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Cabinet Member for Community Wellbeing

July 2016

Ref No:CW0116-17

Healthy Child Programme (0-19/25)

Key Decision: Yes

Report by Executive Director Care Wellbeing and

Education and Director of Public Health

Part I

Electoral Division(s):

All

Executive Summary

The Healthy Child Programme (HCP) for ages 0-19/25 is a public health programme starting during pregnancy and continuing throughout the early years and school life of children and young people.

West Sussex County Council (WSCC) has had responsibility for commissioning of the HCP

(5-19) since 2013. Commissioning responsibility for the HCP (0-5), including the Family Nurse Partnership (FNP), transferred to the Council on 1 October 2015 from NHS England. Current contractual arrangements expire on 31 March 2017. A comprehensive stakeholder engagement process has taken place to inform the redesign of a vision and

future service model.

This paper recommends that the Council seeks a collaborative partner by competitive procurement to deliver and lead the HCP (including the FNP) and to work with the Council on the future design of these services as part of an Integrated Prevention and Early Help

(P&EH) service. The detail of that integration model and the financial and service implications will be the subject of reports and member decisions scheduled for Autumn 2016 so as to inform the proposed co-design work.

Recommendations: (1) That the Cabinet Member agrees to the commencement of a competitive

procurement exercise to secure a collaborative partner to deliver and lead the HCP

in West Sussex and to work with WSCC to co-design an Integrated P&EH service. The new contract will commence on 1 April 2017 for an initial period of 5 years with the option to extend up to 2 further years. The total estimated value of the services to the Council over the whole of the potential 7 year contract period is £76,813,000;

and that (2) authority is delegated to the Executive Director Care, Wellbeing and Education to

award the contract to the bidder submitting the tender which best meets the

requirements set out in the report; and that (3) work is undertaken to inform future decisions on the detail of a co-designed service

that includes options for the arrangements for service scope, structure, workforce

and costs associated with the transfer of the current workforce.

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1. Background and Context 1.1 The Healthy Child Programme (HCP) 0-19 is a research-evidenced population-

based public health programme starting at conception and continuing throughout the early years and school life of children and young people. It contributes to the Future West Sussex ambition that all children and young people are given the best start in life so that they are able to reach their full potential. It is also a driver for

the Health and Wellbeing Board priority for improving outcomes for 0-2 year olds. It is a progressive universal service, meaning that all children and young people aged 0-19 (and up to 25 for children with special educational needs) should receive the programme with, those that need it, receiving more targeted and

specialist provision (see below). WSCC has had statutory responsibility for the commissioning of the HCP (5-19) since 2013. Commissioning responsibility for the HCP (0-5) transferred to the Council on 1 October 2015 from NHS England. The current contractual arrangements for the delivery of the HCP expire on

31 March 2017. The progressive universal Healthy Child Programme

1.2 In West Sussex, the HCP is currently delivered via two WSCC contracts with

Sussex Community NHS Foundation Trust - one for health visiting as well as the FNP (a targeted programme supporting pregnant teenagers and young parents) and one for school nursing. The total value in 2016/17 is £13,249,000.

1.3 Guidance from Public Health England1 states “whilst recognising the contribution of

other partners, there will be some elements which require clinical expertise and knowledge that can only be provided through services led and provided by the

1 Best Start in Life and Beyond: Improving public health outcomes for children, young

people and their families (2015), Public Health England.

Increasing

need of

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public health nursing workforce, i.e. health visiting and school nursing teams.” The guidance also recognises the opportunities that local authority commissioning of the HCP provides to strengthen public health delivery through other services to improve

public health outcomes for children and young people.

1.4 In West Sussex a comprehensive service review and redesign of the HCP has been undertaken. The purpose of the review and redesign has been to engage with stakeholders as to what is currently done well in programme delivery as well as to

identify ways to improve outcomes for children, young people and families in the future.

1.5 Local data and demographics information has been collated and is included by way of additional background information in Appendix 1a.

