This report provides an update on progress to better integrate health and development checks for children aged 2.5 to 3 years. This issue was originally highlighted in the 2018 Local Area Inspection of SEND services in the borough.
Phil Tomsett (Head of Early Years) and Andy Kimber (Public Health Commissioning Manager) presented the report which provided an update on progress to better integrate health and development checks for children aged 2.5 to 3 years.
The committee was informed that there were currently two reviews for very young children - an education review that took place in an Early Years setting and a separate Health Visiting review. Both reviews took place at around the same age and making them more integrated would ensure that needs were addressed earlier.
The way this was done nationally was through the use of the Personal Child Health Record (PCHR) or ‘red book’ as it’s commonly known. The red book is primarily used in health settings but there is a page in it for early years settings so professionals can cross-reference. The example was given of a health visitor wanting to know how a child was doing socially – the Early Years practitioner could write information in that the health visitor could then see when visiting a child alone.
Officers had already undertaken work with the private nurseries' forum (there were around 90 private nursery settings in the borough) to promote the use of the red book and were starting to develop and take that forward.
Phil Tomsett said officers had explained to Early Years providers an approach they wanted to adopt across the borough to ensure consistency. Every Early Years provider had a contact so they knew who their health visitor was. Health Visitor reviews at 2.5 years were one of 5 mandated touchpoints for all children aged 0-5 under the Health and Social Care Act 2012. If Early Years also identified an additional need they can flag it and request a review.
The Chair asked if health visitors had been engaged in this process. Officers said they were ‘fully engaged’ – and noted that it was health visitors who delivered the new process to the private nurseries’ forum.
Officers were undertaking a commissioning exercise in 2020 with a new specification that could deliver a more efficient, joined-up service in respect of two year reviews.
Councillor Lucy Richardson asked, regarding the recommissioning, if the fact that health visitors had to be qualified nurses meant the only provider was the NHS. Officers said there were a number of NHS and very few private providers who could deliver the service. They expected around ten organisations to apply. Some private providers may not have the clinical governance standards to get through the commissioning process.
Councillor Richardson asked if H&F Council was limited to its local NHS trust purely because of geography. Officers explained that EU procurement rules required the service to go out to market and they expected around 8 to 10 providers to attend the market testing event.
Councillor Richardson asked what special measures the Council was taking to ensure the most vulnerable residents were being engaged. She added that the take-up of healthy start vouchers had been very low – and asked what lessons had been learned from that. Officers replied that they were working with the Family Support service to improve uptake. Phil Tomsett added that if a child attended an Early Years setting there would be a SENCO who could feed any concerns into the integrated review process. Andy Kimber added that data sharing protocols between H&F and CLCH had been a challenge, and that this would be addressed in the new specification for Health Visiting and School Nursing.
Eleanor Allen asked for more information on the red book, was there a page for each child? Officers explained that there was a page for each child and a page for Early Years practitioners. The Early Years review covered three prime areas of development - communication and language, personal development, and social and emotional development. Eleanor then asked how the reviews were undertaken. Officers said health visitors used observational assessments in the Ages and Stages Questionnaire (ASQ).
Nandini Ganesh asked what happened if children didn’t attend an Early Years setting. Officers explained that health visiting was a universal service. They covered the entire population and aimed to see all children within a local authority area by age two. The target was 100 percent coverage – in H&F the service was achieving approximately 75 percent, which was significantly higher than the average in London of approximately 65 percent. Phil Tomsett added that there were other areas where you could identify some groups of children's needs like children's centres or other Children's services.
Councillor Alexandra Sanderson asked what happened if children were missed - did the service try to track them down? Phil Tomsett said the services had access to birth data so if a child didn't attend an Early Years setting, they reached out through community champions to reach hard-to-reach families.
Councillor Sanderson asked if the reviews also looked at the parents and environment a child was being brought up in. Officers said they did also look at the family environment, including and evidence of issues with parents, maternal mood scores - there was a long list of family markers. The reviews were designed to be holistic, though they were predominantly focused on the child.
Councillor Sanderson asked if the same health visitors carried out follow-up visits. Officers said they were nearly always the same - continuity was very important.
Nandini Ganesh asked what happened with children who didn’t have red books – e.g. expats or asylum seekers. Transfers in and out of borough are managed and Officers said it was a good point and they were looking at best practice elsewhere to see what could be put in place through the commissioning specification. The Chair asked for an update on this area once a solution had been put into the specification.
Councillor Asif Siddique asked how data was shared when people moved or changed GPs. Officers explained that CLCH managed transfers in and out of particular areas. The data sets were regularly audited and very well monitored.
Councillor Lucy Richardson asked if the existing workforce knew about the upcoming recommissioning. Officers said the workforce was fully informed.
Councillor Richardson asked if decommissioning CLCH would be disruptive. Officers said they may apply and be successful in which case it was a moot point but otherwise staff would transfer over via TUPE.
Councillor Lucy Richardson asked why maternity champions had not taken off as well as others. Phil Tomsett said officers were looking into it. The new Early Years Strategy had a proposal for 'parent champions' who would take on a similar role.
The Chair noted that vaccinations rates had reduced in the borough over the past few years and it was a key concern for the committee – she asked if this would be addressed by health visitors. Andy Kimber noted that there had been a change in the way immunisations were commissioned - they used to be commissioned through Public Health but were now commissioned by NHS England, directly from NHS Trust providers. One area that the local authority could still work on was population health promotion to encourage families to change their behaviour.
Councillor Alexandra Sanderson asked if we had access to data on vaccinations. Andy Kimber said it was managed by NHS England, is published nationally and the Council could access it. It was noted that Children’s Services had commissioned Healthy Early Years London to promote healthy lifestyles to children known to services which included keeping up to date with vaccinations.
The Chair thanked officers for their update and requested an update on the new Early Years Strategy later in the year.