|
Report to: |
Lead Member for Children & Families |
|
Date of meeting:
|
27 February 2023 |
|
By: |
Director of Children’s Services |
|
Title: |
The extension of the Collaborative Partnership Agreement between East Sussex County Council (ESCC) and East Sussex Health Care Trust (ESHT) for the provision of 0–19 Early Help Service.
|
|
Purpose: |
This report seeks agreement to extend the Collaborative Partnership with ESHT for 3 years until 31 March 2026 |
___________________________________________________________________
RECOMMENDATION:
The Lead Member is recommended to approve the extension of the Collaborative Partnership Agreement between East Sussex County Council and East Sussex Health Care Trust (ESHT) for the provision of 0–19 Early Help service for 3 years until March 2026
_____________________________________________________________
1 Background
1.1 The Health and Social Care Act 2012 sets out the statutory responsibility of local authorities to deliver and commission Public Health Services for children and young people aged 0-19 years. Commissioning responsibility for the Healthy Child Programme 0-5 (HCP) transferred to the local authority (ESCC), in October 2015. In April 2016, Health Visiting, the Family Keyworker Service and Children’s Centre Services were brought together under an integrated management structure to provide services for families in East Sussex with children aged 0-5 years. The following link is Government guidance for Healthy child programme 0 to 19: health visitor and school nurse commissioning
1.2 The HCP offers every family an evidence-based programme of interventions, including screening tests, immunisations, developmental reviews, and information and guidance to support parenting and healthy choices. Its aim is to build healthy communities for families and children, reducing inequalities and vulnerabilities.
1.3 The health visiting and school nursing service delivery model and commissioning guidance was updated in May 2021. The Healthy Child Programme remains universal in reach continuing to set out a range of public health interventions to build healthy communities for families and children, reducing inequalities and vulnerabilities.
1.4 The updated model emphasises the health visiting and school nursing role as leaders of the Healthy Child Programme, whilst acknowledging the important contribution of a range of delivery partners.
1.5 Key changes to the model for health visiting include:
· A modernised delivery model that is Universal in reach – Personalised in response.
· The modernised HCP no longer uses the terminology of Universal, Universal Plus and Universal Partnership Plus, the language of the “4,5,6 model” has also been removed .
· In the new service model, the HCP is based on 4 levels of service – community, universal, targeted and specialist – depending on individual and family need.
· The commissioning guidance places further emphasis on the role of skills mixed teams in delivering the HCP, with a shift in language referring to health visiting, rather than “health visitor”.
‘Whilst both services should be led by health visitors and school nurses as Specialist Community Public Health Nurses (SCPHN), there will also be a skill mix within the team, including community staff nurses and nursery nurses. The determination of skill-mix required should be led by identified local health needs and underpinned by a robust workforce plan’
· The 5 mandated reviews remain the same, however two additional reviews are suggested at 3-4mths and 6mth, where needed. See Fig 1 below.
Fig 1 - Universal health and wellbeing reviews
Figure 1 describes universal health and wellbeing reviews and suggested contacts as part of overall support 0 to 5 years, detailing key aspects at the following stages:
· antenatal health promoting review
· new baby review
· 6 to 8 week review
· 3-month contact
· 6-month contact
· 1-year review
· 2 to 2 and a half year review
Figure 1. Universal health and wellbeing reviews and suggested contacts as part of overall support 0 to 5 years
1.6 The High Impact Areas provide an evidence-based framework for those delivering maternal and child public health services from preconception onwards. They are central to the health visitor model and have been refreshed to contain new evidence, policy and suggest additional material to support implementation in order to support maternal and family mental health. The high impact areas are listed below:
· supporting breastfeeding;
· supporting healthy weight and nutrition;
· improving health literacy and reducing accidents and minor illnesses;
· supporting health, wellbeing, and development; and
· ready to learn, narrowing the ‘word gap’
1.7 In East Sussex, the 0-5 HCP is delivered as part of the Early Help Service delivered by ESCC and NHS professionals. Components of the service include:
· Health Visiting health clinics and home visits
· Keywork support
· Family groups at a Children’s Centres/ Family Hub
· A volunteering programme (e.g., breastfeeding, peri-natal mental health)
· Training courses to improve life skills
· Support with child speech and language
· Antenatal support
· Parenting advice and courses
1.8 The full 0-5 offer for children and families is extensive and summarised in the Service Offer document (Appendix 1) and the Service Aims document (Appendix 2).
2 Commissioning Responsibility/Arrangements
Commissioning History
2.1 In 2016, following the transfer of Healthy Child Programme to ESCC and in response to the national and local Better Care agenda the existing standalone Health Visiting services model, based with ESHT was explored. A wide-ranging review of models of delivery for children services and comprehensive redesign process was undertaken. Work to establish a partnership agreement began in 2016 with an integrated 0-5 health visiting and children’s centre service and the Partnership Agreement was established in April 2018.
Timeline
2013 - The responsibility for commissioning the HCP was transferred to Public Health as part of the Health and Social Care Act 2012.
October 2015 - Commissioning responsibility for the Healthy Child Programme 0-5 (HCP) transferred to ESCC.