1.6 Current Service – in scope of redesign:

1.6.1 The HCP 0-5 is based on the ‘4, 5, 6’ model, describing 4 levels, 5 mandated visits (until April 2017), and 6 high impact areas (see diagram below). The current national service specification for HCP 0-5 is based on this model. The HCP 0-5 is currently

delivered by the health visiting workforce, predominantly trained health visitors but with some skill mix. The numbers of health visitors in any particular area was subject to a Government Call to Action2 2011-2015 and at that time West Sussex was expected to employ 172 whole time equivalent health visitors to deliver the model

below.

1.6.2 The FNP is a voluntary home visiting programme for first time young mothers, aged 19

or under (and involving fathers). A specially trained family nurse visits regularly and provides targeted support from early in pregnancy until the child is two, with the aim of improving outcomes for both parents and child.

1.6.3 The HCP school entry to 19 years is the universal public health programme for all

children and families. It consists of a schedule of reviews offering all children from school entry to school leaving age a programme of screening tests, immunisations, health reviews and advice regarding healthy lifestyle choices. The HCP covers children

who are resident in or attending maintained schools and academies in West Sussex. In 2015

Public Health England published a proposed 4, 5, 6 model for the HCP (5-19) (overleaf).

2 https://www.gov.uk/government/publications/health-visitor-implementation-plan-2011-to-2015

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2 Consultation

2.1 Stakeholder engagement has underpinned the HCP service review. An Early Years Needs Assessment3 was carried out in 2015 to inform the HCP service review.

This combined qualitative and quantitative methodologies.

2.2 As part of the HCP review and redesign a stakeholder engagement process was undertaken. This was wide ranging, and reached over 700 people (children, young

people, parents, carers and professionals in district and boroughs, town and parish councils, voluntary sector and other internal and external partners) through face to face contact and online surveys4.

2.3 The table set out in Appendix 1b summarises the findings of the Early Years Needs

Assessment and HCP stakeholder engagement process.

2.4 The messages about change were clear and asked that any new model:

Develops transparent pathways, clear referral criteria, a single point of access (at sub-safeguarding level) and a lead professional role to coordinate support

and services. Improves information sharing between professionals. Maintains a progressive universal model with enhanced support at all transition

points.

Increases support for emotional health and wellbeing need. Develops school-based health services and enhance the Find It Out model. Provides consistent local information online, to enable access out of office hours,

and clarity about service pathways.

Contributes to a reduction in inequalities, particularly those related to deprivation.

2.5 Members - Notification of the HCP engagement was included in the Members’

Information Service and the process and emerging model were scrutinised at a joint meeting of the Health and Adult Social Care and Children’s and Young People’s Services Select Committee in April 2016. The Cabinet Member for Community

3 West Sussex Early Years Needs Assessment Summary - Final Version.pdf 4 HCP Survey Parents Carers.pptx HCP Survey Professionals.pptx HCP survey results potx.pptx

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Wellbeing has been provided with regular written and face to face briefings and the Cabinet Member for Children - Start of Life (current and previous) was also briefed on a monthly basis. The survey links were sent to all members of the West Sussex

Health and Wellbeing Board and to relevant Cabinet leads. 3. Proposal

3.1 The proposal is to commence a competitive procurement exercise to identify a collaborative partner to work with WSCC services, stakeholders and families to co-design the delivery of the services that are to be procured so as to address the issues raised above and to help prepare for an Integrated P&EH service and to lead

the clinical delivery of the HCP in West Sussex. The offer will span children and young people -9 months (from conception) to age 19 (25 for those with special educational needs).

3.2 Others contributing to the co-design and eventual delivery of an Integrated P&EH

service will include the following WSCC services: Children and Family Centres, Early Help and Young People’s Services. The HCP collaborative partner will be expected to share the values and principles set out in the service specification for the HCP which reflect the intention to develop a more holistic Integrated P&EH service. All

parties to the service offer will commit to working towards improving shared outcomes and value for money. A further report leading to a separate decision by the Cabinet Member later in the year will set out the detail of the integration proposals and their consequences and impact.

