Agenda and minutes

Apologies were received from Ms P Agar.

The Chairman wished to put on record his thanks to the outgoing Chairman Councillor Oborski for all her work in leading the Panel for the last 3½ years.  The Vice Chairman endorsed this and thanked Councillor Oborski for her very good leadership.

None.

Members of the public wishing to take part should notify the Head of Legal and Democratic Services in writing or by e-mail indicating the nature and content of their proposed participation no later than 9.00am on the working day before the meeting (in this case 12 November 2020).  Enquiries can be made through the telephone number/e-mail address below.

None.

(previously circulated)

The Minutes of the Meeting held on 15 October were agreed as a correct record and would be signed by the Chairman.

Attending for this item were:

Herefordshire and Worcestershire Health and Care NHS Trust

Sue Harris, Executive Director of Strategy and Partnerships

Sally-Anne Osborne, Associate Director for Children, Young People & Families

Louise Langston, Clinical Services Manager

Worcestershire County Council

John Smith, Cabinet Member with Responsibility for Health and Well-Being

Liz Altay, Public Health Consultant

Members were reminded that the Starting Well Partnership had previously been discussed by the Panel as the 0-19 Prevention and Early Intervention Service.  The tender for the new service had been awarded to the Herefordshire and Worcestershire Health and Care NHS Trust (HWHCT).  The service had launched on 1 April 2020 and from the start, the service had had to work in a different way, in light of the COVID pandemic.

Members received a presentation from the Clinical Service Manager, HWHCT.  The following main points were made:

·       Starting Well Plus was a service offering intensive home visiting to young mothers and families from other vulnerable groups.  A task and finish group had been established to review Starting Well Plus and improve the service going forward.

·       During the pandemic, face to face visits had been scaled back to only the most vulnerable.  Others were offered virtual contact, although some families were reluctant or unable to use this.

·       The pandemic had also had some positive consequences including the development of virtual breast feeding support and community support.

·       Members were told about the half term hampers which had been delivered to vulnerable families as part of the HENRY scheme which promoted healthy eating.

·       The families of children who had not re-engaged with school following the extended break due to COVID had been supported via a series of webinars for parents and young people provided by Parent Support Workers, School Health Nurses and CAMHS team members.

·       In response to the reduction in face to face contacts, the Health Visitor Telephone Advice Service had increased from one line to six.

·       The School Health Nurse Team was currently supporting the Worcestershire Local Outbreak Response Team (LORT).  School Health Nurses were also implementing the School Screener digital assessment system to gather information about pupils’ health in a Health Needs Assessment.

·       A working group of Early Years providers, Early Years Advisers and Health Visiting teams had been set up to pilot the development of an integrated two-year review with the aim of gathering a more complete, holistic picture of a child’s progress.

Members had the opportunity to ask questions and the following main points were raised:

·       In relation to the distribution of Henry half term hampers, a Member informed the Panel that he had funded cookery classes for families in his division, and it was important to ensure that suggested recipes were those that people were able to cook with the ingredients provided.  The half term hampers scheme was currently being evaluated and the effectiveness of the inclusion of recipes would be part of the evaluation.

·       In the light of the government’s recent decision to fund free school meals during the school holidays, a question  ...  view the full minutes text for item 461.

Attending for this item were:

Herefordshire and Worcestershire Health and Care NHS Trust

Sue Harris, Executive Director of Strategy and Partnerships

Sally-Anne Osborne, Associate Director for Children, Young People & Families

Stephanie Courts, Lead Children’s Nurse and Clinical Services Manager

NHS Herefordshire and Worcestershire Clinical Commissioning Group

Maria Hardy, Lead for Children and Maternity

Worcestershire Children First

Gabrielle Stacey, Assistant Director for SEND and Vulnerable Learners

By way of introduction, the Associate Director for Children, Young People and Families reminded Members that they had previously discussed the assessment pathway for children and young people who may have autism in September 2019.  The Clinical Commissioning Group (CCG) had supported the Trust by providing funding for the pathway as it was recognised that there were significant delays from referral to diagnosis.  There had been significant progress but further challenges remained and the service was not yet where it wanted to be.

The Panel received a presentation from the Lead Children’s Nurse and Clinical Services Manager (HWHCT).  In the course of the presentation, the following main points were raised:

·       Delays in Autism Spectrum Disorder (ASD) assessment had been a national and local challenge for some years.  The Pathway had been re-designed in 2017 with an expected maximum of 40 referrals per month in mind.  However, the level of referrals had varied between 40 and 100 per month causing significant delays.

·       Investment from the CCG had been received in 2019.  At that time, it had been very challenging to recruit staff with the right skills.  However, it was confirmed that all posts had now been filled.

