Agenda item

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Interim Director of Public Health on the operation of services which will become a responsibility of the County Council in October 2015, prior to a formal decision being taken by the Cabinet Member later in the year.

Mr C Thompson, Consultant in Public Health, and Ms K Sharp, Head of Public Health Commissioning, were in attendance for this item.

1.            Mr Thompson introduced the paper and summarised the key points of the services.  He outlined the detail of the health visitor service contained within the paper. The family nurse partnership project was relatively new in Kent and, as there was not a specific UK precedent to follow, the project had been researched from similar projects in the USA. The evidence base for improving outcomes was very strong.

2.            Mr Thompson outlined that the current NHS England contract would expire in March 2015 so the intention was that an extension be made to October 2015 and a new contract between the County Council and the Kent Community Health Trust be started when the commissioning transferred. Mr Thompson, Ms Sharp and Mr Scott-Clark responded to comments and questions from Members, as follows:-

a)    the Chairman referred to the valuable role of the health visitor and family nurse partnership services in reaching young parents who, for various reasons, did not engage with or attend children’s centres. The relationship that these services could establish with young parents was different from that which a social worker would have;

b)    the number of family nurse partnerships required in any area would be based on the rate of teenage pregnancies in that area.  Each family nurse partnership would have a workload of 25 families, and if the need in an area exceeded this level, the aim was to increase the number of family nurse partnerships;

c)    the key aims of the family nurse partnership service were summarised: to see all young mothers under the age of 20 (or up to 25, if resources allowed) who were having their first child, and offer them the chance to have a family nurse link to act as additional support, including support to the family as a whole, for about two years, gradually reducing support so the family would manage on their own at the end of the two years. The aim was to offer a universal service but this would have implications for resources and training;

d)    a view was expressed that part of the support role for young parents would be to encourage them, if they were not in a stable relationship, to avoid having a second baby. The service should also link with the Troubled Families initiative. Mr Scott-Clark agreed and added that young mothers would also be encouraged to take up employment, as a regular work habit and income had been identified as vital in supporting families.  He confirmed that the family nurse and Troubled Families initiatives did indeed work together and that, where research had taken place, the two client groups had approximately a 9% crossover;

e)      one speaker referred to her recent experience of the health visitor service and highlighted its great value in supporting exhausted new mothers to avoid post-natal depression, particularly if they lacked the support of close family. The ’listening service’ they offered was vital. It could also be extended to benefit older and more experienced mothers, who could still encounter problems and need support. Mr Scott-Clark added that this sort of support was exactly the purpose of the service and said he hoped that listening visits would continue;

f)       it was suggested that, as cases of tuberculosis (TB) were currently increasing in Kent, the family nurse service could be used to look into this. TB often related to poor housing, which the health visitor and family nurse services could identify during visits.  Mr Scott-Clark added that Kent had a good TB plan; 

g)      Members asked if they would have the opportunity to see the proposed contract before it was awarded, and wanted to be sure that the current provider was the only one equipped to deliver the required service.  Ms Sharp explained that the health visitor service would be reviewed in the six months available before the new contract was to be awarded and that work would be undertaken in this time to identify the most vulnerable stages at which each service could become involved with a family, how services could best link up and how outcomes could be monitored as part of the contract.  A report on this issue would shortly be made to the Health and Wellbeing Board, and this committee would receive update reports as work progressed;

h)      the report listed the areas currently covered by the service and concern was expressed about how the areas omitted would be covered.  The service was not arranged in clinical commissioning group (CCG) areas but could be. Mr Thompson supported the need for all areas to be covered by the family nurse and health visitor services and said the suggested move to CCG areas would be considered. Ms Sharp explained that the estimated costs of covering the current gaps would be £2 – 3 million.  The family nurse service required nurses who were experienced and trained in specific areas, but this same limited work force was also supplying the school nurse and health visitor services.  The challenges currently facing the service were being identified and a plan put in place to address them;

i)        one speaker pointed out that Sevenoaks was not listed among the areas currently hosting a service, although there was a family nurse service there. The services would need to be realistic and respond to the issues present in any one area, and all areas had different issues; and

j)        better use could be made of the 85 existing children’s centres, and these should be the default option to accommodate the family nurse and health visitor services. The costs of accommodation for the service should be looked at carefully, to eradicate any duplication or waste. Mr Scott-Clark said that NHS England was looking at property costs to ensure that they were minimised as far as possible and to ensure that money to cover them would accompany the contracting process. Another speaker referred to a time when mothers would attend the local ‘clinic’, at which a range of services could be accessed.  They knew where the clinic was in their area and what services it offered.

3.                  The Cabinet Member for Adult Social Care and Public Health, Mr Gibbens, thanked Members for their comments and reassured speakers that the six month period leading up to the new contract award would be used to review the service and address the issues identified above. 

4.            RESOLVED that:-

a)    the information set out in the report and given in response to comments and questions be noted; and

b)     option 2, the preferred option recommended in the report, be endorsed as the best way forward, given the time limitations and the need for the County Council’s Public Health Department to have an increased understanding of the health visitor and family nurse partnership services provided by Kent Community Health Trust.