Agenda and minutes

To receive apologies for absence and notification of any substitutes present

Apologies for absence had been received from Mr D S Daley, Mrs L Game, Ms D Marsh, Mrs P A V Stockell and Mr I Thomas.

Mrs T Dean was present as a substitute for Mr Daley, Mr M J Northey for Mrs Game, Mr P Cooper for Ms Marsh, Mrs A D Allen for Mrs Stockell and Mr G Cooke for Mr Thomas.  

To receive any declarations of interest made by Members in relation to any matter on the agenda.  Members are reminded to specify the agenda item number to which it refers and the nature of the interest being declared

There were no declarations of interest.

The Chairman thanked the lead petitioners and others for attending and explained that, following the process set out in the County Council’s petition scheme, the committee would be addressed by the lead petitioners and the Cabinet Member and would then have a time-limited debate of the issues raised in the petition.   

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  ...  view the full minutes text for item 51.

To consider a report from the Cabinet Member for Strategic Commissioning and Public Health and the Director of Public Health, on the findings of the consultation, the proposed model and the additional investment planned.The committee is asked to comment on and either endorse or make a recommendation to the Cabinet Member for Strategic Commissioning and Public Health on the proposed decision to implement the new model for infant feeding support.

1.            Ms Sharp introduced the report and explained that she would be taking the lead on establishing and overseeing the new service to ensure it bedded in well.  She set out the historical context of the breastfeeding support service and the background to the current proposed new service.  The health visitor service had been the subject of concern in the past but work on improving their performance indicators had proved successful.  She reiterated points made in the petition debate about the need to promote breastfeeding and improve rates of initiation and continuation and the new model being a blend of the most positive elements of the previous model and new aspects, such as spot-purchasing of lactation consultants and use of new technology.  She emphasised the importance of careful monitoring of the transition period from the present service to the new and added that the new system was still a proposal; no decision about it had yet been made and would not be made until later in March. Ms Sharp, Ms Poole and Mr Scott-Clark then responded to comments and questions from Members, including the following:-

a)    the use of the most positive parts of the current service to build the new one was welcomed but concern was expressed about training of health visitors to prepare them for their new role, the limited time available at appointments and the number of issues which might need to be covered in that time. Ms Sharp emphasised that the 36 weekly drop-in clinics were a new addition which would offer more capacity for appointments. Ms Poole explained that health visitors were committed to the Unicef Baby Friendly Initiative (BFI) and that 98% of health visitors had undertaken the latest additional BFI training required to achieve accreditation at stage 2 of this. She added that the 36 new drop-in clinics would be run by health visitors with a special interest in breastfeeding and who championed breastfeeding. Peer supporters would also be encouraged to be part of the new model.  Any complaints arising about the operation of the new clinics would be addressed by infant feeding leads (IFLs) but mothers would still have access to qualified, directly-employed or self-employed lactation consultants who could support them promptly with any complex breastfeeding issues. To employ lactation consultants to supplement planned specialist clinic sessions as part of a mixed model of fixed and flexible provision was considered to be the best way forward;

b)    asked about health visitor qualifications, the accreditation of these and how many health visitors held such qualifications, Ms Poole explained that all health visitors were registered nurses, many were also trained midwives, and all were trained in Infant feeding as part of their additional public health training to become health visitors.  The lactation consultants employed directly within the health visiting service would have the same  additional qualifications as those held by lactation consultants. Lactation consultants would be both in-house and self-employed, to offer optimum flexibility of service.  Mr Scott-Clark referred to the National Healthy Child  ...  view the full minutes text for item 52.

1.         Returning to the requirement for the committee to set out its response to the petition, the Chairman then asked the committee whether or not, after passing the resolution above, it felt able also to support the action requested in the petition. Members indicated that they did not feel able to support the action requested and wished instead to note the petition.

2.         It was RESOLVED that the action requested in the petition be not supported but that the petition be noted.