3.3 The governance of the contract will comprise of two boards - a partnership board and operational/delivery board which will be in place for the contract period. There will also be a mobilisation/transition board in place shortly after contract award up to the service commencement date. Both the Council and the Service Provider will

be represented on these boards (with options to include other providers if appropriate, for example midwifery services). The mobilisation and later the delivery/operational board will report to the partnership board which will offer strategic oversight and direction setting (in the context of the Integrated P&EH

service developments), review performance against outcomes and be the point of escalation for the other boards. The delivery/operational board will discuss, consider and monitor operational aspects of the contract and developments towards the Integrated P&EH service model. It will monitor progress against the service

levels/KPIs and maintain a risk register. The operational board will work to identify operational issues which support or impede collaborative working. Terms of reference will be drawn up for each board.

3.4 Following an options appraisal it is recommended that a “Light Touch” procurement

is followed to secure the HCP clinical delivery and leadership thereof. The services to be procured are classed as “Light Touch” services under the Regulations. The current EU threshold for “Light Touch” services is £589,148. Where a “Light Touch” contract exceeds the threshold a limited number of the Regulations will apply. The

“Light Touch Regime” means a procurement which complies with the principles of transparency, equal treatment, non-discriminatory, mutual recognition and proportionality.

3.5 The Council has an obligation as a best value authority under section 3 of the Local Government Act 1999 to “make arrangements to secure continuous improvement in the way in which its functions are exercised, having regard to a combination of economy, efficiency and effectiveness.” Compliance by the Council with its own

Standing Orders and the requirements of the Public Contract Regulations 2015 in tendering for the services will assist to satisfy the best value duty.

3.6 The financial envelope is described over the contract duration with expected efficiencies to be generated through more integrated service delivery, clearer

pathways and better information sharing between services. There is no intention for the contract value to be index linked to inflation. The procurement will use the “most economically advantageous tender (MEAT)” criterion enab ling the authority to

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take into account key aspects of the requirements and outcomes that reflect the qualitative, technical and sustainable aspects of the tender submission, as well as price, when reaching an award decision. Further development of the specification

and commercial model will inform the exact high level weighting, and sub-criteria will be shaped against the outcomes required to identify the most suitable collaborative partner.

3.7 A service specification setting out the requirements of the public health nursing

service to deliver the HCP in West Sussex is being developed. In it, the term “public health nurse” is used to describe children and families’ public health nurses (health visitors) and young people’s public health nurses (school nurses). While these terms are well known, their public health remit can be under-utilised, and

their role is age restricted. The broader term “public health nurse” sets out the intention to strengthen the public health delivery of this workforce and to work with the collaborative partner to remove the silos that age restrictions can place on service delivery, thereby supporting transitions in work with families. A skill mix in

HCP delivery will continue to underpin the service model, with the clinical leadership being provided initially by public health nurses employed by the provider. The service specification will also describe the qualities of collaborative working expected in the provider including commitments to co-design and user engagement

and participation.

3.8 It is envisaged that the Integrated P&EH service (including HCP) will be delivered through locality based community hubs by an integrated workforce including public health nursing. The fundamental feature of the Integrated P&EH service will be

whole family working, and intervening early and at the earliest opportunity. The detail of these aims and how they can best be delivered will be the subject of a further decision for consideration by members.

3.9 In line with national guidance and research evidence, many elements of the delivery

of the HCP are best undertaken by nurses with public health training. Other elements can be delivered by professionals in integrated teams with support and leadership of key elements provided by public health nurses.

3.10 The service specification will set out what the Council requires the partner provider

to deliver to improve outcomes for children and young people and their families in line with the HCP high impact areas.

3.11 The HCP stakeholder engagement demonstrated clear gaps in information sharing and transitions across services for children and young people. Over the course of

the collaborative partnership, partner(s) will work together to ensure that information sharing is strengthened as part of the developing integrated model.

3.12 The Integrated P&EH service, with HCP delivery at its core, will require a public health nursing workforce that is flexible and dynamic and that fits around the needs

of the child(ren) and family. Dual qualified midwives and health visitors or health visitors and school nurses would enable professionals to be responsive to family need and transition. In line with national guidance we will require public health nurse prescribers (i.e. nurses who are able to prescribe from a controlled list of

medications). Leadership and delivery of the core elements of the HCP will, at least initially, continue to be by a public health nurse (health visitor, school nurse or dual qualified). Integrated teams and development of a Make Every Contact Count

(MECC) approach as part of workforce development will drive coordinated and consistent approaches to improving public health outcomes across the programme.

