The Directors of Public Health, and Children, Families and Communities had been invited to the meeting to brief Members on the latest developments in relation to the 0-19 Prevention and Early Intervention Service.
The Director of Public Health welcomed the Panel’s interest and informed Members that this was a time-critical moment in the tendering process, meaning she would be to some extent limited on the information she could share. She went on to provide the Panel with a presentation, including slides which had been shown to potential bidders. In the course of the presentation and resulting discussion, the following main points were raised:
· It was confirmed that the service would remain within the Directorate of Public Health and would not transfer to Worcestershire Children First.
· As part of the tendering process a ‘competitive dialogue’ would be held with potential bidder(s) to clarify the details of required outcomes. Until this process was complete, the final shape of the service would not be known. It was confirmed that more than one bid had been received.
· To set the context, Members were reminded that this was a service for the whole population.
· It was suggested that the estimate provided in the presentation that 36% of the 0-19 population were vulnerable, seemed high. In response, it was confirmed that this was a national assumption based on national data. The Local Authority did not have exact figures for Worcestershire, but there was no reason to believe that it would be more or less.
· It was confirmed that the reference to <5% of the population requiring statutory help was based on actual figures.
· Further information on what was meant by ‘vulnerable’ would be helpful, as it could be argued that all teenagers were vulnerable to some extent.
· In relation to levels of school readiness, although the figures had improved, the picture in Worcestershire was not as good as elsewhere. (Officers agreed to provide the Panel with school readiness data). The Director of Children, Families and Communities confirmed that there was no link between attending nursery and school readiness.
· The Early Help Needs Assessment (EHNA) 2018 had shown increasing levels of need. It was confirmed that this did not necessarily lead to increased funding. The current service included some duplications and areas of overlap with a number of different service providers. Also, some practice was not in line with the national evidence base. It was suggested that outcomes could be improved with the same resources.
· In relation to school places for children with Special Educational Needs and Disabilities (SEND), it was confirmed that there were no children in the county without a place. However, it was acknowledged that there was an issue with funding for pupils with SEND. The Local Authority had twice bid for funds for a new special school, but no capital was available.
· It was confirmed that the available budget was adequate to provide the necessary universal services.
· In response to a question about community capacity and the role of the voluntary and community sector, the Panel was informed about the integration of a number of services to provide a universal countywide service. This included professional services involving a huge number of volunteers, such as breast-feeding advice. Services were led by professional experts who recruited and trained volunteers.
· Clarification was provided on the term ‘universal’. This meant that the service would reach every child (as opposed to simply being available to every family).
· In response to a question about the amount of money available, the Director of Public Health acknowledged that this was a statutory service and as such was an absolutely top priority. She believed that the money available was sufficient to deliver a safe secure service which met national standards.
· A question was asked about whether an individual could hide the birth of a child from those in authority. In response, Members were told that every birth in hospital would generate an NHS number, placing the child within the system. However, it was suggested that simply registering a birth would not automatically create a link to the NHS system. This was linked to a previous question about community capacity. It was suggested that trained volunteers working within an active community created a ‘soft network’ which would make it harder to hide the birth of a child.
· It was confirmed that Early Intervention Family Support was funded through school funding. The Director of Children, Families and Communities acknowledged that the boundaries between different teams working with children were not always clear and emphasised the importance of working together. Members were reminded that a social care assessment could be very intrusive and the challenge was to put energy into meeting needs at the right time.
· In response to a question about how the service’s linked with schools, Members were reminded that the Healthy Child Programme was delivered via schools and every school had a named school nurse. The Panel was also informed that every school also had a health improvement plan and safeguarding conversations would include a school nurse presence when the child was of school age.
· Clarification was requested about the role of the school nurse and Members were informed that, although on occasion they might work with individual children, they also worked more generally on school health improvement plans, meet with headteacher to discuss vulnerable children and hold various drop-in sessions such as Time4U in high schools.
· The aim was to create an integrated service which would have less chance of anyone falling through the gaps. For example, there was good information sharing between midwives and health visitors with health visitors providing one ante-natal check.
· In response to a question about how community activities would be provided in more rural areas, Members were informed that this would be discussed as part of the competitive dialogue. It was confirmed that potential bidders had been made aware of where children’s centres were still in use.
· It was confirmed that the service would include a conversation with families about future contraception and this had been strengthened in the new specification.
· Figures were requested for the number of schools and youth centres that held Time4U drop-in sessions. It was agreed that these figures would be provided after the meeting. Members were reminded that the service also had links with outreach sexual health nurses.
· The competitive dialogue would include how to improve contact with those who were ‘hard to reach’.
· Members were reminded that the Early Help ‘windscreen’ was not linear and a child might be born at level 3 or 4.
· A question was asked about whether service improvements would make it easier for parents going through the process of obtaining an Education, Health and Care Plan. In response, the Director of Public Health commented that greater service integration could only help.
· In response to a question about difficulties in recruiting specialist speech and language staff, Members were informed that the aim was to skill up universal staff to assist. Those children requiring speech and language therapy would be referred to the specialist service.
· The contract had an annual value of £9.3 million. Concern was expressed that over the length of the contract, the service provider may request more money to provide the commissioned service. A question was asked about whether the Directorate was certain that the funding would be sufficient and continue to be available. The Director of Public Health reminded the Panel that the funding was part of the Public Health Ring-Fenced Grant and decisions on this were made by central Government. However, it was very unlikely that the local authority would be relieved of its statutory duty to provide this service. Based on the latest needs assessment, it was judged that £9.3 million would be sufficient unless something unusual happened. Commissioning officers within the local authority would hold weekly discussions with the service providers and so would have early knowledge of any such event.