticeship model for 2020 if needed;

-       How does cross – border work take place over the borders? – This is an ongoing challenge. If a client is seen in Henley, they are seen by Berkshire midwives. Regular meetings take place between midwives in different counties every 6-8 weeks to ensure that each is aware of who they are working with, regardless of borders. There are also links with GP colleagues over the borders. Birth notifications come via the Child Health Information Service to ensure knowledge of babies from birth;

-       Mental health and children is a priority area nationally with concerns that children waiting for the Child & Adolescent Mental Health Service (CAMHS) is nowhere near target. What are the issues causing it? Is there anything you would put into your services to assist the process, if you had the finances with which to do it? – Mental wellbeing is a real issue and the system is currently looking at a Public Health England Prevention Concordat in a bid to make mental health a priority. A bid has been submitted to provide additional capacity to support school health nurses in their ability to intervene and give them access to CAMHS. Early anxiety and distress amongst younger children, leading to behavioural issues; and emotional distress amongst teenagers, is a big issue.  There is currently work taking place looking at the impact of social media on children and young people. If money was not a problem then there would be a wish to put it into work around resilience amongst primary school children. The Kingfisher Team (CSE) was currently working with primary school teachers to educate them. Parents had a significant role to play in providing their children with protection and resilience to problems encountered with social media and more study in relation to this role could be undertaken.

Councillor Hilary Hibbert-Biles concluded the discussion by pointing out her view that the Family Nurse Practitioners service should be expanded because it did a very good job. In addition, since the School Health Nurses and Health Visitors service had come into the local authority, some good work had taken place and continued to take place. 

The Chairman thanked all for their attendance and for an excellent presentation.

It was AGREED: to

(a)  request the information documented above in relation to target/performance measures for breastfeeding;

(b)  refer the issue of where the division lies between scrutiny of health services in HOSC and in OCC’s Performance scrutiny to ensure that effective scrutiny is taking place on both sides; and

(c)  request service officers to let the Committee know if there was anything the Committee could do to help in furthering any requirements needed in the service, as documented above.