Agenda item

Joint report of the Director of Public Health, Harrow Council and Chief Operating Officer, Harrow Clinical Commissioning Group

The Board received a joint update report from the Director of Public Health and Chief Operating Officer on the award of the contract for the 0-19 Health Visiting and School Nursing services to CNWL with effect from 1 July 2018.  It was noted that the three main public health priorities were oral health, healthy weight and school readiness.

The Director of Public Health advised the Board that the new service had been in operation in new premises from 2 July 2018.  The first two days had been taken up with induction training.  The Director drew particular attention to the following:

·                     the key focus during the transition had been on the use of a risk register to mange and monitor risks;

·                     the new service enabled the breastfeeding service to continue and also absorb the planned £65k budget saving.  It would also enable the introduction of vision screening for all reception-aged pupils which, if funded as a stand alone service, would have cost in excess of £75k per annum;

·                     oral health was now the responsibility of all health visitors, school nurses and other staff instead of a specialist oral health promoter;

·                     additional checks, initially for the most vulnerable, would take place at age 4-5 months and at 3.5-4.5 years old.  The latter aimed to improve school readiness in those not already attending an early years setting;

·                     the new service would provide an increased school nurse presence in every school and the introduction of questionnaires for secondary aged pupils in order to identify and address areas of concern to young people and to build on the recent Young People’s Needs Assessment;

·                     the delivery model for school nursing in the two PMLD special schools would be brought in line with the statutory guidance on supporting pupils with medical conditions at school.

The CCG representative emphasised the commitment to working closely with Public Health and CNWL which had made a positive impact during the tendering process and early mobilisation.  The CCG welcomed the inclusion of additional health checks to aid early identification and intervention and hoped the increase in school nurse provision would improve multi agency collaboration.  It was however important to monitor whether  nurses withdrew as a result of the change in the delivery model for school nursing in the two PMLD schools.  She also stressed that health advice should include signposting alternatives to A&E.

The Board was informed that discussions were taking place between the CCG, Harrow Council and NWL regarding a joint specification for speech and language development, an area which had absorbed a £50k reduction in Council spending.  Although no clinical risks had been identified it was hoped that in the longer term provision to meet the rising demand, linked to the increasing numbers of Education Health and Care Plans, would be commissioned.

The CCG representative expressed the hope that the suggested change to the school nursing delivery models for PMLD special schools would not result in unreasonable cost pressures for the CCG.

A CCG clinical representative stated that it was important for health visitors to liaise with primary care and GPs.  Feedback on the new arrangements would be welcomed.  The additional health checks would be useful in supporting improvement in low immunisation rates.

A Member referred to the discussion at the Corporate Parenting Panel earlier that week on CNWL Looked After Children (LAC) health team and stated that this confirmed the successful partnership working.

In response to questions, the Board was informed that:

·                     links with other services ensured signposting to other referral pathways.  Specific mental health needs were given as an example.  Mothers with mental health needs were identified as soon as possible and were given additional support known as universal+ and universal partnership+.  Prenatal visits focused on vulnerable people and first time mothers.  GP checks at 6 and 8 weeks would include assessments of maternal mental health and the new 4-5 months check by the health visitors would give an additional opportunity for identification of maternal mental health issues;

·                     the officer undertook to provide information on the number of staff employed in the 0-19 Public Health Nursing service at Milmans.  There were approximately 70 staff in the service as a whole;

·                     there was no provision for inflation in the contract.  It was a set price contract and efficiency savings were expected throughout the life of the contract to counter the impact of inflation.

A Member stated that the Young Harrow Foundation sought the raising of the profile of emotional and mental wellbeing, particularly in view of suicide and self harming.  The Director of Public Health stated that meetings had taken place with Thrive London and the CCG regarding mental health needs and funding.  The public health team were also delivering more Mental Health First Aid training for schools and other groups that worked with young people.  This was in addition to the national MHFA in secondary schools programme that was now being rolled out in Harrow.

A Member who had served on the Scrutiny Review stated that she was delighted that all the recommendations had been taken into account.

The Director of Public Health stated that regular performance meetings would be held with the Trust and key performance indicators would be monitored.  An update would be submitted to the Board.

RESOLVED:  That the report be noted.