Education CommitteeFurther written evidence submitted by Department for Education (Annex A)

Examples of integrated delivery of services in Sure Start Children’s Centres

Case study 1 East Lancashire Health Coordinator Team—joint commissioned model East Lancashire

This is an example of a Primary Care Trust commissioning support to all the 26 children’s centres in its area. A team of four health coordinators based within Lancashire Care NHS Foundation Trust acts as the bridge between all mainstream health services, the children’s centres and well-being providers. Each coordinator covers a locality, and leads across the whole area on specific topics, such as healthy eating.

They provide mentorship on health development plans as well as training and support to centres to ensure that health activities are evidence based and delivered to high quality standards.

Outcomes:

They have led on specific projects, such as a dental access scheme which enables children’s centres to make a child’s first appointment with a dentist—this has increased the take-up of dentistry in the early years and generated over 7,000 new dental attendances. Vitamin D is distributed by all children’s centres—important in an area with a high Asian population and a growing problem with Vitamin D deficiency. Uptake of vitamin D ha shown a significant increase from 300 units pa to 18,000 pa within two years of the scheme starting.

There is also an emotional health team, comprising Infant Mental Health Workers and Drug and Alcohol Workers. This plugs the gap between universal and specialist services. Outcomes are that 60% of those completing targeted work with the team are subsequently managed back into universal provision.

Case study 2 Training cascade model, Luton

Three midwives have been seconded to Luton Children’s Centres to provide evidence based antenatal classes based on Birth & Beyond five themes (Barlow, 2010). Sessions are delivered to couples from 28 weeks of pregnancy and run over five consecutive weeks in Luton’s Children’s Centres, offering localised, universal provision and access for vulnerable groups. Each session is two hours long co-facilitated by CC Midwives and CC Co-ordinators or Family workers. The co-facilitated approach provides support to CC staff to build confidence and expertise in delivery of sections of the programme. Running the course within Children’s Centres provides an early introduction to CC services, and once parents have completed the sessions they are encouraged to integrate with Children’s Centre activities such as Bumps & Babies groups or adult education. Once their babies are born a further “week six” session is offered, a return to a Baby Babble or Baby group within the Children’s Centre to all meet at a reunion. This gives opportunity for CC Midwives to gain feedback on the content of the previous sessions and outcomes, and for parents to further develop a relationship with the Children’s Centre. Week six sessions vary according to each Centre, for example CC Dieticians may attend to give information on weaning. Follow up visits are also offered for debriefing of labour events and to gain information on key public health targets such as Breastfeeding. In order to ensure sustainability of the project CC midwives are training the Community Midwifery team to deliver sessions 1 & 2, the health visiting team to deliver session 3, and the infant feeding team to deliver session 4. Sessions 5 & 6 will be delivered by Children’s Centre outreach workers. It is expected that once staff are confident in the delivery of the programme the sessions will become part of their everyday workload, and no longer a bespoke project.

Promoting integrated practice

Case study 3 Integrated working between a health visiting team and a children’s centre The Chai Centre, Burnley

This is an example about two teams, a health visiting team and a children’s centre team, working together. The two teams share an office and co-location makes communication easier. To step across an office and talk to someone is simple, leaving messages which are returned when you are out is a laborious process.

Sharing records was a major hurdle. It took time and training to get this right, but the result is one set of records for each child.

The teams developed an enhanced version of the Healthy Child Programme, with every family receiving 12 core home visits in the first three years of life. These are enhanced by bespoke packages of care being jointly delivered to families with assessed additional needs.

Health visitors and children’s centre workers do some joint visits, particularly where the issues are more complex. Where children’s centre workers provide family support, the health visitor is always fully informed and provide on-going guidance and support to the worker.

Outcomes:

Safeguarding issues are less likely to fall through a gap and problems are spotted sooner for early intervention

Common Assessment Framework’s (CAFs) are completed holistically and efficiently with Teams around the Child/Family meetings being hosted jointly.

Health visitors have helped children’s centre staff develop their skills and the children’s centre team has helped health visitors by delivering on-going support to lower level families and working effectively in an ethnically diverse area.

The intensive outreach programme led to a dramatic increase in families accessing services at the centre and very high levels of engagement are maintained.

Integrated working has allowed the teams to use the mix of skills effectively—families are supported by the worker with the right skills and knowledge for them, freeing health visitors to concentrate on the most complex issues.

Case study 4 County-wide health initiatives Lancashire County Council

Lancashire County Council has worked strategically with the three PCT’s and children’s centres. Early Notification is a simple system for engaging families with their children’s centre at the earliest opportunity. Midwives routinely ask pregnant women for consent to share their details with children’s centres. The children’s centres then make contact to offer whatever support is needed, for example helping to sort out housing problems before the baby is born. There are processes in place to minimise the risk of centres contacting a family who has lost a baby.

