Agenda item

For the Sub-Committee to receive an update on the Antenatal and Health Visiting Service, including Key Performance Indicator (KPI) trends since the last update in June 2023, as well as information on changes and improvements in the service.

The Sub-Committee considered a report set out on pages 17 to 32 of the agenda, which provided an update on the Health Visiting service in Croydon. Deborah Kelly (Chief Nurse of Croydon Health Services) and Matthew Kershaw (Chief Executive of Croydon Health Services) introduced the item to the Sub-Committee.

The Sub-Committee asked about the challenges of implementing cultural change across Health Visiting services. The Chief Nurse of Croydon Health Services responded that new leadership had been able to take a critical view of systems and processes that had been in need of strengthening and modernisation. There had been some initial resistance with changes, but the Sub-Committee heard that it was felt that a corner had been turned and that staff were on board. Members asked about feedback they had received from staff on difficulties with planned service improvements. The Chief Executive of Croydon Health Services acknowledged that a number of changes had been made, and were planned, but stated that they felt staff were being brought along with the changes and that this had been evidenced in improved performance, recruitment and retention. Members heard that there was still work to do in improving culture and aligning the service with desired values but that this was headed in the right direction.

Members asked, should they repeat a visit with frontline staff, if they would likely hear better feedback. The Chief Executive of Croydon Health Services explained that he thought overall, that Members would receive more positive feedback, but that the service was still on an improvement journey and so some mixed comments would be expected.

The Sub-Committee asked why targets for New Birth Visits were not 100%, and what happened for children who were not seen within the target timeframe. The Chief Nurse of Croydon Health Services explained that ‘minus exceptions’ on performance data meant children still in hospital or who had left the borough; reaching 100% would be a significant challenge and it was stated that the current targets were ‘improvement targets’ that would likely be stretched further in future. Members heard that it was the aim of the service to visit every child in the borough. The Chief Nurse of Croydon Health Services explained that resources were deployed following a risk-based approach and that more information could be provided following the meeting on what was done for children whose visits were missed. The Director of Public Health explained that the service was commissioned on their behalf and that the four performance areas included in the report were for mandated checks.

Members asked for more detail on the school nursing service and the Chief Executive of Croydon Health Services responded that the service did not provide one on one services to each school, as there were not resources in place to deliver this. The service was prioritised into the areas of greatest need and worked to provide a supplementary level of support in addition to other public nursing services. The Chief Nurse of Croydon Health Services explained that school nurses were increasingly working in an integrated way with Health Visitors and that the 0-19 Transformation programme would look to further develop this model. Members heard the effectiveness of the service would be measured by looking at developmental milestones in children’s school lives.

The Sub-Committee asked about the move to providing services over four localities, instead of six, and whether this could present any additional risks to families with high or complex needs. The Chief Executive of Croydon Health Services explained that the intent was to create slightly bigger teams, with broader skills, to increase their robustness and ability to respond to the need in Croydon by better allocating the available resource. The 0-19 Transformation was intended to help the service effectively triage and assess need to better target resources where they were most required. The Chief Nurse of Croydon Health Services stated that they had met with the four locality leads to draw up aspirations of what the new locality teams would look like and to discuss the change programme. Members heard that over the last few months there had been meetings with the commissioners to discuss the makeup and responsibilities of the new integrated teams. The Chief Nurse of Croydon Health Services explained that the aim was to co-design the change programme with staff to help bring them along with the transformation process.

Members asked whether the service was prioritising New Birth Visits and 6-8 Week Checks at the expense of performance on 12 month and 2-2.5 year reviews. The Chief Nurse of Croydon Health Services explained that the service was taking a risk-based approach to ensure that the most vital checks were prioritised. The Chief Executive of Croydon Health explained that now New Birth Visits and 6-8 Week Checks were compliant, work would begin on improving 12 month and 2-2.5 year review performance. The Sub-Committee heard that the biggest factor holding back compliance for all areas had been the national shortage of Health Visitors but that performance had overall improved from June 2023. The Director of Public Health acknowledged that the service was on an improvement journey and agreed with the importance of bringing all four checks into compliance. The Sub-Committee asked about how performance had been maintained over December 2023 and heard that this had been as a result of focussing resources on the highest risk visits and use of agency staff. The Chief Nurse of Croydon Health Services commented that expanding access to the service through a seven-day a week provision had also helped and had made services more accessible to families.

The Sub-Committee asked about the 1200 children placed into the borough by other boroughs and how services for these children was funded. The Chief Nurse of Croydon Health Services explained that the placing borough should pay for assessments and health checks. Members heard that Croydon had 249 children placed in other boroughs.