3.13 The new contract for a collaborative partner will have a commencement date of 1 April 2017 with an initial period of five (5) years, with the option to extend up to a

maximum period of seven (7) years.

3.14 A timeline has been developed for procurement to allow for the new contract to be awarded and a four month mobilisation period. Bidders will be required to submit a mobilisation/implementation plan as part of their tender to ensure there is no gap

in service delivery.

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3.15 The ambition for flexibility, integration and continuous development and efficiencies will be defined in contract documents to create a clear and effective pathway for both the Council and provider. Reasonable adjustments to the size and scope of the

contract will be included in the contract and procurement, in line with regulation 72 of the Public Contract Regulations 2015 regarding modification of contracts.

4. Other Sourcing Options Considered

4.1 Services delivered in-house by WSCC:

4.1.1 The option for WSCC to wholly (or in part) deliver the HCP in house has been considered as not appropriate at this time. The following risks or challenges meant

that this option was not considered further:

i. The liabilities that WSCC would be responsible for, from “in-sourcing” including TUPE transfer costs, pensions and redundancy payments.

ii. Increasingly, delivery of these services requires innovation and technological

solutions which external partners are better placed to provide. iii. Given the time and investment required to establish this service in house it is

unlikely financial savings would be delivered in years 1 and 2, therefore building pressure on year 3.

4.1.2 Discounting this option does not preclude the Council, within the recommended approach, from integrating services delivered in-house or increasing or developing further in-house delivery through the life of the contract.

4.2 Other sourcing options were considered at an exploratory level to identify whether

arrangements for service provision through arrangements other than the proposed open procurement route were viable or appropriate. No such options were pursued further.

5. Resource Implications and Value for Money 5.1 A commercial model for this procurement is being developed. It will take into

account the total cost of delivering the services, as well as using the redesign,

stakeholder and market engagement to design commercial evaluation criteria and methodology to ensure that the “most economically advantageous tender” and high quality is identified, meeting immediate financial priorities but also future fiscal challenges. The HCP is funded through the Public Health Grant. There are annual

reductions in local authority allocation from Public Health England until 2019/20, necessitating reductions in local spending.

5.2 It is proposed that the provider relationships with WSCC will start to operate from the point of award (planned for November 2016) via the mobilisation plan before

the formal start of the new contract on 1 April 2017 to enable joint priorities and outcomes to be developed and the co-design of integrated provision to begin.

5.3 The HCP service redesign has been conducted in the context of needing to achieve improved outcomes along with increased value for money. The proposed

development of an integrated model will achieve savings through a reduction in duplication, streamlined pathways, integrated management structure, development of skill mix and improved prevention.

5.4 The specific and unique qualities of the HCP are the focus on primary prevention and promotion of resilience and wellbeing in families. Over time the model will improve prevention through early identification through universal engagement and the earliest intervention to either directly support families or ensure they are able

to help themselves. This will reduce the number of complex issues arising later that would otherwise cost the Council and wider health economy more.

5.5 The more we can help families to be resilient and enable them to help themselves and know where to access support when they need it, the less draw there will be on

the Council’s services. It is anticipated that there will be an impact on improved

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education attainment, particularly readiness for schools, youth offending, emotional wellbeing of parents/carers and therefore their capacity to be strong and effective parents promoting good attachment.

5.6 The merging of the Health Visiting and School Nursing contracts into one presents an opportunity for efficiencies around the support functions of the contracts (IT, contract management) , and will enable the provider to achieve economies of scale on managing and running a single contract.

5.7 The HCP 0-19/25, including the FNP, is funded from the Public Health Grant. The budget in 2016/17 is £13,249,000 inclusive of £270,000 planned in-year savings to be met by the current contract. The £270,000 savings are part of the £1m of planned Public Health savings to be delivered by 2019/20.

