Agenda item

Maria Hardy, the NHS Children, Young People and Maternity Lead, explained that the NHS worked in tandem with the Children and Young People’s Strategic Partnership, and gave an update on the health related work which was happening.

The NHS Long Term Plan had some clear expectations to improve the health and wellbeing of children in response to the particular areas of diabetes, epilepsy, infant mortality, childhood obesity, urgent and emergency care and asthma. These were all areas which posed significant challenge across the UK. Locally two additional priorities had been added, which were Children with SEND, and mental and emotional good health and wellbeing. Two priorities reflected in the work of the CYPSP and Worcestershire Executive Committee (WEC) were infant mortality and child obesity.

The work around child obesity was highlighted. Worcestershire Children were in a slightly better position compared to the national average, although there was a slight data gap due to COVID. Nationally the trend was that children were getting heavier and more unhealthy. A one-year pilot, starting in early spring, The Family Coaching Service, would work with around 100 families (80% of which will be within Index of Multiple Deprivation 1 and 2 population). At the check for two and half year olds they would be offered additional support and get the opportunity to be paired with a trained buddy to look at their lifestyle choices. There would be a whole family approach to help them be healthy, well, and active. Health visitors would make the initial contact and then a dedicated Family Coaching team would provide support.

When asked about what could be done about vulnerable families who do not accept or welcome help, it was agreed that there was not a straightforward answer. Efforts would be taken to ensure the approach to the family was by someone who already had a trusted relationship with the family. As the pilot progressed, feedback would be sought from the families who were involved about the best methods of communication.

It was clarified that the focus was on prevention, so work was starting pre-pregnancy, to help Mothers maintain a healthy weight.

There was a concern from the Board that even if the pilot with 100 families was successful, whether it would be possible to scale up the work to cover the whole county. It was explained that there were opportunities to build mentoring into the existing workforce who already had a relationship with families in need. A whole system approach was needed, where this was just one element. within an entire obesity strategy. It was also explained that often a small number of the population could take up a proportionally larger share of resources, so if a small number of vulnerable families were targeted the results could be significant. It was queried whether it would make sense to base the pilot within one District.

It was clarified that an equality and diversity impact assessment had been carried out for individual projects even though it was not recorded specifically to do with this report.

The Board felt that some of the waiting times for young people’s services were shocking and there was no mention of the resources, either funding, staffing or training, that would be needed to improve the waiting times. It was acknowledged that there were currently significant challenges facing the children’s community health services in Worcestershire. There had been a tremendous increase in demand post COVID. It was unclear whether the increase in demand would continue or be time limited. The challenges faced by the Health and Care Trust had been shared with the CYPSP. It was explained that the clinical prioritisation framework meant that those children with the most complex needs were seen first, but the data did not reflect that. Also, the electronic patient record system had not been available since August due to a national cyber-attack.

Reassurance was given that there was an improvement plan and mitigation in place around clinical prioritisation, and recruitment was underway to increase capacity, but there was not a quick solution as it was proving difficult to recruit health professionals. It was confirmed that the Children’s Transformation programme was a high priority for the Health and Care Trust, led by led by an Executive Directors with Phase 2 starting in January 2023. Children with the highest needs were being prioritised and work was being carried out with partners.

It was clarified that priorities from a social care point of view were being considered as well as the clinical priorities, but Children with Education, Health and Care Plans were getting stuck in a backlog both in terms of assessments and for the provision of services following assessment. Parallel planning was on-going, looking at what can be done for children straight away while at the same time working on longer term improvements to the system. It was felt to be positive that the clinical priorities as well as the social care priorities were being considered and it would be interesting to see how working together would impact the lives of children.

Following a request for more context around the figures, such as what were the wait times pre pandemic and how long children had to wait for follow up appointments, it was stated that the challenge was greater now than it ever had been. Each service was feeling pressure with the number of referrals and level of demand. The NHS was concerned about access to Children’s community health care services. Different approaches were being brought in such as earlier intervention, professional developments, expanding the workforce, looking at the effectiveness of the current referral pathways and what was that the most effective way to meet need.

The Chair requested that WEC provide a report to the HWB around childhood therapies, accessibility and treatment plans.

RESOLVED that the Health and Wellbeing Board:

a)     Noted the development and delivery of the NHS Long Term Plan ;

b)     Noted the risk in service delivery raised by the Herefordshire & Worcestershire Health & Care NHS Trust [HWHCT]; and

c)     Noted the action being taken to offset the risk and support delivery of the NHS Long Term Plan