Members asked about integration with Family Hubs and the Chief Nurse of Croydon Health Services explained that integrating public nursing with Family Hubs was the current aim and the reasoning behind moving to four locality teams. Whilst the first Family Hub had launched, a Health Visiting team had not yet been mobilised to work from the locality and take full advantage of the integration with Education and Social Care. The Sub-Committee heard that Westminster had successfully integrated services with their Family Hubs model and that the transformation journey over the next 12 months would look to facilitate the change to four localities and to work on creating integrated 0-19 Health teams. The Chief Nurse of Croydon Health Services explained that critical milestones would be developed to assess, at the end of the 12-month period, what a Family Hub team would look like. Members heard that building Family Hubs into the community was important to ensure they became a destination for families in need. The Director of Education explained that the first Family Hub had been launched at Woodlands Children's Centre, with one planned for Selhurst, and conversations ongoing about where the remaining two would be located. A bespoke Croydon model would be developed to ensure it met the needs of residents; it was highlighted that Family Hubs would not be located in schools.

Members asked for a definition of what a ‘Family Hub’ is. The Director of Education explained that the Woodlands Children's Centre Family Hub had been launched and that they would be happy to escort the Sub-Committee on a visit. Woodlands Children's Centre Family Hub had services from Education, Health and Social Care; the services available in Family Hubs were prescribed by the Department for Education. The Director of Education explained that Family Hubs would evolve with time to meet the bespoke needs in Croydon and provide Early Help or signposting through a partnership model. The Department for Education funding model was for transformation over three years, and Croydon was approaching the end of the second year.

Members asked when families who did not receive a visit in timescales were seen and whether these were the same families missed moving through the four mandated checks. The Chief Nurse of Croydon Health Services responded that missed checks did create a risk of pushing back the following checks but that it was the aim that all families were seen, even if this was not within target timeframes. The Chief Executive of Croydon Health Services explained that it was unlikely that it was the same cohort not being seen in timeframes for each check, and that reasons visits were delayed varied but could include demand, capacity, sickness, availability of families, disengagement with the process, etc. The Sub-Committee asked, if families missed a visit, if they would be able to rebook it. The Chief Executive of Croydon Health Services responded that they would absolutely find a way to connect with these families in some form.

Members asked about subsidised housing provision for nurses and whether this was something that could increase recruitment and retention levels. The Chief Nurse of Croydon Health Services responded that this was crucial for all key workers and was a national problem; the Sub-Committee heard about the importance of recruiting staff from, and keeping staff within, the borough. The Chief Executive of Croydon Health Services explained that the service owned some limited housing stock but were not in the process of increasing this provision. Members heard that around 70% of Croydon Health Services staff were Croydon residents, in part, due to more reasonable housing costs when compared to Inner London Boroughs. The Chief Executive of Croydon Health Services acknowledged that, whilst the level of staff who were Croydon residents was high, there was always more that could be done to further increase this.

The Chief Executive of Croydon Health Services acknowledged that the service was still on an improvement journey, but stated that there were signs of positive progress. The Chief Executive of Croydon Health Services thanked colleagues in Commissioning, Public Health and Education for all of their work in delivering and supporting the improvement of the service.

The Chair thanked the Chief Executive of Croydon Health Services, Chief Nurse of Croydon Health Services and officers for attending the Sub-Committee and answering Members’ questions, as well as those delivering services on the frontline.

Conclusions

1. The Sub-Committee commended the priority given to service improvement by the Chief Executive of Croydon Health Services and Chief Nurse of Croydon Health Services and stated that they were keen to see this trend continue.

2. Members thanked the Chief Executive of Croydon Health Services and Chief Nurse of Croydon Health Services for their open and thorough engagement with the Sub-Committee’s questions.

3. The Sub-Committee thanked the Director of Education for their offer of a tour of the Woodlands Children's Centre Family Hub and stated that they would look to take this up in the near future.

4. The Sub-Committee were positive about improvements to New Birth Visits and 6-8 Week Checks and were encouraged to hear that the service was now looking at how to increase performance for 12 month and 2-2.5 year mandated checks.

5. Members requested that the next update provide information on how flexible seven day working had been implemented in a way that worked positively for staff whilst increasing the accessibility of services.

Recommendation

1. The Sub-Committee requested that the Council work with Croydon Health Services to explore what possible incentives it could help to provide to aid in recruitment and retention for public nursing.