0-19 Healthy Child Programme �Service Delivery Model�Public Consultation

April 2024

westmorlandandfurness.gov.uk

Intro to public consultation ��The current Healthy Child Programme contract is due to end 31 March 2025 and we are redesigning the new service. We are looking to consult with the public to enable them to understand the changes and have an opportunity to comment and have a say in the new service design

westmorlandandfurness.gov.uk

0-19 Healthy Child Programme (HCP)

• The Healthy Child Programme (HCP) offers every family a programme of interventions, including screening tests, immunisations, developmental reviews, and information and guidance to support parents, children and young people to grow, develop and thrive.
• The HCP is for all, building healthy communities for families and children, reducing inequalities and vulnerabilities. It includes a range of activity from universal services for all through to intensive support.
• The HCP needs the support and contribution from a range of delivery partners such as Early Help Services, midwifery services and the community and voluntary sector to ensure there is clear, seamless offer of support for children and families.

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Our model is based on the National Healthy Child Programme Guidance (2023)

Mandated Duties (what we have to do)

The Health and Social Care Act 2012 tells us what public health services we have to provide (mandated responsibilities) for families, children and young people aged 0 to 19 years. For the HCP these include:

• ALL families with babies are offered 5 health visitor reviews before their child reaches 2 and a half years old
• Report on the delivery of these checks to government
• Deliver the National Child Measurement Programme (NCMP)

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The funding for Healthy Child Programme is part of The Public Health Grant which is set annually by central government

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Why are we changing our approach?

• The current 0-19 Healthy Child Programme (HCP) contract ends in March 2025.
• Our research (including our recent Joint Strategic Needs Assessment (JSNA)) has shown the changing and diverse needs within our communities
• The end of the current contract gives us the opportunity to think differently about how we deliver our services – it’s flexibility, accessibility and responsiveness. We want to utilise all methods of delivery including digital and outreach - building on our community assets.
• Our model aims to make the best use of our budget by prioritising the areas for delivery which we’ve identified through our data and engagement with children, young people, families and partners.
• There are significant challenges with the consistency of current delivery across the footprint and the capacity to meet the varying levels of need across the 0-19 age range.
• We have some excellent relationships with partners and integrated ways of working across the three ‘districts’, which we want to develop and embed across the whole WaF area.
• We are committed to Trauma Informed Practice and embedding this across the HCP
• Our new contract will have clear outcomes, which will demonstrate the impact and difference for children and families.

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What engagement have we already done?

• We held 6 engagements and dropped into community venues throughout W&F. We also used surveys to ask for feedback
• We have spoken to over 500 people

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• People told us:
• Help them to understand each service (pillar) and the pathways between them
• Use accessible places to meet families, more community facing
• Better communication about services and what they do
• More digital options (eg to book amend appointments,
• Better referral processes

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Our approach…..

• Our proposed model will fit within a wider system of support and will link with the wider council Family Help offer
• Our approach recognises that preventative and early help support is crucial to promoting better health, education, emotional and social outcomes in the longer term
• The HCP offer will be aligned and integrated with the Council’s wider Early Help strategy, ‘Team around the Setting’ approach and Family Hubs
• Our model recognises the importance of sharing knowledge, coordinating our approach and resolving challenges together to make sure our families get comprehensive, holistic support no matter which area they contact first or at what level of need.
• The service will be embedded within wider pathways of support with clear roles and expectations regarding health and wellbeing needs.
• As a Council we are committed to ensuring that the HCP is supported by wider council proprieties such as Housing, Transport and Community Power.

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The 3 pillars of our model

• We have chosen to split the model into 3 ‘pillars’:
• 0-5 Health Visiting
• 5-19 Public Health Nursing
• Strengthening Families

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• There will be clear links and pathways between the pillars
• Each pillar will have a balanced skill mix so we are using the expertise and capacity where needed.
• For example, increased Child Development Practitioner role to provide universal outreach and low level, targeted packages of support (with oversight from HV or 5-19 Public Health Nurse).

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0-5 Health Visiting Service�

Level of Need:

• Covering all 0-5 children (where there is no additional health need identified requiring

additional support from Strengthening Families (see further slides))

• Child Protection where there is no additional health need identified requiring

additional support from Strengthening Families

• Will offer both universal and targeted interventions

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Priority areas :

• Mandated contacts and routine checks
• Attachment and bonding
• Infant Feeding
• Child Development including toileting, weaning, behaviour, sleep,

home learning environment

• Developmental delay and SEND early identification
• Speech, language and communication identification
• School Readiness
• Healthy Lifestyles including weight
• Oral Health
• Parental mental health
• Bereavement/ Care of Next Infant (CONI) support

How we will deliver the health visiting service:

• Family Homes
• E-Health Visitor
• Libraries, Family Hubs, GP practices etc
• Outreach into communities utilising existing groups
• Team around the Settings i.e. via Nursery's

Timeline and by whom

6 – 9 month contact

6-8 week Visit

2-2.5 year old visit

12 month Visit

School Readiness contact at 3-4 years

Health Visitor led unless identified by midwifery as vulnerable and will then be Strengthening Families

Delivered by Child Development Practitioners unless additional needs identified

Delivered via group sessions by Child Development Practitioner

Each mandated contact will promote all Public Health messages – attachment, safer sleep, safety, infant feeding, parental mental health, ICON, CONI, healthy weight, physical activity, oral health, Immunisations, home learning, cost of living etc.

