Memorandum submitted by Westminster City Council

 

Summary of submission

 

· Outreach has been central to the success of Westminster's Children's Centres (Paragraph ii)

 

· The targeting of Children's Centre services to the most vulnerable groups needs to be systematic and involve both health colleagues and a dedicated outreach service. This work needs to be scrutinised to ensure that robust systems are in place. This work will form a key component in the early identification of children with additional needs. (See paragraph ii & iii)

 

· There could be better guidance from the DOH on the role of health in Children's Centres, which would reduce lengthy, time consuming negotiations at local level about commitment. Community health service partners, particularly health visitors, seem split between the needs of General Practitioners (GPs) and Children's Centres. (See paragraph vi)

 

· Develop a 'joined up' response to attainment at foundation stage and this could be achieved by linking more closely the connection between the child health surveillance programme undertaken by health visitors and the Foundation stage outcomes (paragragh v).

 

· Effective leadership is key to successful integrated working both at a local and strategic level. Too much emphasis is still placed on line management rather than leading multiagency teams. The NPQICL has gone some way to address this but there needs to be a similar qualification for local authority strategic managers (paragraph vii).

 

 

Jayne Vertkin

Head of Children's Centres Development, City of Westminster

 

 

This submission focuses on your question about 'whether services are being accessed by those most in need and how effective they are for the most vulnerable'

 

I. Case Study evidence from our local area and conversations with parents suggest that Children's Centres can transform the lives of families with very young children and in so doing give children a richer pre school experience. Much of this evidence suggests that it is the benefits of outreach together with integration and colocation that result in a better experience for families. For this to be robust and available to all families the work of Children's Centres needs to be underpinned with effective leadership as well as systems that can identify the most vulnerable children as early as possible.

II. Reaching the most disadvantaged families. Experience in Westminster has demonstrated that a dedicated outreach service is central to effectively engaging families and reaching those whose children may not have benefited from early pre school experiences. Outreach work acts as the gateway into and between services. It provides families with the opportunity to make those initial contacts on their terms and in settings where they feel most comfortable. However, it is only effective, when inter connecting systems are developed with local health visiting teams. In Westminster, a core offer for outreach has been developed that defines what will be offered to all families and details the communication systems between health visitors and outreach teams. In essence, the health visiting team undertake a new birth visit and at this visit offer families the service of the outreach team. This generates a 1^st outreach visit at 6 - 8 weeks and subsequent visits dependent on need. Outreach is well evaluated by parents and there is some case study evidence to suggest that it contributes to earlier identification of need, particularly in the area of domestic violence, where families have access to outreach workers who speak their community language. Westminster has just commissioned a more robust evaluation of outreach to determine the impact on early intervention. The mid way report on this evaluation will be available in early December.

III. Intervening early. A monthly Early Access and Support team meeting (EAST meeting) has been established around each Children's Centre in Westminster. It is attended by the Children's Centre manager, health visitor, outreach worker, midwife and children's centre social worker. The aim is to identify as early as possible parents who begin to disengage with services and consequently reduce their child's pre school experiences. The meeting has a fixed agenda, which considers new birth visits relevant to the last month, feedback from outreach visits, families not attending for initial checks or immunisations, any children with a disability (all children 0-5 years within the catchment area should be identified by the centre), any changes to children subject to a Child Protection plan, families new to the area, Children aged 3 - 4 years not accessing any pre school care / education, 'no further action' families from Duty and Assessment Team and Review actions from previous meetings.

IV. There needs to be more emphasis on work force development both at a local authority and national level in relation to reaching the 'harder to engage' families. Practitioners need to be equipped with skills to break generational cycles of deprivation and associated habits, which is not currently provided in professional training. A whole systems approach across a local area to training staff in motivational interviewing and the use of effective intervention tools is needed.

V. Developing a 'joined up' response to attainment at foundation stage.Children's Centres have a unique opportunity to contribute to raising attainment at foundation stage. Currently, there is not a whole systems approach to this work, it is seen as the responsbility of education and yet the work of health visitors is vital in nurturing the parent child relationship and in promoting early language development and play. The child health surveillance programme undertaken by health visitors could be more closely linked to outcomes at foundation stage. Health visitors who identify children at risk of minimal pre school experiences needs to work in partnership with the local Children's Centre, who can offer an intensive home visiting programme.

VI. Health involvement in Children's Centres. Health visitors need to be an integral part of Children's Centres if we are to reach the most vulnerable families and yet there are real tensions for them between work in Children's Centres and GPs. Local GPs still want health visitors to undertake child health clinics in their surgeries that are poorly attended and time consuming. GPs see the health visitor as belonging to their surgery. The shift surely has to be to GPs being linked to their local children's centre (that can offer a range of support including a health visitor) rather than to one local health visitor.

 

VII. Effective leadership is key to successful integrated working both at a local and strategic level. Too much emphasis is still placed on line management rather than leading multiagency teams. The NPQICL has gone some way to address this but there needs to be a similar qualification for local authority strategic managers.

 

Jayne Vertkin

Head of Children's Centres Development

October 2009