Agenda item

To consider a report from the General Counsel, which sets out the process in the County Council’s Petition Scheme for considering a petition received. To this is appended a statement from the lead petitioner and a position statement from the County Council. The committee is invited to debate the issues raised in the petition, comment to the Cabinet Member for Strategic Commissioning and Public Health and say how it intends to respond to the petition.

The lead petitioners, Ms A Le Grange and Ms C Mitford, were present at the invitation of the committee and Ms K Sharp, Head of Public Health Commissioning, Ms W Jeffreys, Locum Consultant in Public Health, and Ms C Poole, Deputy Chief Operating Officer and Community Services Director (Public Health), Kent Community Health Foundation Trust (KCHFT), were in attendance for this and the following item.

1.         Ms Le Grange addressed the committee, explaining that she had started the petition in summer 2017 as she had been concerned that the proposed new model of support for the community infant feeding service would not provide support in a way which was required, including the number and geographical spread of clinics available, the training of those whom it was proposed would deliver the service and the speed of access to urgent and specialist support to address complex needs. Recognition of tongue-tie was welcomed but there was not confidence that this could be adequately treated in the new model of service.  Ms Le Grange asked that the County Council extend its planned service to ensure that specialist and dedicated support was provided so mothers would continue to be encouraged to breastfeed and that mothers and children would continue to experience the health benefits of breastfeeding.

2.         Ms Mitford added that she had struggled at first to breastfeed, had lacked confidence and had felt shame and stigma. She had attended a weekly group for eight weeks and described the support she had received there as ‘brilliant’. She added that, when she had experienced problems with breastfeeding at the start, she could not have waited for a referral or been able to travel any distance to access support. She emphasised that all women needed to be able to exercise choice over how to feed and needed access to expert help and support.  She asked that the County Council keep its breastfeeding support service unchanged.

3.         The Cabinet Member, Mr P J Oakford, said that he needed to have the fullest possible information before taking a formal decision on the future of the infant feeding service, of which breastfeeding support services were a part. He assured the petitioners and mothers present that the County Council was committed to supporting and promoting breastfeeding, was taking the issue very seriously and had invested much work and officer time in preparing the proposed new model. The issue of breastfeeding had been discussed several times at committees during the formation of the current proposals. He added that an independent company had been engaged to evaluate the findings of the public consultation so the analysis would be clear and objective.  He emphasised that the proposed new model was a co-ordinated whole-system approach, based on guidance from Public Health England and linked to the NHS, GPs and the maternity service. By embedding this into a health visitor service, commissioners would ensure the provision of more profession-led clinics, with the spread and frequency based on need. Adjustments had been made to the model as a result of comments arising from the consultation. The service would be an infant feeding service, offering women options, one of them being breastfeeding.  The County Council would embark on a joint campaign with health visitors and the maternity service with a priority of providing clear and consistent information to families.  He gave his personal commitment to oversee the new model.

4.         The committee then debated the issues raised in the petition and sought clarification of details of the service from Ms Sharp, Ms Jeffreys, Ms Poole and Mr Scott-Clark.  Comments made were as follows:

a)    the attendance of mothers and children at the meeting was welcomed and they and the petitioners were thanked for their participation;

b)    Ms Le Grange was asked, and confirmed, that she was a self-employed lactation consultant contracted to PSB Breastfeeding;

c)    asked about the accessibility and placing of clinics, Ms Sharp explained that the new model had at its heart the aim of improving accessibility to the service in a variety of ways.  Health visitors would continue to visit families following a birth and at 6 - 8 weeks after birth and would provide an additional 36 drop-in clinics per week across the county.  In addition to these, there would be 6 dedicated specialist clinics across the county per week, equating to approximately 24 per month, with their locations being dictated by need. These would be supported, where required, by spot-purchasing of lactation consultants. Additional need would be identified via regular monitoring of service demand. Full-time lactation consultants, within the health visiting service, would be able to respond to demand in a more flexible way than they would when based solely at clinics. Additional funding would be made available to support spot-purchasing of lactation consultants to supplement other provision;

d)    concern was expressed that new mothers leaving hospital on the same day as giving birth (i.e. within 6 hours) had less opportunity for support following skin-to-skin contact and breastfeeding initiation, and had less time and support than they once would have had to try breastfeeding.  Once out of hospital, new mothers wanting to breastfeed would need help and support from a family and community network;