Each mandated contact will use relevant assessments i.e.:

• Ages and Stages 3 – Development AND Social Emotional assessments
• Schedule of Growing Skills will be used when potential additional needs
• Safer sleep assessments
• Edinburgh Post Natal Depression Scale

Each mandated contact will cover expected checks i.e. growth, hearing, blood spot etc as per the Healthy Child Programme and set out in OHID specification and also Safeguarding, Neglect assessments as per Cumbria Safeguarding Children Partnership

18 month month contact

0-5 Health Visiting focus areas

5-19 Public Health Nursing including National Child Measurement Programme (NCMP)

Level of Need:

• Early Help where there is a health needs identified

(and no other health professional identified/engaged)

• Health needs which prevent accessing education (non-clinical)

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Priority areas :

• Transition – all stages 5-19 where there is a health and wellbeing need
• Healthy Weight offer
• Healthy Relationships including Sexual Health
• Continence
• Health Care Planning (not delivery)
• Advice and support for Health issues (non-clinical)
• ‘Healthy School offer’ including Training offer
• National Child Measurement Programme (NCMP)

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How we will deliver 5-19 Public Health Nursing:

• E-School Nurse – extended offer
• Team around the Schools/settings
• Family Hubs
• School outreach

5-19 Public Health Nursing focus areas

Strengthening Families�

Level of Need:

• All vulnerable Antenatal identified from 12 weeks onwards (including young parents, parental SEND, Care experienced)) will keep on caseload until appropriate to transfer to HV
• Complex Early Help cases 5 -19 where there is a complex health need identified (and no other health professional identified/engaged)
• All Child in Need/Child Protection (CP) at 5-19 where there is an identified health need (and no other health professional identified/engaged)
• CP at 0-5 ONLY when there is an identified health need (otherwise to remain with the HV)

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Priority area

• High levels of need and vulnerability
• Families living with high numbers of ACEs, mental health and resilience issues, attachment disorders and presenting behaviour difficulties.
• Evidence based interventions responding to individual needs
• Liaising with and linking other services
• Targeted trauma informed health assessment, advice and packages of support
• Understanding of impact of parental wellbeing on their child’s development
• Enhanced attachment interventions
• Listening visits to support maternal mental health
• Enhanced monitoring of developmental progress
• Emotional development, regulation and resilience enhanced support

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Delivery mechanisms:

• Family Homes
• Other settings as appropriate
• Intensive number of visits
• Enhanced packages of care enabling more intensive support for individuals

Strengthening Families focus areas

So, what's different?

• Priority areas based on data – focus on improving outcomes
• Clarity of service offer including boundaries and limitations
• Increased universal offer through additional community outreach
• Improved on antenatal offer including vulnerable antenatal pathway
• Increased capacity for 5-19 Public Health Nursing to offer Early Help support
• Refocus of Strengthening Families – utilising expertise earlier to prevent escalation and offering support for 5-19.
• All 0-5 cases which are not with Strengthening Families will remain on HV caseload
• Skill Mix –utilising and increasing capacity at different Grades/Bands to make the most of skills and expertise across 0-19 HCP
• Improved technology enabling better use of time
• Improved healthy weight and oral health offer

Proposed consultation questions

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1. To what extent do you agree with our reasons for changing our approach to HCP?
2. To what extent do you agree with the aims we have identified for the new HCP service?
3. We identified 5 focus areas for the 0-5 Health Visiting Service pillar of the HCP. To what extent do you agree with the proposed delivery of each of the areas:
1. Early Years
2. Parenting/ relationships
3. SEND
4. Health and wellbeing
5. Emotional wellbeing and mental health
4. We identified 6 focus areas for the 5-19 Public Health Nursing (including National Child Measurement Programme) pillar of the HCP. To what extent do you agree with the proposed delivery of each of the areas:
1. Early Years
2. Parenting/ relationships
3. SEND/ Health needs
4. Health and wellbeing
5. Emotional wellbeing and mental health
6. Whole school
5. We identified 5 focus areas for Strengthening Families pillar of the HCP. To what extent do you agree with the proposed delivery of each of the areas:
1. Early Years
2. Parenting/ relationships
3. SEND
4. Health and wellbeing
5. Emotional wellbeing and mental health
5. Do you have any other comments?