Agenda item

The Cabinet Members with Responsibility for Health and Well-Being, and Children and Families, the Interim Director of Public Health and the Strategic Commissioner (Early Help and Partnerships) had been invited to the meeting to discuss the development of the new 0-19 integrated prevention service for children, young people and families (Starting Well Service) and feedback from the recent consultation on the use of Children's Centre buildings.

By way of introduction, the Interim Director of Public Health and the Strategic Commissioner (Early Help and Partnerships) made the following points:

·       The tender specification was currently on the County Council's tender portal and was open for people to make bids to run the service.  The specification (which had been included in the agenda papers) included a great deal of technical detail.

·       The new service would roll together areas of spend that had previously been commissioned separately to create an integrated service with a better skill mix, providing a strong universal offer, including childhood checks, identifying those who might need more support and help.

·       Concerns had been expressed that the previous service may not always have reached those who were most in need.

·       A factual summary outlining the results of the consultation on the use of Children's Centre buildings had also been included in the agenda papers.

·       The next stage would be to hold further discussions with those respondents who had suggested alternative ideas for using Children's Centres.

·       The extent to which the Starting Well service would make use of Children's Centre buildings would not be clear until all of the tenders had been evaluated.

Members were given an opportunity to ask questions.  The following main points were raised:

·       Although the services to be provided were outlined in the specification, it was not yet clear what additional services providers might choose to offer.  The full range of services to be provided would not be clear until the tenders were received.

·       It was confirmed that focus groups had been held to establish what services people currently liked.  Formal consultation on any service reduction would be held at the next stage.

·       Members were informed that service improvement was a strong driver behind the changes as a result of the evidence provided by the Early Help Needs Assessment (EHNA).  The EHNA would have been completed even if the Council was not facing budget reductions.  However, financial reductions were also a driver in the service re-design.

·       The total budget for the new service was £9.8 million.  It was difficult to say how this compared with previous spend on these services, as budgets that were previously separate were now being integrated.  However, it was estimated that this figure represented a reduction of 12.5%.  Members were reminded that this information had been included in the Council's medium term financial plan.

·       Paragraph 1.2.3 of the service specification stated that there was good evidence for the cost effectiveness of prevention and early intervention programmes, which could be shown to save money in the longer term.  It was suggested that it was odd to reduce spending in an area that showed such value for money and could save the Council money further down the line.  In response, although it was acknowledged that prevention was better than cure, these potential savings could not easily be shown as cashable savings.

·       The detail of how the service would be delivered would not be known until the tenders were received.  The tender process asked those who were interested in bidding to tell the Council their plans.  The specification was clear that the Council would not hold potential providers to using the existing buildings.  It would be for the incoming provider to decide how many buildings it wanted to use and for what purpose.  Once it was clear what the Starting Well service would look like, it would then be possible to assess the impact on the use of buildings in local communities.  If there was to be a significant impact on a local community, further consultation would be held from June onwards.  The Cabinet Member confirmed that local members would be included in any consultation.

·       Figures on the County Council's capital investment in Children's Centre buildings were not available at the meeting but the Strategic Commissioner (Early Help and Partnerships) agreed to provide these after the meeting.

·       With reference to Wyre Forest it was suggested that, if the current provider of services at Children's Centres was not part of the preferred bidder for Starting Well, and the successful bidder did not want to use the current Children's Centre buildings, this could mean that those services would have to stop.

·       It was confirmed that the service would be run on a 'prime provider' or consortium model, with a common core across the County together with a tailored local offering.  The service would be commissioned through one contract rather than the 6 separate contracts that currently existed.

·       The specification had asked for an easily accessible service, although the details of this would depend on who the successful bidder was.  It would include a virtual front door providing advice and guidance, as well as telephone access.  Access may also be developed through the use of apps, and 'talking heads' (ie Skype).  There would not be one route for all – service users would be able to use different routes and media to access services.

·       There was a need to acknowledge that the service provided would be the one that the Council could afford.  Extensive face to face advice was good to have but evidence suggested that this was not always the best approach for families.  It may be more effective and empowering to encourage self-sufficiency through peer to peer support, community parenting and helpers or buddies.

·       Members were reminded that the consultation had been with people who currently used the Children's Centres.  Therefore it was not surprising that they wanted services to continue.

·       Concern was expressed about the reliance on volunteers.  It was recognised that the training of volunteers would be important.

·       It was confirmed that health assessments for looked after children would be part of the Starting Well service.  Subject to data sharing legislation, it was suggested that performance information on services in relation to looked after children should be shared with the Corporate Parenting Board.

·       A question was asked about services for children over the age of 5, as there appeared to be a heavy emphasis in the specification on 0-5s.  In response, it was confirmed that the exact nature of services to be provided would only be clear once bids were received.  Members were reminded that schools also had a role in this area, in particular in relation to pupil premium funds.  Further work would be carried out, including the development of a service directory for young people and online resources for teachers.  Concern was expressed at the suggestion that schools may be asked to use some of their already stretched budgets to support this work.

