Agenda item

(To receive a report by Charlotte Gray, Team Manager Children's Commissioning, which provides the Committee with an opportunity to consider the final service model and commissioning route for children's health services in scope of the review prior to consideration by the Executive on 1 November 2016)

Consideration was given to a report which invited the Children and Young People Scrutiny Committee to comment on the children's health services model and commissioning plan which was due to be considered by the Executive on 1 November 2016

Expenditure on these services in 2016/17 was £13,998,367. 

The current contractual arrangement with Lincolnshire Community Health Services NHS Trust (LCHS) for Children's Health Services was due to cease on 31 March 2017 with an option to extend to 31 March 2018.  The review of children's health services would support the Council to find savings of £350k in 2017/18 and a further £350k in 2018/19.

Members were provided with an opportunity to ask questions to the officers present in relation to the information contained within the report, and some of the points raised during discussion included the following:

·         The Committee was advised that a letter from the Lincolnshire Medical Committee (LMC) had been received which highlighted a number of concerns about the proposed reduction in the role of the school nurses.  These concerns were addressed by officers, and it was reported that a letter from the Executive Director for Children's Services had been sent in response to a similar letter from the LMC, but that this letter would also be responded to.

·         Concerns were raised about what support would be available for schools to help young people suffering from anxiety.  It was reported that there would be an Emotional Wellbeing Service which would focus on upskilling and supporting schools to support pupils with emotional needs.  In addition to the new service it was noted that there was already support around anxiety provided for schools through the CAMHS contract, which also included an advice line, as well as an online service called Kooth.  More information would also be available to young people online through apps.  Members were advised that CAMHS had attended every Head teacher briefing to clarify the offer around emotional wellbeing and all head teachers had also been provided with a toolkit around emotional wellbeing.  It was commented that Head teachers had been very positive about the support schools had received. 

·         There were concerns about young people not having private access to online services.  However, members were advised that a large number of young people already accessed the online counselling service, Kooth, particularly during school lunch breaks.  This included access by young people on free school meals.  It was highlighted that young people wanted instant access to services and anecdotal evidence suggested that visiting a school nurse was not anonymous enough and it felt too visible using this service in school.

·         It was queried how many additional health visitors would be required and if school nurses would be redeployed.  Officers reported that there would potentially be a need for an additional 20 health visitors as the engagement with professionals and service users indicated that there should be a greater focus on the early years.  It was hoped that school nurses could be redeployed into other areas which were being commissioned if they had specialist skills or were willing to be retrained.  Further work was needed on this

·         It was confirmed that support would continue to be commissioned through CAMHS for young people with eating disorders as this was a national requirement.  However, there would also be a community based eating disorder service, which would work with all aspects of the community to raise awareness.  It was noted that this service was only in its first year of contract, and so it was currently focused on ensuring that all children and young people with a diagnosed eating disorder were receiving services.  The next step would be to work with schools and other organisations within communities.

·         This model was about a change to the way that services were commissioned and it was recognised that Lincolnshire had a very skilled workforce.  Any staff who wanted to retrain as health visitors, would be supported, subject to the availability of training and affordability.

·         It was noted that a decision had not been made yet, and officers had tried to ensure that the current provider was kept up to date with what was happening.  It was acknowledged that this would be a massive change and there were things which the authority could do to try and protect the NHS staff.  It would be important to ensure that staff were still identified as being health qualified.  Subject to the decision which was taken, it was the intention to get the message out to staff of what it would mean for them at the earliest opportunity.

·         If the model was approved, there would be an urgent need to appoint a Chief Nurse to ensure that Clinical governance requirements were maintained.  It was hoped that this would also give confidence to the sector that the authority wanted to harness and develop the skills of the Health Visiting profession.  From discussions with other authorities who had implemented a similar model, it had been found that the staff had considered it important that they still had NHS on their identity badges, as it gave assurance to families that they were appropriately qualified.  This would be explored

·         It was queried whether staff currently on permanent contracts would still have permanent contracts with the Council.  Officers reported that anyone who was eligible for TUPE would transfer to the Council on their existing terms and conditions which would include their NHS pension scheme.

