Agenda item

UPDATE ON THE 0-19 SERVICE - BROMLEY HEALTHCARE

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Minutes:

The Sub-Committee were provided with an update on 0-19 Public Health Service being delivered by Bromley Healthcare, presented by Fe Akers, Associate Director for Children's Services and Loretta McGurry, Head of Health Visiting – Bexley and Bromley 0-19 Service (“Head of Health Visiting”).

 

The Associate Director for Children's Services advised Members that the 0-4 element of the service had transferred on the 1st October 2020. Due to the pandemic, mobilisation had been slightly different to what they were used to, but the transfer had gone as well as expected.

 

The Head of Health Visiting informed Members that the Health Visiting and Family Nurse Partnership (FNP) were based in three localities across the borough (central Bromley, Penge and Orpington), in alignment with the Children and Family Centre reach areas. Health Visitors led the delivery of the 0-4 Healthy Child Programme, which was provided in partnership with other agencies, providing a universal offer for all, and more intensive support for the families that required it the most. The 0-4 element now formed part of the 0-19 Public Health Nursing Service with health support for schools, and offered families seamless support. Post-pandemic, there was the potential for child health clinics to run alongside Speech and Language and Dietetic drop-in sessions.

 

At the time of transition, there had been one Head of Service; 3 Operational Leads; an FNP Supervisor; 36 Health Visitors; 16 Nursery Nurses; 3 Family Nurses and 9 Administrators. The aim had been to maintain the safety of clients and ensure that service and quality standard were maintained during the transition. Progress to date had included the recruitment of three fulltime Health Visitors, who would be starting in post shortly – this left only a 3.5% vacancy rate in Health Visiting, which was the lowest it had been for some time. They were also in the process of recruiting an FNP Supervisor, for which the interviews would be taking place the following week. In terms of service delivery, a centralised duty system had been established which was the “front door” for any client queries. Due to some staff being required to self-isolate or having COVID-19 related sickness, a centralised rota and allocation tool was being used to plan across the service, and was working well. Communication had been vital due to the high volume of remote working, and fortnightly team and leaderships meetings had been held. The team had also been developing processes and standards, aligning them across Bexley and Bromley and sharing best practice. Access to the service had been increased via duty and appointment only clinics – this included the appointment only weight clinics, which had been increased from 27 to 51, and allowed any client whose weight needed to be monitored to receive an appointment within a matter of days. Demand and capacity were being monitored on a weekly basis, in collaboration with commissioners. They were also engaging with teams and seeking feedback and ideas from them, particularly in relation to service delivery and the EMIS template designs.

 

The Head of Health Visiting advised Members that during October 2020, the Health Visiting teams had delivered more than 7,000 contacts, of which 4,000 had been first appointments such as antenatal or new births. The FNP consisted of three fulltime nurses and a Supervisor, who had delivered in excess of 150 face to face contacts. The Infant Feeding Team consisting of an Infant Feeding Nurse and two Nursery Nurses, and had delivered 150 contacts over the same period, which highlighted how responsive they had been to new mums.

 

With regards to safeguarding during the first period of lockdown, it was noted that whilst the number of children with Child in Need (CIN) and Child Protection Plans had not differed greatly, there had been an increase in the number of meetings. There had been over 130% more core group meetings between April – June 2020, and the number of CIN meetings had also increased by 81%. During stage 1 of COVID-19 recovery, the aim had been to prioritise home visits for families that: were not known to the service; where there was a safeguarding concern; and families where there was vulnerability or clinical need and the Health Visitor had judged a visit to be clinically necessary. Face to face visits had been maintained for:

- all new birth visits;

- removal in under 1’s;

- families where there were safeguarding concerns;

- mandated contacts for families with additional needs;

- antenatal where health and/or safeguarding concerns had been identified;

- faltering growth, infant feeding appointment only clinics.

 

Appointments had been provided virtually for universal antenatal; 6 to 8-week reviews; and 1- and 2-year reviews. The extended central duty system had ensured access and responsiveness for clients contacting the service in lieu of drop-in sessions.

 

COVID-19 had been the main challenge faced by all services, and the requirement for them to be delivered in different ways – the COVID SOP had been reviewed weekly, and staff had been given laptops and phones to enable remote working. Following the suspension of drop-in clinics, the service had needed to ensure that families knew how to contact them. The service had also worked to improve the number of Health Visitor vacancies, with recruitment already underway. Other challenges faced had included the data migration on transfer of the service, and staff adapting to a new clinical records system. As mitigation, lead Health Visitors had been provided with access to the clinical records of the previous service provider. A staff training plan had been developed, and ad hoc training would be provided where necessary.

 

The Head of Health Visiting informed Members that there would be a number of enablers and opportunities for the service. This would include an increase in the CAFs enabled by the adapted BCP assessment form, and feedback from staff would be used to ensure that the EMIS template developed would collect data in an accurate and user-friendly way. It was noted that the shared record system with allied health professionals and GPs would be invaluable for improving their collaborative working, as would the co-location of the central Bromley Health Visitor team with allied health and specialist children’s teams. In the future, there was also the potential to work with the school nursing teams. The “next steps” for the service included increasing and improving their collaborative working with the Early Intervention and Health for Schools and Early Years Settings. They would also establish a joint training plan; undertake weekly reviews of COVID SOP and complete the BFI Level 3 reassessment in March 2021.

 

The Associate Director for Children's Services noted that there was a Bromley 0-19 website (https://www.bromley0to19.co.uk), which Members were encouraged to view.

 

On behalf on the Sub-Committee, the Chairman thanked Fe Akers and Loretta McGurry for their presentation on the 0-19 Public Health Service.

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