The Board received
a comprehensive update and presentation on the 0-5 Health Visiting
Service (HVS) from Rob Sabin, WCC commissioner and Sarah Foster,
Deputy General Manager for 0-5 HVS, SWFT.
provided on the role of the service to protect and promote the health and wellbeing of
children and their families through the delivery of the nationally
mandated Healthy Child Programme (0-5). The HVS was key to
delivering the Warwickshire Health and Wellbeing Strategy priority
around helping children and young people to have the best start in
life. The current service was delivered by SWFT, with the contract
due to expire on 31 March 2023.
A summary was provided of service
performance. This service met a wide
spectrum of needs for all children (birth to five) within
Warwickshire, with some key areas that delivered more targeted
needs. The service continued to innovate and adapt its practice,
with examples being provided. Developmental reviews and checks were
mandated, and contract performance was monitored against five HV
mandated contact performance indicators. The provider's performance
in this area had declined with tables providing data to demonstrate
The report then set out the identified service
issues and challenges. It included challenges around recruitment
and retention of qualified HVs, which was a national issue. It was
coupled with increasing caseloads, increases in population,
complexity of cases and level of need.
SWFT and WCC had co-developed a joint
recovery/restoration plan in the Autumn of 2021. The report set out
the short-term and longer-term actions proposed. The recovery plan
was reviewed monthly involving service and commissioning leads,
with oversight from the WCC Assistant Directors. A presentation was
provided to highlight key messages from the report.
The following questions and comments were
submitted, with responses provided as indicated:
- The re-employment
of retired HVs was discussed. Such people had vast experience and
recently a retired HV had recommenced work in the Rugby area.
- The value of
nursery nurses was recognised, it being questioned how they could
contribute to HV roles. It was also asked what WCC could do to
assist. It was noted that some HV functions could not be undertaken
by other personnel.
recommendation was to note this report but there were concerns.
Reference to the challenges observed at the Rugby Family Centre,
specifically around HV caseloads. Also, the increasing complexity
of cases identified at a body which determined grant funding
applications. These included concerns around mental health and
drug/alcohol issues. There was a national staffing shortfall in
HVs. In the Rugby area a meeting to discuss the Joint Strategic
Needs Assessment had included a number of aspects relevant to this
discussion. However, there was no awareness of the concerns around
the HV service, which showed the need within the system to better
connect. Co-production was seen as a good way forward and it was
about ‘how’ organisations could work together and
enabling that to happen.
- Another speaker
echoed the points around how WCC and other organisations could
help, focussing on recruitment aspects and making the HV role more
attractive. There was potential to provide support in schools and
through seeking volunteers to help too.
- In response to
these points, it was confirmed there was a shortage of HV staff.
There were some roles such as mandated contact which only HVs could
undertake. There were roles that others could deliver and an
outline was given of the approaches utilised so far and potential
for greater collaboration with other agencies. Referrals and making
the best use of all staff in related services were emphasised.
However, there were staff shortages in those areas too. Assurance
was provided of the additional HV staffing secured recently for the
Rugby area. Whilst there was still a shortfall, the position was
much improved. There was praise for the way that current staff had
- Katy Coates added
context around the staffing shortage to deliver the healthy child
programme in Warwickshire, which would need some 120-130 HVs.
Elected members needed to consider the forward planning for the
next five years, the increased funding which would be required,
albeit that the shortage of qualified HVs currently meant that
finance was not the only concern.
- The Chair noted
the requirements around reporting on mandated contacts, the current
challenges and resultant performance levels. The Council owned its health visiting contract,
setting the targets and measures within it. She spoke of the
priority of seeing new babies and 98% were seen within 30
days. This enabled triage to specialist
help and other pathways where it was required. She advocated having
a contract which worked for Warwickshire, with appropriate
priorities set against the known shortage of HV staff to focus on
the areas deemed of most importance.
- Anjali Dave, an
Associate Director of SWFT agreed with the idea of local criteria
for recovery of the services, with a focus on vulnerable families.
Reporting on those figures would mitigate the clinical risk given
the current resources. There was a need to influence national
strategies around university courses and making the HV role more
attractive to address the recruitment challenges.
- Shade Agboola
provided reassurance of the ongoing work with health colleagues to
seek to escalate the known concerns. Conversations were also taking
place with local universities. She spoke about the current
indicators and whether there was an appetite as a local system to
deviate from the national criteria. This had been required in
response to the Covid pandemic to provide tailored solutions for
the local area.
- The need to
provide university courses to create the future workforce was
reiterated. It was questioned if the voluntary sector was currently
assisting where it could.
- Similarly, a
question about other skills available within the county council and
whether these could provide additional support. The points about
co-production were reiterated. This did include the voluntary
sector and it was evident from a meeting earlier in the day that
different parts of the same organisation had different levels of
awareness of voluntary sector involvement. Aside from making
representations at the national level, there was an opportunity to
shape things locally and ensure information was shared effectively
across all relevant organisations.
- In response to
the above points, context was provided on the number of applicants
for vacant HV positions and the shortages in other parts of the
NHS. In terms of co-production, there was a HV representative on
all of the Children and Family Centre advisory boards. From
discussion it was evident that other health leads could similarly
be invited to attend such meetings and Sarah Foster offered to be
- The Chair added
that WCC offered a range of training opportunities. There was a
need to ensure that once trained, the funding for HV posts was
sustainable. The demand for such support was increasing and it was
necessary to ensure that forward planning took place. There were
other professionals involved including midwives and GPs. A need to
avoid duplication and to make sure the appropriate professional
undertook each role. In terms of the report recommendations, she
proposed that the Children and Young People Group take on
monitoring of this area. The Chair was keen to find a local
solution in addition to the ongoing national lobbying.
That Health and
- Notes and endorses the best practice and innovation associated
with the service.
- Notes and comments, as set out above, upon the issues and
challenges the service is currently experiencing.
- Supports the short-term and long-term actions being taken
locally by the Health Visiting Service and Commissioners to assist
with and improve recruitment and retention, as well as improve
performance and mitigate the risks and to look at local
That this area becomes part of the agenda for
the Children and Young People’s Partnership Board.