·         There was support for the services being based around children's centre, but concerns were raised around those children who did not attend settings and whether any additional check would be put in place.  It was commented that non-attendance at settings would not normally trigger additional checks, however, under the new model regular early checks would be put in place which would highlight those in need of additional support regardless of whether they were in a setting or not. 

·         Concerns were raised about how advice would be provided to young people around sexual health.  It was noted that there was a need for some information online, but schools still had a responsibility to deliver PSHE.  It was confirmed that there would still be a county wide service provided which included intervention services in schools but it would no longer be provided by school nurses.  Face to face advice would still be available to young people.  This service would also be extended to under 13's with an emphasis on prevention and delay messages as well as healthy relationships.

(NOTE: Councillor B Adams arrived at this point in the meeting)

·         Concerns were raised around the rationale for the changes being proposed given the savings being made, and whether the savings took into account the transitional costs.  It was reported that the rationale was to modernise the service to better meet young people's needs.  There would be efficiencies made through the new in-house service with the revised service specification.  The transitional costs and contingencies for setting up the new model had been taken into account and were not part of the savings.  There would be a combined circa £1m saving between Public Health and Children's Services.  Officers highlighted that there was the potential for further efficiency savings in years 3-5 of the new service through co-location of staff and streamlining management.

·         It was queried whether the financial risks due to a rise in inflation and the fall in the pound along with the growing population and potential increase in refugee children coming into Lincolnshire had been taken into account.  Officers highlighted that they recognised the growing population and the need to maintain the workforce but could only look at medium term forecasts.  If there was a large increase then there would be a need to re-examine the budgets.  Based on the information known, officers were comfortable that the proposed model would be sufficient for the revised service specification.

·         Concerns were raised as to whether services would be reduced in future.  Members were advised that as this would not be a contracted service in future, then the Council would not be locked into providing the service specification outlined in the report.  It would be for the Executive to propose any changes to the service specifications and further reductions in the future.  However, assurances were given by officers that there were no planned cuts in service for the next two years although the Executive could decide to make reductions, but officers were not aware that there were any plans to reduce costs.

·         Concerns were raised regarding the loss of the Family Nurse Partnership (FNP) and how that service would be covered in the future.  It was highlighted that the FNP had ceased recruiting new clients several months ago and current users were being transferred to the health visiting service.  Most young people had now moved over to the health visiting service which was able to provide a wider range of support to young mothers.

·         Members were pleased to learn that ante-natal classes would be reintroduced but highlighted that the report did not mention anything about the breastfeeding service.  Officers advised that this was a fundamental part of the ante- natal service and it was hoped that initiation would be increased due to the roll out of the peer support programme and increasing the checks to include 3-4 months as well.

·         Concerns were raised about the training of health visiting staff and whether they would have the capacity to cope with the workload, especially if some of the existing staff decided to leave instead of transferring over.  It was thought that there was a need for training for new health visitors to be more comprehensive.

·         It was queried whether there were any alternative plans for staffing if there was a high number of staff who decided to leave, such as through retirement.  Officers reported that they were working with the current provider to understand the current workforce and how many may want to retire.  For the longer term, there was a need to identify how many places were needed, how many staff may want to leave and then how many new health visitors needed to be trained by the University.  In the short term, it was hoped that transferring staff over on existing terms and conditions with their NHS pension and appointing a Chief Nurse would help to encourage staff to stay.  In addition, officers would look at opportunities around upskilling other roles such as nursery nurses and others.

·         It was noted that in terms of the training for health visitors, this was delivered by the university, and so the role of the authority would only be to influence the training.

·         Concerns were raised about the number of risks with the proposals, such as the changing model, demographics, financial risks, skills and staffing, and it was queried whether a risk assessment had been undertaken.  It was confirmed that one had been undertaken and officers would share the risk assessment with the Committee if permissible.

RESOLVED

1.    That the Committee unanimously support the recommendations to the Executive as set out in the report.

2.    That the additional comments set out above be passed on to the Executive.