Financial Year

Proposed

Contract Efficiencies

Total potential contract value

(2017/18

budget for 5+2)

2017/18 13,249,000 - 1,300,000 11,949,000

2018/19 11,949,000 - 930,000 11,019,000

2019/20 11,019,000 - 250,000 10,769,000

2020/21 10,769,000 10,769,000

2021/22 10,769,000 10,769,000

2021/22 10,769,000 10,769,000

2022/23 10,769,000 10,769,000

-2,480,000 76,813,000

5.8 The proposed financial envelope for the procurement for a collaborative partner to provide HCP clinical leadership is £55,275,000 for 5 years with an option of

additional 2 years (£76,813,000 over the potential 7 year period). The financial modelling for this procurement and subsequent contract sees an initial reduction in available budget with an expectation of generating savings of £2.480m to be achieved within the first 2-3 years, including the remainder of the Public Health

Grant planed savings of £.73m. The collaborative partner will be obliged to work with the Council to identify options for further efficiencies, savings and financial remodelling throughout the life of the contract.

5.9 The £1.75m (£2.48m - 0.73m) of new savings for the provision of the HCP generated from the procurement will be used to mitigate pressures in the Children’s Start of Life Portfolio by funding the Children’s Early Help services that contribute towards the Council’s Public Health priorities and which meet Public Health Grant

Conditions. The procurement will not provide funding to help manage the Public Health Grant reductions due in future years.

5.10 Any savings arising from the co-design work to develop an Integrated P&EH service

outlined in paragraph 3.2 above will be in addition to the £2.48m savings outlined above.

5.11 An outcomes framework is being developed and will be available at the point of

Invitation to Tender. This will enable the monitoring of progress in achieving improved outcomes for children, young people and families, as well as measuring impact at programme and service level while also seeking improvements in performance. This will be supported by key performance indicators in the service

contract.

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6. Impact of the Proposal 6.1 An Equality Impact Report has been compiled and is attached as Appendix 2.

6.2 The proposal will seek to address inequalities and ensure equitable provision of services in the future. No detrimental impacts are anticipated.

6.3 Social Value:

6.3.1 Relevant economic, social and environmental benefits have been considered as part

of pre-procurement activity because the new service contract will be above the EU Threshold (£164,176). The new service contract will support delivery of the Future West Sussex vision to Give Every Child the Best Start in Life.

6.3.2 The redesigned service model will require significant human resource to deliver,

whilst the services themselves deliver social benefit to the Council’s residents and communities. It will be part of the evaluation criteria that all bidders offer additional social benefits to West Sussex, linked to the subject matter of the contract. These could include employment opportunities, skills and apprenticeships,

additional community engagement as well as increasing resilience and effectiveness of other services through integration.

7. Risk Management Implications

7.1 That the recommended approach does not attract any bids: this has been mitigated

to some extent by market engagement to gain interest in the Council’s redesign and approach, and has confirmed to the Council that a number of potential partners

exist. The specification is designed to be outcome based, and award criteria will not be so prescriptive or onerous as to make the ability to offer a solution unviable.

7.2 That the recommended approach does not identify a provider who meets the partnership qualities required by the Council: the criteria for selection and award

will need to be designed to, as far as is possible, identify a partner who is partnership and outcomes focussed, collaborates with the Council, children, young people and parents, and is flexible to new ways of working, changes to delivery and can make continuous improvements and efficiencies.

7.3 That the financial savings required from the service are not delivered: competitive procurement, combined with a redesign of services, most efficient interventions and use of resources is the best way to drive savings. An affordability cap will be included in the commercial model for the tender to ensure savings are met and

partnership working will greatly enhance the ability of the Council to reduce impact on the quality of the service.

7.4 That the HCP element of the Integrated P&EH service does not deliver the anticipated improvements in service quality and delivery: the contract and

partnership will be defined and governed in such a way as to reduce this risk.

7.5 That due to one or a combination of the above, the Council is unable to award a contract: this will require contingency in the form of an emergency waiver proposal to vary or extend the current contracts for a short period whilst a review of

objectives and procurement strategy is undertaken. This would however present its own risks to the Council. To help mitigate this risk a competitive procurement exercise should commence as soon as possible.

7.6 Impacts on the local health economy: reducing budgets, both within the Council and amongst NHS partners will have an impact on the local health economy, both at employment and skills level and potential increased knock-on pressure on other related social services. A partnership approach, which is aligned to meeting

common objectives, outcomes and challenges and where the partners co-operate towards this aim is more likely to cushion these impacts.

