Agenda item

Children's Health Service 0 -19

(To receive a joint report from Linda Dennett, Lead Nurse, Children's Health and Sally Savage, Assistant Director, Commissioning, which advises the Committee of the progress and improvement in performance of the Children's Health Service 0 -19 since the service was in-sourced in October 2017) 


The Interim Director of Education provided the Committee with a short update on the situation regarding the Lincolnshire Health Visitors.  The Committee was advised that the Council was still in dispute with one union who represented some of the health visitors.  The Committee noted that further strike days were planned.  It was noted further that the Council valued the professional work undertaken by health visitors and the support they provided to Lincolnshire families.  It was felt that the offer made by the Council was a fair and reasonable one.  Reassurance was given that cover had been arranged and that no one would be left without support.


The Interim Director of Education highlighted that the Health Visitors strike action should not detract the Committee from the report presented, which provided a very positive picture of the Children's Health Service 0-19.


Linda Dennett, Lead Nurse, Children's Health presented the report making reference to the background behind the service.  The Committee was advised that the Children's Health Service 0-19, alongside others supported the delivery of the Healthy Child Programme across Lincolnshire for children and young people and their families (aged 0-19 years) and up to the age of 25 years for young people with Special Educational Needs and/or Disabilities.


It was reported that the health visiting service delivered five mandated universal reviews: antenatal 28+ weeks; new baby 10-14 days, 6-8 weeks, 9-12 months, and 2-2½ years.  It was noted that where it was identified a child/family required further support, for example if there were to be safeguarding concerns, the health visitor would then work as part of a multi-agency team to ensure the child's needs were met (Universal Partnership and Universal Partnership Plus). 


Key Performance Indicators for the Mandated Contracts were shown on page 16 of the report.  The Committee noted that overall performance had improved.  Particular reference was mentioned to the two/two and a half year review, which had shown significant improvement from 39.5% at December 2018 to 75.5% at the end of May 2019.  The Committee was advised that the latest performance figure was 80%.  The Committee noted that this progress was testimony to all staff involved.  It was noted further that the service currently had 14 vacancies, but from September 2019, the service would be fully established.


It was reported that an independent survey of parents had been carried out in February 2019, with over 100 parents being contacted; out of the 100, 71 parents had taken part in the survey.  A summary of the results were detailed at the bottom of page 17 of the report.  The Committee was advised that overall, comments received had been very positive.


The Committee noted that the number of complaints received had been consistently low; and that the three complaints received had not been upheld.


It was reported that the Single Point of Access had been well received. It was highlighted that parents and professionals accessed the service via a single contact point and phone number.  It was highlighted further that responsiveness through the Single Point of Access was extremely high and that the service was consistently maintained.


The Committee was advised that the Corporate Clinical Governance framework had been ratified and that new terms of reference had been established for the Clinical Governance Board.  The Committee was advised that Clinical Mandatory training was 100% compliant and that this had been achieved in 2018/19.  Reassurance was given that mechanisms were in place to monitor clinical quality at service level and that improvements in reporting had also been made.  The Committee was advised further that the service maintained a clinical risk register, which was monitored by the Children's Health Quality Group.


It was reported that performance across the service remained good and that from September 2019, the service would have a full complement of staff, as the service had been in a position to offer posts to the current cohort of trainee health visitors when they qualified in September 2019.  It was highlighted that this was the first time in 14 years that the service had been fully staff, which was credit to the work of the Deputy Leadership team.  It was highlighted further that sickness absence was slightly higher than the corporate target, but good staffing numbers and support from HR had meant that the operational impact had been mitigated.


The Committee was advised that the results of the CQC inspection had been rated as 'Good' overall, which was a very positive result based on the limited length of time the service had been delivered by the Council. 


The CQC had identified a number of areas of good practice; and a number of areas that 'require improvement' under the 'safe' domain.  Attached at Appendix A to the report was a copy of the Regulation 12 Breach of Action Plan, in response to infection, prevention and control being insufficient to protect children from harm due to the inconsistency of toy cleaning and hand hygiene in some of the Children's Centres visited by the inspectors.  It was noted that other areas that had been identified as 'could' be improved had an action plan in place to address the issues raised.  These had related to lone working practices; a suggestion that there should be a staff survey specifically for 'health' staff; and ensuring that risks were captured on the service risk register.  Appendix B provided the Committee with a copy of the Children's Health CQC Improvement Plan.


During discussion, the Committee raised the following issues:-


·         That the number of complaints should be represented by some percentage measure.  Reassurance was given that complaints during the last year had been very low, as there had been approximately 70,000 contacts;

·         One member enquired whether the 0-19 service had noticed an increase in abuse and neglect cases; and whether processes were in place for staff to follow.  The Committee was advised that for Health Visitors in the Universal Service a risk assessment was undertaken for every contact they made; and if any concerns were identified, an additional level of support would be introduced.  As the system was now more integrated, health visitors would speak to social workers and have input into the Early Help Service and Team around the Child.  The Committee noted that the integrated working arrangements had strengthened the pathways to ensure that families were helped from an early stage;

·         Congratulations were extended to staff for what they had achieved.  A question was asked as to whether the single point of access dealt with an abandoned call.  Officers advised that they would have to confirm this information.  It was however highlighted that there was a voice mail facility, which enabled callers to leave a message; and that these were considered by call handlers very quickly;

·         The Vision for the Service.  The Committee was advised that the vision was to improve the outcomes for children and young people; and that working together had strengthened the offer available to families.  Working together had also strengthened integrated working across all services; and

·         One member enquired who the lead officer was for infection control.  The Committee was advised that the lead officer was Tony McGinty, Consultant, Public Health, with assistance from Children's Services and Business Support.  It was noted that there would be an overarching Infection Policy for all services.


The Vice-Chairman on behalf of the Committee extended congratulations to the staff for the service provided and to the fantastic news that the service would be fully staffed from September 2019 onwards, despite national shortages.




That the progress and improvement of the Children's Health Service 0 - 19 since being in-sourced in October 2017, be noted. 

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