April 2016 - A contract waiver agreed to allow service redesign and procurement. The service was partially integrated under an integrated joint management structure with ESCC Children’s Services (Keywork and Children’s Centre’s),
July 2017 – The Children’s Strategic Planning Group agree that a collaborative partnership with ESHT could be entered into for the provision of Health Visiting, Family Keywork and Children’s Centres.
April 2018 - Collaborative Partnership Agreement commences.
April 2020 - Collaborative Partnership Agreement – renewed for 3 years
November 2022 – The Partnership group agreed further extension until 31 March 2026
Governance Arrangements
2.2 The Partnership Agreement is managed and overseen by the Partnership Group, comprising representatives from East Sussex Health Care Trust (ESHT), East Sussex County Council’s Children’s Services (“Children’s Services”) and East Sussex County Council Public Health (“Public Health”) (Appendix 3 - Governance Structure)
Finance arrangements
2.3 Funding for the Healthy Child Programme 0-5 sits within the overall ring-fenced public health budget, and the current contract value is £7.8 million per annum
3 Service Delivery – Workforce Challenges
3.1 COVID-19 has had a significant impact on the Early Help service delivery. In February 2020, the service was nearly full staffed and was offering varied and flexible services that met population needs. It was generally achieving high performance against the mandated reviews and other Key Performance Indicators (KPI’s).
3.2 In the early part of the pandemic Health Visitors (HVs) were seconded to the acute trust and some did then not return. Coupled with high early retirement rates and staff moving to less pressurised roles, this has led to a steadily increasing vacancy rate. Currently the vacancy rate for HVs is 52%. The drivers of this workforce change are not unique to East Sussex, with the recent report State of Health Visiting, UK survey and Health visitor survey highlighting the scale of the national challenge.
3.3 Despite the severe pressures during COVID-19, the service had demonstrated a very flexible and responsive approach. For example, adopting working remotely when possible but also keeping face to face contact with vulnerable families.
3.4 The service has developed a number of initiatives to maintain service delivery. This includes a recruitment & retention payment, increased student placements, extending skills mix and reducing workload via risk assessment.
However, the capacity issues have led to the suspension of the formal antenatal contact and reduced performance against the time limits expected for other mandated reviews.
4 Partnership Agreement – Case for Renewal
4.1 The modernised HCP programme has presented opportunities to extend the skills mix and look at ways to effectively deliver the full HCP service to families within current constraints. It is expected that proposed change to skills mix and a more flexible delivery model under the new partnership agreement will enable service to return to full delivery of the programme.
The partnership believes that the existing model for commissioning and the integration of services under the Partnership Arrangement brings has a number of advantages as follows:
· It has joined up the Healthy Child Programme (HCP), the work of Children’s Centres and the Early Years Foundation Stage (EYFS) childcare and early education agendas. For example, enabling the growth and development of the Early Communication Support Workers in Children’s Centres as part of the multi-agency East Sussex Early Years Speech, Language and Communication Pathway.
· It has increased opportunities for collaborative work, streamlined services and reduced chances of children falling through the net.
· It has provided the mechanism through which capacity can be maximised in all three services, in a period where there has been a decrease in funding for Keywork/Children’s Centres.
· The integrated service delivery support Family Hub and Start for Life developments as we have an established 0-5 workforce able to work flexibly across teams to provide the very best support to children and their families.
· It has increased opportunities to explore innovative ways of working with vulnerable families and young people. For example, the introduction of Video Interaction Guidance (VIG) Early Help Keyworkers (who are accredited VIG guiders or VIG guiders in training.)
5 Partnership Agreement Renewal – Next Steps
5.1 The Early Help service will be at the core of the delivery of developing Best Start Strategy and Family Hubs programme. It is proposed that the agreement is extended for a further three years until 31 March 2026.
5.2 The extension of the partnership agreement includes a review and refresh of the partnership agreement, to ensure it reflects current guidance and standards. This will be carried out jointly between Public Health, the Early Help service and ESHT, it includes staff consultation on updated delivery model and Standard Operating Procedures, consultation, and discussion with Key partners. This will include consideration of:
· Governance arrangements
· Aims and Outcomes
· Performance against KPIs and High Impact Areas
· The Scope of the services
· Current workforce challenges and potential service delivery redesign
· Contribution to the Early Intervention Agenda – including Family Hubs and Supporting Families
· Proposals and impacts linked to the Council’s priority outcomes and other relevant strategic plans and policies
· Any previous Member involvement in the issue, including for example, previous reports and Council decisions.
5.3 Further details on the Schedule for the extension of Partnership Agreement can be found in Appendix 4
6 Supporting information
6.1 The original Partnership agreement was approved by Stuart Gallimore, Director of Children Services as Chief Officer
7 Conclusion and reasons for recommendations
7.1 Following review of the collaborative agreement by the partnership, for the reasons set out above, the Lead Member is recommended to approve the extension of the Collaborative Partnership Agreement for the provision of 0–19 Early Help service for 3 years until March 2026.
ALISON JEFFERY
Director of Children’s Services
Contact officer:
Simone Lane
Tel. No. 07872055122
Email: Simone.Lane@eastsussex.gov.uk
BACKGROUND DOCUMENTS
None