From “Bump to Birth and Beyond” is a standardised six week ante-natal programme, delivered by children’s centres with input from health visitors and midwives.

Outcomes:

The impact of a coherent strategy to develop health through children’s centres is demonstrated by Ofsted judgments for the health outcomes, which are well above the national averages (Ofsted, 2011).

Integrated practice: the opportunities

Case study 5 Health visitors integrated into a children’s centre

Bowthorpe, West Earlham and Costessey Children’s Centres

This is an example of formal integration. The health visiting team is fully integrated within the children’s centre and managed by the Centre Leader, who is a social worker.

Integration is supported by shared processes, policies and protocols including the child health record keeping system, which is also shared with GPs. Ofsted singled this centre out as a model of good practice for partnership with GP’s, who are a vital part of ensuring family health and well-being but have often felt cut off from children’s centres. The Centre is currently working with a local GP practice to pilot the East of England Strategic Health Authority Systm1 Safeguarding Template prior to roll out across the whole of NCH&C’s Children’s Services in autumn 2012.

Outcomes:

Children, parents and families who are most likely to benefit from additional or intensive support are often first identified in the context of the universal health visiting service, then offered the most appropriate package of support through the multi-disciplinary team—as in the previous example, this contributes to high levels of contact with local children and families.

The whole team is trained in the Solihull Approach, so there is a coherent approach, and a strong, shared language which has enabled a freeing up of roles, a shared professional identity and created the ability to challenge others, and change and create thinking and practice.

The centre was judged outstanding by Ofsted.

NCH&C took on lead agency responsibilities for an additional number of Norfolk Children’s Centres in July 2012 and the integrated model of Bowthorpe Centre will be used as a template for the future development of these centres. As a health led centre it is planned to increase the remit of centres by the co-location and integration of our specialist children’s centres alongside universal provision.

Case study 6 Health visitor led children’s centres

Brighton and Hove, children’s centres

This is an example of full integration of health and children’s centres across a local authority. In Brighton and Hove, Children’s Centres are managed as a city-wide service, led by three Neighbourhood Sure Start Service Managers, two with health visitor backgrounds and one from social work. The entire health visiting service for the city has been seconded into the Council through a Section 75 agreement and work as an integral part of the Children’s Centre service.

The integrated children’s centre teams are led by health visitors who supervise out-reach workers. In addition there are specialist city wide teams offering specific support, for example breastfeeding coordinators to encourage initiation and sustain breastfeeding in areas of the city where this is low. Traveller and asylum seeker families are supported by a specialist health visitor and early years’ visitor post. Teenage parents are supported by named health visitors at each Children’s Centre and early years’ visitors.

Outcomes:

This model has delivered value for money, transparent and effective use of resources, and safe evidenced-based health care delivery. The impact is demonstrated through improvements in breastfeeding rates, obesity rates in reception and a sharp rise in the percentage of children living in the most disadvantaged areas who achieve a good Early Years Foundation Stage Profile score—from 33% in 2008 to 55% in 2011. Key development include focussing support on the most disadvantaged families and increasing the use of evidence based programmes including Family Nurse Partnership which will start in the autumn. The most recent Children’s Centre to be inspected by Ofsted was judged to be outstanding in every area and it noted that the health-led model plays a fundamental part in streamlining services and integrating provision. Ante-natal and post-natal services are delivered directly from the centre. As a result, the centre reaches 100% of children aged under five years living in the area. Highly effective intervention by the centre’s health partners has made an impressive impact on children’s welfare and family well-being.

Addressing barriers to information sharing

Case study 7 Example Health Visitor Early Implementer Site

Warwickshire

Birth data is shared using the “first visit” form that health visitors complete at the first baby review. On this form the parents give consent to share: the birth date; name; and address with local children’s centres. The Child Health department enters the data on the appropriate system and each month an encrypted list is sent to the data lead in the local authority, who then sends this out to all appropriate children’s centres. The children’s centres then send a “welcome” card with details of all the children’s centres’ activities to families. Children’s centres have agreed not to visit families unless a referral for services has been made—or the parents get back to the children’s centres and register for services. As an extra check, midwives and health visitors ask parents to register at children’s centres. The Trust also informs children’s centres about the total number of babies that have been born each month so that they can gauge the numbers of families not registering in their reach area.

Other information is given to Child Health from the maternity units from the 20 week scan—to inform of the total number of pregnant women in the area. This info at the moment is not shared with the CC unless again the parents-to-be require additional services and have registered with the CC.

December 2012