·       The referral process had improved significantly since January, giving teams the right information in order to decide whether to proceed to an assessment.  Members were reminded that teams were required to involve both parents in the process even if they were no longer together and this sometimes presented challenges and could be a cause of delay.

·       In March all assessments for children on the pathway were halted following a Government directive that all non-essential services should be stopped due to the COVID pandemic.  Medical staff were redeployed to an acute setting and other staff were also redeployed to assist in the COVID effort.

·       Virtual assessments, in particular for teenagers, had been trialled.  Initially there were challenges with this approach but improvements were made and some assessments were still carried out virtually.

·       Staff who remained in the team were able to hold virtual multi-disciplinary meetings which had focused on planning and diagnostic discussions.  With reference to diagnostic discussions, the waiting time following assessment had reduced from 6 months to 4 to 6 weeks.

·       At the start of lockdown, an email account had been set up for families who wished to seek support and this had been accessed by over 100 families.  Web based training in emotional regulation had received more than 19,000 hits.

·       The Panel received information on numbers of children currently waiting for individual assessments.  Although waiting times for Speech and Language Therapy, Clinical Psychology, Occupational Therapy and Community  ...  view the full minutes text for item 462.

The Assistant Director, SEND and Vulnerable Learners, updated the Panel on the review of the delivery model for medical education provision ahead of the findings and proposals being discussed at Cabinet in February 2021.

The Panel received a presentation and the following main points were made:

·       The Service was now at a point where the findings of the review could be assessed and plans could be made for implementation of a new delivery model.

·       The cohort of children using the medical education service had changed over time and the service now saw more children with mental health difficulties.  Approximately 80% of children referred to the service had low mood or anxiety.

·       In June 2020 Cabinet had approved an extended timetable for the review as COVID-19 had made it difficult to engage with stakeholders especially families and health colleagues.  This engagement work had been completed in July 2020.  Task and finish groups were held in October to develop a series of proposals which were circulated to stakeholders and made public via a webinar.

·       The proposals would be considered by Cabinet in February 2021 by which time there would be a clear implementation plan.  There was further work to be done on financial modelling, legal implications and HR issues.

·       It had been important to include all stakeholders in the co-production process to ensure an authentic voice and early buy-in for the proposals.

·       Feedback from children and young people highlighted many positives about the current service.  Parents and carers appreciated the small nurturing environment and the flexibility in learning provision.  Parents also welcomed the support for how to meet their child’s needs.

·       Schools wanted to see a wider curriculum with both short and long-term provision which maintained continuity with the GCSE curriculum for older pupils.

·       Feedback from Medical Education staff included pragmatic questions, such as where the service would be located, continuity of staffing and the implication of Ofsted registration. 

·       Health colleagues recognised the changes in the cohort of children attending medical education provision and the need for a jointly commissioned approach to meet children’s welfare needs as well as their educational needs.  With reference to children with an autism diagnosis, it was recognised that there was a growing cohort who had high anxiety but were academically able, and the service would work with mainstream schools to develop mainstream autism bases to meet the needs of this cohort.

·       The proposed pathway was based on a preventative approach and recognised the input needed from the whole system.  It aimed to intervene early to prevent issues escalating allowing children to remain in mainstream provision.  It recognised that, for some children, there may be a need for a short period of recovery and rehabilitation in a safe environment with a focus on recovery and reintegration.

·       Interim interventions would see the creation of a Multi-Agency Assessment Panel to offer advice and guidance to schools.  At this stage it was accepted that some children may need a short period out of school at a registered base.  There may  ...  view the full minutes text for item 463.

The Panel was updated on performance information relating to Quarter 2 (July to September 2020), financial information for period 6 and emerging pressures and challenges for services ahead of setting the budget for 2021/22.

The Director of Children’s Services informed the Panel that she was very pleased and impressed with the performance data from WCF particularly at the time of the COVID pandemic.

Children’s Social Care

The Assistant Director, Family Front Door and Partnerships introduced the performance information for children’s social care and made the following main points:

·       The Family Front Door (FFD) had seen a significant increase in demand during this period.  On average, the FFD would see 800 referrals per month whereas this had increased to 1500 per month.

·       Although some of the referrals related to high risk concerns, there were also some that were classed as low risk, such as calls relating to breaches of COVID regulations.  Despite the rise in demand, the service had been able to respond with decisions made within 24 hours for 91% of calls.

·       91% of social work assessments had been carried out within timescales.

·       There had been a slight increase in the number of repeat social work assessments but this figure remained below England national levels.  This was to be expected given the increase in demand.

·       Challenges for the service related to an increase in domestic abuse and mental health concerns (of both adults and children).  There had also been an increase in concerns relating to physical health, disability and illness with COVID restrictions having had an impact on family support networks.

·       The number of looked after children had risen slightly from 822 last year to 834 this year.

·       96% of looked after children reviews had been completely within timescales and the service had kept in touch with 95% of care leavers.