e)    Ms Sharp explained that the proposed new model, although based on Public Health England and Department of Health guidance and in line with most other local authorities in the UK, had yet to be tested in Kent. The new model had been designed to provide more support to women who wished to breastfeed and had been built to respond to concerns expressed, for example, by additional investment to address concerns raise by lactation consultants. The aim was to smooth the transition from the maternity services, which looked after a mother for the first 10 days following birth, and the health visitor service, to which she would transfer after 10 days. The service would have the opportunity to connect to GPs’ surgeries as this was where mothers would go first to seek help with health issues. The new model sought to combine the best of the previous model with new innovation.  She emphasised that the transition period between the old and new models would be given dedicated resources and be carefully monitored;

f)     concern was expressed that some 25% of mothers did not attempt to breastfeed once they had left hospital, so any help in smoothing the transition between the maternity and health visitor services was welcomed. Ms Sharp added that peer supporters were very important as a resource to visit and encourage new mothers, as mothers often preferred to speak to another mother rather than to a health professional.  Ms Poole added that the KCHFT, which would be delivering the new service model, remained committed to retaining and encouraging the county’s peer supporters, which currently numbered some 200, and to adding new ones. Peer supporters would be instrumental in supporting the 36 new drop-in clinics across the county;

g)    one speaker said that the County Council seemed to be reluctant to promote breastfeeding but should champion it, as it was well documented as benefitting the short and long-term health of both child and mother. The UK had lower rates of breastfeeding than many other countries so needed to improve. Petitioners were thanked for the points they had raised as part of the consultation, which had led to changes being made to the proposed new model, however, some details of the new service were not yet clear. It was difficult to work out where and when the clinics mentioned would be held, the way in which an out of hours service would be provided, the level and accreditation of health visitor training and how this compared to the training undertaken by current lactation consultants, the workload of each health visitor and whether or not this was sustainable, how Kent’s services compared to that of other local authorities, and the data modelling used to identify the number of clinics required. Spot-purchasing would need to be carefully monitored, and Members would need to be able to see how such contracts would be worded.  Ms Sharp responded to these points and offered to provide the information requested. She added that the proposed new model would offer more flexibility to respond to demand, offering a combination of sessional and individual bookings, run by health visitors with a specialist interest in infant feeding and lactation consultants, supported by peer supporters, but would be firmly rooted in established best practice;

h)    in response to a question about the service for the first 9 days following birth, Mr Scott-Clark explained that the responsibility for this part of the service rested with the NHS/clinical commissioning groups, and the County Council would take on the responsibility from day 10, when service provision transferred to the health visitor service. The rate of initiation of breastfeeding in Kent was below the national average for the UK and the County Council was working with NHS colleagues to address this;

i)     one speaker said how much the breastfeeding support service had improved since she had given birth in 2000 and said the service now on offer to new mothers was outstanding;

j)     another speaker reminded that, although it was recognised that ‘breast is best’, it must be remembered that not every mother was able to, or wished to, breastfeed;

k)    the aim of a joined-up service, with the transition from maternity service to health visitors, was welcomed. Other speakers were assured that all health visitors were highly-qualified registered nurses with post-graduate qualifications;

l)     it was difficult to picture, from the information provided, what exactly the service would look like on the ground and how and where a new mother seeking help would find out about the support she required. Ms Sharp offered to supply a list of the locations of clinics; and

m)  the retention of peer supporters in the proposed new model was welcomed.       

5.            The Leader of the County Council, Mr P B Carter, agreed that rates of breastfeeding in the first 10 days following birth needed to be improved and that those who were unable to breastfeed should not be ostracised, and added that the committee should monitor access to, and use of, the new service. He emphasised the enormous amount of work which had gone into building the new service model and the need to listen to feedback from mothers using the service to identify problems and areas for improvement, which would then need to be addressed.  He reminded Members that £100,000 of additional funding had been made available to support the spot-purchasing of lactation consultants. He added that the committee would monitor the embedding and operation of the new service.

6.            At the conclusion of the petition debate, the Chairman summed up by saying that the committee was required to decide how it intended to respond to the petition, i.e. to recommend either that the action requested in the petition be taken, that it not be taken (or that some of it be taken), or that further investigation be undertaken. He suggested that, as there was a full report and recommendation in the next agenda item, the committee could defer a decision at this stage and move on to have that report presented by officers, discuss it and then return to the decision on how to respond to the petition. 

7.            It was RESOLVED that the next agenda item be considered before the committee set out its response to the petition.