Agenda item

Ansaf Azhar (Director of Public Health, Oxfordshire County Council) and Emma Leaver (Chief Operating Officer- Community Health Services, Dentistry & Primary Care, Oxford Health NHSFT) have been invited to present a report on Health Visitor Services in Oxfordshire.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

Donna Husband (Head of Public Health Programmes – Start Well – Public Health, Oxfordshire County Council); Mark Chambers (Head of Children’s Community Services Community Health Services, Dentistry and Primary Care Directorate | Oxford Health NHS Foundation Trust); Emma Leaver (Chief Operating Officer for Community Health Services, Dentistry & Primary Care, Oxford Health NHS Foundation Trust); and Taylor Nicola (Senior Clinical Lead for Public Health) were invited to present a report on Health Visitor Services in Oxfordshire.

Officers outlined the extent of organisational change following the establishment of the integrated 0–19 Children’s Community Public Health Service, which had brought together health visiting, school nursing, and related services within locality‑based teams operating under a single point of access. This model had been informed by learning from the COVID‑19 period, evidence on widening inequalities across Oxfordshire, and the County’s commitment to the Marmot principles.

Members questioned reported performance against mandated contacts, particularly delayed new birth and early years reviews, and sought clarity on how such delays arose and how risks were mitigated. The statutory window for new birth visits was extremely narrow and that apparent “misses” often reflected legitimate clinical and social circumstances, including prolonged hospital stays, overlapping midwifery involvement, parental choice to stay with family out of county, or non‑attendance at clinic appointments.

Officers stressed that recorded performance metrics did not fully reflect the extent of follow‑up activity undertaken by teams. Examples were provided of families who had initially failed to attend scheduled appointments but were subsequently followed up through home visits, enabling practitioners to assess both the child and the home environment. The Committee was reassured that delayed contacts did not equate to withdrawal of support and that persistence, professional curiosity, and escalation were embedded in practice.

Members expressed concern that families who did not engage might be those most at risk, particularly in more deprived or vulnerable circumstances. Officers described clear escalation policies, including structured records review, checks against GP and safeguarding databases, and liaison with other universal and specialist services. Health visitors did not work in isolation but as part of multidisciplinary arrangements designed to ensure that no child became “invisible” to services.

The Committee explored arrangements for transition from maternity to health visiting care. Officers described close operational integration with midwifery services, including daily birth notifications, shared vulnerability scoring, and regular local and strategic meetings. The introduction of improved digital systems was noted to have strengthened information flow, although challenges remained around county borders, private births, and families moving shortly after delivery.

Members were advised that vulnerability assessments were dynamic rather than static and were reviewed throughout the antenatal and early postnatal period, enabling proactive targeting of additional support where risk increased. Officers clarified that reported data focused on face‑to‑face contacts, even where telephone contact or hospital‑based engagement had occurred, creating a risk that activity was under‑represented in headline figures.

Members referred to sections of the report describing increasing acuity, safeguarding activity, and complexity within caseloads, and questioned how this was reflected in staffing models. Officers explained that locality team sizes were intentionally uneven, weighted for deprivation, vulnerability, geography, and travel time, rather than population size alone. The service delivered a very high volume of mandated contacts each month across the county and that workforce modelling had been explicitly designed to protect universal provision while enabling targeted intervention.

Officers advised that a comprehensive demand‑and‑capacity review was underway, including a time‑and‑motion study to reassess whether assumptions made at the start of the contract remained valid. The Committee welcomed the dynamic nature of this approach but emphasised the need for continued assurance that safeguarding demands were not crowding out preventative activity.

Members returned repeatedly to the balance between statutory safeguarding responsibilities and universal preventative work. Officers described the use of a skill‑mixed workforce, with clinic‑based provision supporting efficient universal delivery and enabling health visitors to focus on more complex cases. The integrated 0–19 model was cited as enabling a more coherent lead professional role for families with children of different ages, reducing duplication and hand‑offs between services.

Members explored the principle of continuity in detail, including references in the report to visits being delayed to preserve continuity with the same practitioner. Officers explained that continuity was valued by families, supported trust, and enhanced safeguarding judgement by allowing practitioners to recognise changes over time. This approach could affect reported performance against strict timeframes, but officers argued that clinical value outweighed the marginal impact on metrics.

The Committee welcomed the extension of health visiting involvement beyond age five for families with ongoing needs, describing this as a significant development that helped bridge the gap between early years and school‑age services. Members noted the introduction of additional pre‑school reviews and their relevance to school readiness.

Members raised concerns about food insecurity, temporary accommodation, and material deprivation affecting families with babies and young children. Officers described how such issues were escalated through appropriate channels and addressed in partnership with housing, voluntary sector, and other statutory services. Health visitors acted as system-navigators and advocates rather than sole problem‑solvers.

The Committee explored links to the Best Start in Life programme, Family Hubs development, and Marmot priorities, and was assured that Health Visitor Services were a core component of whole‑system planning for early years outcomes.

The discussion also covered immunisation uptake, infant feeding, breastfeeding, obesity prevention, screen time, and speech and language development. Officers described an extensive health promotion offer, including local groups, digital support through ChatHealth, infant feeding hubs, and enhanced feeding support. The Committee welcomed evidence of improved breastfeeding continuation rates and the proactive sharing of safeguarding intelligence arising from hospital data to inform age‑appropriate prevention messaging.

Members questioned the robustness of digital systems and data integration, particularly following previous cyber incidents affecting NHS organisations. Officers outlined strengthened cyber security standards, business continuity planning, and the benefits of alignment with GP clinical systems. While acknowledging that data consistency across the system remained a work in progress, the Committee welcomed progress toward more integrated intelligence to support early identification of need.

The Committee noted the scale of transformation undertaken by the service, the complexity of current demand, and the central role of health visiting in prevention, safeguarding, and early years outcomes.

The Committee AGREED to issue the following recommendations subject to any necessary amendments required by the Chair and Health Scrutiny Officer offline:

1. That health visitors are integrated into whole system planning in the community. It is recommended for integration of HV services within Best Start in Life, with improvements to information to babies, children and families.

2. For Health visitor services to continue to focus away from crisis management to core health functions including addressing the impacts of health inequalities on families.

3. For Health visitor services to continue to work on promoting specific issues such as health immunisation uptake and breastfeeding.

4. For there to be an assessment/review of workforce capacity; to ensure safe management of caseloads and to provide essential early intervention for families.

5. To continue to prioritise continuity of the Health Visitors visiting families as well as the Four Year Visits.