·       There had been an increase in the number of children on child protection plans.  In part this was due to the fact that, in phase one of the COVID plan, it had not been felt appropriate to take children off plans at a time when families might be more in need of support.

·       Members were informed about a new project being undertaken with partner agencies in relation to safeguarding babies.  In particular, this project would look at babies born in 2020.  Work would start in December.

·       In relation to Children in Need, again these cases were not ‘stepped down’ during COVID leading to a slight inflation of the figures.

·       There had been a reduction in the number of missing children during this period, although some of this reduction could be due to COVID restrictions.

Members raised the following main points:

·       A Member wished to congratulate all staff who had been working throughout the pandemic.  She went on to express concern about the timeliness of missing from home return interviews.  In response, Members were informed that work had been done to understand this lack of engagement and it had shown that young people often did not see the point of  ...  view the full minutes text for item 464.

The Panel was presented with a joint report by Worcestershire County Council (WCC) and Worcestershire Children First (WCF) which had been submitted to the Department for Education (DfE) and set out details of progress made during WCF’s first year of operation.

The Director Children’s Services (who was also Chief Executive of WCF) reminded Members that the County Council was still under the direction of the DfE.  Part of that direction had been to set up an alternative delivery model and WCF had been launched on 1 October 2019.  The top priority had been to improve outcomes for children and Worcestershire remained the only local authority which had improved its children’s services prior to the alternative delivery company being set up.  Relationships between the County Council, WCF and partners were important in improving outcomes.

In summary, the first year had seen very good performance across the piece and the trajectory of improvement was upward even during the COVID pandemic.  The Director expressed her thanks to all staff involved and to scrutiny for its critical friend approach.

Members were given an opportunity to ask questions and the following main points were raised.  The Director of Children’s Services also confirmed that she was happy to answer any questions by email after the meeting if Members preferred.

·       A Member welcomed the excellent report.  It was confirmed that the good relationship between WCF and WCC had not happened by accident but was the result of good leadership and staff relationships.  The setting up of the company was a construct and, in reality, the same staff were working in the same way, in the same place and within the same legal framework.

·       The Director of Children’s Services was accountable to the County Council but was also a demanding customer in relation to WCC support services, such as legal, property and HR.

·       Another Member welcomed the report and praised staff for their achievement.  She went on to remind the Panel that some scrutiny Members had been sceptical about whether the Panel would get the same level of information and support from WCF, but she was able to report that this had not been the case.

·       In relation to the increase in contacts to the Family Front Door relating to domestic abuse, a question was asked about whether additional support and training would be provided for staff, both social workers and staff in schools.  In response, the Director of Children’s Services expressed concern about the ‘hidden harm’ agenda following the return to school in September.  She reminded the Panel that an increase in contacts did not necessarily mean that all referrals represented children at significant risk of harm.  However, the volume of contacts meant that it was more difficult to identify those cases.

·       The Panel was reminded that the workforce at the Family Front Door was made up of experienced and permanent members of staff who were able to deal with the volume of referrals.  Work had been undertaken to look at hidden harm areas such as county  ...  view the full minutes text for item 465.

The Panel reviewed its 2020/21 work programme and considered whether any action was required in relation to previous agenda items.

Update on 0-19 Starting Well Partnership (item 5)

It was agreed that:

·         When evaluating the Henry half term hampers scheme, thought should be given to whether families had the necessary cooking skills in relation to the recipes provided.

·         In the light of the recent Government announcement that funding would be provided for provision of Free School Meals in school holidays, care should be taken to ensure coordination between different agencies to provide a joined-up response.

·         Further thought should be given to developing effective methods of evaluation of community projects in a joined-up way.

·         It was agreed that the number of Henry hampers provided in October half term would be provided to the Panel.

·         The Panel wished to encourage further Quality Assurance modelling and would welcome further details on WCC’s quarterly performance monitoring processes.

The Panel wished to receive a further update in 12 months.

Update on the Assessment Pathway for Children and Young People who may have Autism (Item 6)

Although the Panel acknowledged the significant progress made, they were still very concerned about the length of waiting times from referral to diagnosis, and the impact on families.

It was agreed that the Panel would wish to see any available benchmark data about waiting times in other comparable authorities and would welcome further information on how the Service recruited and retained staff, including any incentives/benefits provided.

The Panel wished to receive a further update in 12 months.

Review of Delivery Model for Medical Education Provision Findings (Item 7)

The Panel would receive a further update at its 29 January meeting ahead of discussion at Cabinet in February.

Performance, In-Year Budget Monitoring and 2021/22 Budget Scrutiny (Item 8)

It was agreed that the Chairman would report back to OSPB in relation to emerging budget pressures, in particular on home to school transport and placements for looked after children.

The Scrutiny Team would update the Panel’s work programme in the light of these discussions.