7.7 Reduction of the Public Health Grant over and above anticipated levels: funding for the HCP is via the Public Health Grant. This is a potential risk for all services funded

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through the Public Health Grant and is being managed at director level within WSCC.

7.8 There may be a risk that the selected partner provider does not deliver: this will be

mitigated by having in place a robust contractual agreement which will contain implementation/mobilisation planning, governance and performance monitoring arrangements.

Avril Wilson

Executive Director Care, Wellbeing and Education Dr Nike Arowobusoye Director of Public Health

Contact: Tanya Procter, 0330 22 22352 / 07736 126 060

Background Papers

Healthy Child Programme Report of Stakeholder Engagement

Appendix 1 - attached below

Integrated Prevention and Early Help – vision on a page

Includes service data (1a) and summary of stakeholder feedback (1b)

Appendix 2 - attached below

Healthy Child Programme Equality Impact Report

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Appendix 1 - Integrated Prevention and Early Help Vision on a Page

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Appendix 1a - Local Data and Demographic Information

Within West Sussex there are 198,800 children aged 0-19, which represents 22.5% of the population of the county. Of these, 12.1% are defined as living in poverty. West Sussex compares favourably with other local authorities and England overall on most public health measures, but there are considerable differences within the county and patterns of inequality persist. Of relevance to the Healthy Child Programme:

Quarterly data is released by PHE on breastfeeding prevalence at 6-8 weeks. For West Sussex, data for breastfeeding at 6-8 weeks falls below the 95% quality standard, with breastfeeding status known for 82.3% of infants. As such, these estimates should be viewed with caution as they may be subject to a high degree of change over time, and may not capture a representative sample of the population. Of the 1,842 infants whose breastfeeding status was known, 39.5% were exclusively breastfed and 15.6% were

partially breastfed at 6-8 weeks in West Sussex (total partially or exclusively breastfed = 55.0%) during quarter 3 of 2015/16. Whilst this figure is above the estimate for England5 (42.2% partially or exclusively breastfed), a greater proportion appears to be made up of infants partially breastfed in West Sussex, than national data might suggest (12.9%).

Immunisation against measles, mumps and rubella is above the 90% recommended level in West Sussex (91.3%), although at GP

practice level there is significant variation with coverage of both doses of MMR by age 5 ranging from 81.5% to 98.7% (where estimates are reliable).

In 2014, the teenage conception rate of young women in West Sussex was 18.2 conceptions per 1,000 women aged 15-17; this is significantly below the national rate (22.8 per 1,000 women aged 15-17). However, variation does exist at smaller geographies, for

example the under 18 conception rate in Crawley (24.9) and Arun (25.4) is significantly higher than in Horsham (12.4 per 1,000 women aged 15-17). At ward level, in 2011-13, a small number of wards in West Sussex significantly exceeded the national rate of under-18 conceptions (England – 27.6 per 1,000 women aged 15-17 years). The wards Orchard and River in Arun, Bewbush in Crawley, and Central and Heene in Worthing had significantly higher under-18 conception rates than the national average.

There are higher rates of hospital admissions for accidents and injuries (15-24 year olds) and self-harm (10-24 year olds) in West Sussex than the England average. For example, five of the seven district and boroughs within the county have a rate of admissions

5 Note. Comparisons are descriptive only as confidence intervals cannot be computed at local authority level where data quality is impaired.

National estimates only include those data from local authorities who passed stage 1 validation, see: https://www.gov.uk/government/statistics/breastfeeding-at-6-to-8-weeks-after-birth-2015-to-2016-quarterly-data for more information.

In 2014/15, 9.6% of pregnant women smoked at the time of delivery in West Sussex. This is significantly lower than the England average (11.4%), but there is variation across the county.

A lower than average proportion of children are judged to have achieved a good level of development (school readiness) at the end of the foundation stage of school with 63.5% achieving this milestone compared to 66.3% nationally. In particular, gender and deprivation are associated with poorer outcomes. For example, 55.0% of boys in West Sussex were judged to have a good level of development compared to 72.9% of girls in 2014/15.