·       In response to a question about the future capacity of the service given the number of houses to be built in Worcestershire in coming years, it was confirmed that the results of the Early Help Needs Assessment, including information on projected demographics, had been shared with potential bidders.  In relation to future demand management, it was acknowledged that there was further work to do to better understand the implications of demographic growth and what the Council's response would be.

·       It was confirmed that special schools were not within the scope of the Starting Well service.  Mainstream school nursing was included in the scope, but there was a separate school nursing service for special schools which was commissioned using health money.

·       Concern was expressed about access to the service for those living near the County's borders.  It was confirmed that the service was for those resident in Worcestershire, but that some services provided in schools would be for those attending school in Worcestershire.  This would be an issue for the service providers to work through in due course.

·       It was confirmed that those attending free schools would have access to the service.  It was acknowledged that there was an issue in relation to access to services for children who were educated at home.

·       The issue of children educated in non-registered schools was raised.  The Interim Director of Children's Services confirmed that this was an issue that Ofsted was very conscious of.  Ofsted had asked local authorities to take legal action to close down all un-registered schools.

·       It was confirmed that national tools would be used to identify when intervention was needed.  From a safeguarding perspective, there was also threshold guidance from social care.

·       It was confirmed that the service provider would be asked to target areas of deprivation, something that would be emphasised in regular monitoring meetings.  Data showed that poor performance in relation to school readiness, childhood obesity, young people and alcohol, hospital admissions and teenage pregnancies was concentrated in areas of disadvantage.  The countywide picture was in line with national averages but, by looking at district data, health inequalities were clearer.

·       It was confirmed that the results of the consultation on the use of Children's Centre buildings had been included in the tender pack.  However, there had been a need for caution on the level of detail included, as feedback was anonymous and some responses may have included identifying information.

·       It was confirmed that the consultation had aimed to generate ideas on the future use of the buildings and it was felt that local members (rather than the scrutiny panel) were best placed to do this, using their local knowledge.  The Cabinet Member for Health and Well-Being confirmed that he would take advice from Democratic Services on the involvement of the scrutiny panel in future consultations.

·       A member of the Panel reported that two people had told him that they had been unable to complete the online consultation document as they were not parents of relevant aged children.  Officers had not previously heard of this issue and confirmed that respondents did not need to be a parent in order to complete the form.  Members were informed that significant testing of the online document had been carried out.  The Strategic Commissioner (Early Help and Partnerships) agreed to look into the specific examples further.

·       It was confirmed that no County Council staff would be made redundant as a result of service change as all of these services were already delivered through external providers.

·       The contract for the Starting Well service would run for 5 years with a break clause included.  Oversight would be through a matrix management approach, led by public health but including children's services and NHS colleagues.  The budget would sit within public health.

·       Performance information would be reported via the KPIs included in the tender pack.  It was agreed that the scrutiny panel would wish to see these KPIs annually.

·       Although it was acknowledged that this was a challenging tender, market engagement had identified interest from in the region of 40 people.

·       In response to a question about why the launch of the tender had been delayed, Members were reminded that this was a very complex piece of work and it was important to get it right.  It was suggested that the original timetable had been over-ambitious and it was important to delay slightly in order to get the specification absolutely clear.  It was confirmed that some space had been built into the timetable and the time allowed for bidders to complete their bids remained the same.

·       It was difficult to say how bidders would react to potential public concern about the possible closure of a Children's Centre.  This was currently hypothetical and further risk assessments would be carried out once the tender evaluation was completed in June.

·       It was suggested that, although there would be no local authority redundancies, there remained potential for communities to be upset if local Children's Centre staff lost their jobs.

·       Given the very complex nature of the service, a question was asked about alternative plans should no suitable bidders respond.  The Cabinet Member for Health and Well-Being said that this remained hypothetical at this stage.  It was confirmed that relations with current providers remained good and they would continue to provide services outside of the Starting Well service.

·       It was agreed that the Scrutiny Panel would wish to receive a report on the Stronger Families programme as soon as possible.

·       Members were informed that the proposed inspection regime for Children's Centres had been put on hold.  Latest news was that there would be a consultation held in the summer.

·       It was confirmed that, although there would be links with the Starting Well service, positive activities would remain a separately commissioned service.  An update on this would be brought to the Overview and Scrutiny Panel shortly.

·       Concern was expressed that in November Cabinet had resolved that:

authority to approve the final specification, tendering and contractual decisions and future use of buildings for such an integrated prevention service be delegated to the Director of Adult Services and Health in consultation with the Director of Children's Services and the Cabinet Members with Responsibility for Children and Families and Health and Well-Being.

·       It was felt that these decisions should be brought back to Cabinet for agreement rather than being made under delegated authority, especially given the fact that there may be two new Directors in post by the time decisions are made.

The Panel agreed that:

·       It would wish to receive a further report on the Starting Well service once the tender had been awarded in June; and

·       It would wish to recommend to the Leader of the Council that decisions on the Starting Well service be made at Cabinet rather than through delegated authority.

It was also agreed that:

·       The Panel would receive an update on the Stronger Families programme as soon as possible; and

·       An update on Positive Activities would be brought to a future Panel meeting.