Agenda item

This item provides an update on the Health Visiting Service, detailing the best practice and innovation, the issues and challenges faced and it seeks the Board’s support for proposed actions.

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.

Background was 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 this.

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.
• The 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 responded too. 
• 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 contact.
• 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.

Resolved

That Health and Wellbeing Board:

1. Notes and endorses the best practice and innovation associated with the service.

2. Notes and comments, as set out above, upon the issues and challenges the service is currently experiencing.

3. 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 solutions.

That this area becomes part of the agenda for the Children and Young People’s Partnership Board.