Agenda item

To receive an update on Antenatal and Health Visiting.

The Sub-Committee considered a report set out on pages 15 to 28 of the agenda, which provided an update on Antenatal and Health Visiting in Croydon. Chris Terrahe (Deputy Director of Nursing at Croydon Health Services) and Juliette Penney (Head of Public Health Nursing at Croydon Health Services) introduced the item and went through the presentation provided in the agenda to the Sub-Committee.

The Sub-Committee thanked Elaine Clancy (Chief Nurse at Croydon Health Services) for commissioning the two independent and external reviews into the services, and asked about ‘New Birth Visits’ and whether these were being targeted at the most vulnerable families. The Head of Public Health Nursing explained that the aim was to visit all new mothers within 10-14 days, but this was not always possible due to workforce challenges, and so prioritisation of visits was assessed based on the levels of need or where there were mental health challenges identified through partnership working and intelligence sharing. The Director of Public Health explained that the services were commissioned on behalf of the Council and that New Birth Visits were required for every child; due to the current standing of the service, there did need to be triaging around which families were prioritised. Reporting to the Secretary of State on New Birth Visits looked at how many were completed within specific timeframes.

Members detailed anecdotal evidence that not all new mothers who would have liked to receive New Birth Visits were receiving them. The Head of Public Health Nursing responded that New Birth Visits were provided to all families who wanted them within 28 days, and where this had not taken place, it was known why not; reporting on this was undertaken monthly to the commissioners. The Chief Nurse stated they would be happy to look into individual cases outside of the meeting, but there were reasons why some families were not visited, such as the visits not being wanted by the families.

Andrea Cuff (Associate Director of Operations and Croydon Health Services) gave assurance that there was a robust process in validating and checking which visits had and had not taken place; the performance data in the report showed visits undertaken within 14 days, but the remaining visits did take place within 28 days and New Birth Visits were offered to all families. The Vice-Chair raised a query on Health Visitors needing to conduct the ‘6-8 week checks’ and heard that General Practitioners offered a 6–8-week medical check, which was a different service. Members raised concerns about the historic reporting on visiting data and heard that the services had been on an improvement journey and that reporting was now robust and undertaken monthly. The Chief Nurse explained that there was a national shortage of Health Visitors, which was accepted by Croydon Health Services, and the report had been provided to explain how Croydon Health Services were trying to mitigate this and deliver the best service possible in this context.

Members asked how they could be reassured that those needing help were not being missed. The Head of Public Health Nursing explained that monthly data had to be provided to the commissioners on the visits that had taken place, and where they had not, why not; this data was also reported nationally by the Local Authority. Health Visiting services were accessible by phone, and the number was shared by practitioners and through other groups. The Director Quality, Commissioning & Performance stated that monthly monitoring of the service was robust and that intelligence was being shared between the Council and Croydon Health Services to ensure those that needed help received it.

The Sub-Committee asked for reassurance that the service was improving in the context of health visiting in Croydon underperforming over a number of years; in particular, poor retention and recruitment were highlighted as problems facing Croydon to a greater extent than other local authorities. The Deputy Director of Nursing explained that some local authorities provided health visiting services and were able to pay Health Visitors more; the Central and North West London NHS Foundation Trust provided services to multiple boroughs and were able to pay an inner London weighting regardless of where the services were being provided. Members heard that Lewisham, Greenwich and Bromley all provided recruitment retention bonuses and this, combined with other factors, led to stronger recruitment and retention in other areas, and to people leaving Croydon to work for other providers. The Deputy Director of Nursing stated that there were plans to address these issues by providing a more flexible work offer and by making remuneration of Health Visitors more in line with neighbouring employers alongside the improvement plans detailed in the report. The Director of Public Health added that services were already improving and that organisational and developmental changes were just as important to recruitment and retention as competitive remuneration. The Sub-Committee raised a strong challenge about the consequences of the service not improving for Croydon Health Services and the Council. Members heard that the Director of Public Health reported regularly to the Secretary of State on Health Visiting and that improving the service was a high priority. The Chief Nurse expounded on the commitment and passion of the Health Visiting team and explained how seriously they took their role to the residents of Croydon. The Associate Director of Operations added that governance processes were strong in monitoring month on month performance and that there was a monthly meeting of an Improvement Board, chaired by the Chief Nurse, to provide additional internal challenge.

