Agenda item

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

Sue Hetherington, Clinical Project Manager

Worcestershire County Council

Karen May, Cabinet Member with Responsibility for Health and Well-Being

Dr Kathryn Cobain, Director of Public Health

Liz Altay, Public Health Consultant

Worcestershire Children First

Sarah Wilkins, Director for Education and Early Help

The Chairman welcomed representatives from the Herefordshire and Worcestershire Health and Care NHS Trust to the meeting to provide an update on the latest developments in relation to 0-19 Prevention and Early Intervention Service (Starting Well).

The Cabinet Member for Health and Well-being reported that a meeting had recently taken place with Dame Andrea Leadsom focusing on the importance of enhancing and enabling positive outcomes for 0–2-year-olds via the use of family hubs. She advised that new funding had recently been announced by the Department of Education to support the continued development of this programme.

The Public Health Consultant reminded the Panel of the background to the establishment of the Starting Well service, which had commenced in April 2020. With the restrictions of COVID-19, the implementation of the service had taken longer than planned as there had been the need to adapt and flex to deliver the services differently. An interim report was presented to the Panel in November 2020 and since then robust recovery plans continued to be implemented across the whole partnership.

The Clinical Project Manager led the meeting through a presentation providing an overview of the Starting Well Service including:

·         The broad composition of the Starting Well teams in each District area which were led by a Public Health Nurse Team Leader alongside a Community and Parenting Manager.

·         The flexible and proactive approach to the delivery of services during the pandemic to ensure that need continued to be met.

·         Working with partners to support the needs of each district, as outlined in their district profile, and linked to health outcomes.

·         The development of the Starting Well website which parents could use to self-refer and which included links to other relevant agencies offering support.

·         The Healthy Child Programme which used evidence-based assessments to determine health, well-being, and development of a child, following which appropriate support was delivered through universal services, overseen by specialist public health nurses.

·         The importance of partnership working with Action for Children, Barnardo’s and Redditch Borough Council which provided shared expertise to enhance the service able to be offered to families. Details were provided of initiatives aimed at young people who identified as transgender, offering them and their parents effective means of communication and support networks.

·         The delivery of health visiting services during the pandemic had largely been via virtual platforms but was also backed up by the telephone advisory service and bookable appointments at the family hub. Face to face contacts were now increasing and were once again the usual way of engaging with families. Having listened to feedback from service users, however, a blended approach would continue to be offered, so that there would still be some virtual sessions provided, such as breastfeeding support.

·         The provision of school nursing continued during the pandemic with safeguarding and health assessment work and initiatives to support children and young people such as ChatHealth and the Back-to-School project.

·         Key challenges faced for service implementation during the year including a critical shortage of specialist public health nurses, a reduced access to children within schools and a reduction in 2-year-olds taking up nursery provision.

·         The next steps for the year ahead included embedding the school screener for school aged children and an intensive home visiting programme for young and vulnerable parents.

The Director of Public Health thanked her health colleagues for the provision of the Starting Well service during the last year and also for all their help with the overall response to COVID-19. The Chairman added his appreciation for the service provided.

Members of the Panel were invited to ask questions on the presentation received and the following main points were raised:

·         Referring to the volunteers and peer supporters who support the Starting Well Team, assurance was sought that, with the impact of the pandemic, there was still sufficient numbers available to assist where needed. The Associate Director confirmed that during the height of the pandemic it had been challenging with many volunteers being unavailable, however the situation was now that many of that number had returned and also that new volunteers were being recruited.

·         In response to a follow up question on the recruitment process for volunteers, the Panel was informed that some volunteers came forward through informal means or were ex-service users whereas others responded to external advertising. There was a formal volunteer recruitment process in place for all prospective volunteers to ensure suitability for the role.

·         The return to face-to-face home visits was raised and the Associate Director advised that all new births would receive a face-to-face visit, but that for some areas, they would also be offering a blended approach. The Executive Director highlighted that some families preferred different formats and that some young people were engaging with the service as a result of the virtual platforms, when they previously hadn’t done so.

·         In respect of partnerships, the importance of attracting additional expertise into the County was crucial.  It was clarified that Action for Children led on the transgender initiatives, Trancakes and Safe Space which were available to all young people county-wide. Barnardo’s were the lead partner for the Henry programme which included as part of their ‘growing up’ programme, identifying emotional need and resilience building.

·         Further detail was sought on the shortage of staff previously referred to. The Associate Director advised that whilst there had been a significant number of school nurse vacancies, recent recruitment had proved successful, with only one vacancy now remaining. She added that the Clinical Project Manager had been moved into her role to ensure that there was a robust induction process and supportive environment for the new staff.

·         The low uptake of free childcare for 2-year-olds was raised as a concern and whether there was a current lack of use of early years providers in general? The Associate Director confirmed that the pandemic had contributed to the low uptake levels. The Director for Education and Early Help advised that prior to the pandemic, take up of these free places was at about 70%, slightly higher than the national average. Whilst there had been a significant reduction in take-up in 2020, there hadn’t been a major reduction in children accessing childcare overall. She advised that there was a current drive to ensure families were aware of the childcare options available to them. The importance of targeting first-time parents was essential to avoid developmental milestones not being reached.  It was clarified that the free funding for 2-year-olds was dependent on income, whilst for 3 and 4-year-olds, there was allocated free provision for all.

·         The approach to managing childhood obesity was raised. The Clinical Project Manager explained the child measurement programme that was in place and advised how results were followed up with parents/carers and health partners as appropriate. The personal approach by the family information service engaging with families was used as a proactive way forward to make progress on this issue. The Director also highlighted that promotional work via early years providers was also a helpful method of ensuring key messages reached the target audience.