The Sub-Committee asked about ‘smarter and more efficient’ working referenced in the report and the Deputy Director of Nursing explained that this encompassed a number of different things including operating the service on additional days, flexible working and virtual huddles. Members heard that a report on the improvement journey had been presented to the Croydon Health Services Trust Board, and this would be repeated on a six monthly basis; other regular meetings with Trust executives to monitor the improvement of the service were also taking place. The Director Quality, Commissioning & Performance added that quarterly directors monitoring meetings were also monitoring the progress against the improvement plan.

The Sub-Committee asked about exit interviews for staff leaving the service, and heard that these were conducted anonymously by a third party and fed back to the service so that this could be taken on board. The Head of Public Health Nursing added that the main reasons staff were leaving the service was to work for providers who could pay inner London weighting, to retire and for better a work life balance.

The Vice-Chair asked about the timeframes involved in the improvement journey and how priority of need was identified. The Head of Public Health Nursing explained that that an ‘assessment of need’ was undertaken on first contact with families and this determined the particular care pathway required; once need had been assessed, referrals could be made, or other services engaged, if required. Members heard that the level of risk was always taken into account, and where this presented the possibility of safeguarding risks or harm to the individual, an action plan would be developed and enacted and this could take place at any part of the process. The Chief Nurse explained that the two independent reviews of the service had been undertaken to identify areas for improvement and ways to mitigate shortfalls in the numbers of Health Visitors; many of the mitigation and improvement measures would take time to embed and to dramatically improve the service. The Sub-Committee expressed interest in keeping updates on the service improvement on the Work Programme, and this was supported by the Chief Nurse and Director of Public Health.

The Cabinet Member for Children and Young People thanked Croydon Health Services for the report and asked where safeguarding sat within the priorities of the Health Visiting service. The Head of Public Health Nursing explained that safeguarding was ‘front and centre’ in everything the service did; a high-risk pathway was being developed to identify and help those with high safeguarding , through partnership working with maternity and safeguarding services. These services already worked with Health Visitors, but the pathway would increase transparency of this work and put expected standards, timeframes and processes in place that could be audited.

Members asked how the Sub-Committee would be able to ensure the service would hit the Key Performance Indicators of the improvement plan. The Director of Public Health explained that there were key metrics and performance indicators that could be provided at the next update to the Sub-Committee, and these were already reviewed at the quarterly and monthly commissioners meetings.

The Sub-Committee asked about the effect of reduced Health Visitors on immunisation and heard that the responsibility for immunisations sat with GPs, but guidance and advice on vaccinations was always provided by Health Visitors. The Director of Public Health stated that vaccination rates in Croydon were lower than other comparative areas, but that there was a multiagency taskforce to increase vaccinations and this did work with Health Visitors. The Sub-Committee heard that a Project Manager and Analyst had been recruited but had since left; recruitment to the post for a new member of staff would conclude shortly.

The Deputy Director of Nursing thanked the Sub-Committee for inviting them to speak and for the patience of Members in improving Health Visiting services. The Chair thanked all those who had attended and responded to the Sub-Committee’s questions.

Conclusions

The Sub-Committee were encouraged by the seriousness with which Croydon Health Services were working in a challenging environment to improve and mitigate the challenges facing the Health Visiting service.

The Sub-Committee concluded that an update on Health Visiting would be added to the Work Programme on a six monthly basis.

The Sub-Committee were of the view that commissioning data on Health Visiting should be shared with Members on a regular basis by the Director of Public Health and the Director Quality, Commissioning & Performance.