Obesity rates at 4-5 (7.3% obese, 19.7% excess weight) and 10-11 (15.9% obese, 29.4% excess weight) are consistently below the national average, but these countywide figures mask considerable geographical variation. For example, in 2014/15 prevalence of obesity for 4-5 years olds in Arun (10.2%) was almost double that of Chichester (5.7%). In addition, prevalence of obesity for 10-11 year olds in Crawley (20.9%) significantly exceeds the county as a whole (15.9%).

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caused by unintentional and deliberate injuries in young people (aged 15-24 years) that significantly exceeds the national rate (131.7 admissions per 10,000 population aged 15-24).

The admission rate of young people aged under-18 admitted to hospital with a condition wholly related to alcohol is similar (32.6 per

100,000 population aged under 18) to the England average (36.6 per 100,000 population aged under 18).6

The National Troubled Families initiative has defined that 4,060 families in West Sussex have a range of multiple needs that should be addressed by 2020.

Currently 77% of the 0-2 year old population are registered with Children and Family Centres and 65% are regularly using centres.

6 www.chimat.org Child health profile 2016

Initial research in West Sussex shows there is a small but significant cohort of women who have more than one baby removed into Children’s Social Care. Interviews with the women highlights clear overlap in life circumstances, enabling both those who have

already had more than one baby removed, as well as those at risk in the future to be targeted with support.

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Appendix 1b - Responses to Stakeholder Consultation

What works well – HCP What works less well – HCP

The Family Nurse Partnership was viewed very positively by service users and professionals alike.

Only 30% of West Sussex teenage parents are supported by the FNP; there is currently no consistent pathway for the other 70%.

The universal element offered by the HCP is viewed as a

strength, particularly for the 0-5 year old elements. Health visiting teams view themselves, and are seen by others, as the early eyes and ears of the children’s workforce.

There is no universal health provision between age 2½ and school

entry.

There is no commissioned HCP provision in West Sussex special

schools, for young people over 16, or those attending private schools or being home educated.

Health visiting teams currently only have an identification role in the perinatal mental health pathway. Intensive home visiting by professionals and facilitated self-help may be beneficial in preventing

and alleviating perinatal mental health problems, and group based parenting programmes can also help when delivered alongside another form of treatment7. The biggest barrier to providing better support to women experiencing poor mental health in the perinatal period is the

low level of identification of need.8

The current and potential role of school nurses is poorly understood. This is, in part, a reflection of a decrease in numbers in recent years and of the high proportion of school nurse team time taken up with

safeguarding.

What works less well – services for families, children and young people

Building resilience and emotional health and wellbeing, including maternal mental health, were the single biggest areas of unmet need.

There continue to be gaps in information sharing and information is not always shared effectively between professionals. Professionals

can rely on relationships with colleagues rather than following agreed processes in a consistent way.

7 Rapid Review to Update Evidence for the Healthy Child Programme 0–5, Public Health England, 2015 8 www.centreformentalhealth.org.uk/news/too-many-women-are-falling-through-the-gaps

Children, families and professionals find it difficult to navigate their way into and between disjointed and un-coordinated services; pathways for vulnerable cohorts are unclear.

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Teachers play an important role in supporting young people’s health and wellbeing as well as their parents, carers, friends and families.

Changes to Tier 2 emotional wellbeing services have not yet penetrated at schools’ level.

Young people felt online websites/forums and social media were unhelpful.

Parenting support is uncoordinated and inconsistent. Thresholds for access to parenting programmes are set too high.

The need to increase focus on prevention. The Secondary Heads Executive suggested that more money be invested in primary schools

to enable them to provide prevention, early intervention and support. Secondary Heads reported that by the time children reach

secondary school, problems are entrenched.

Where teams are co-located they appear to simply sit in the same office rather than building increasingly integrated working.

Transitions (postnatal, at school entry, at secondary transition, between school and sixth form, and into adulthood) are critical

touchpoints for identifying difficulties and providing support and are not always well managed.

Schools requested transparent pathways, clear referral criteria, a single point of access (at sub-safeguarding level) and a lead

professional role to coordinate support and services across health and County Council services.

Members of the workforce, parents and carers and children and young people have called for consistent local information to be provided online, to enable them to access this out of office hours, and to have clear access to service pathways.

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Appendix Two- Equality Impact Report

Title of proposal Healthy Child Programme 0-19 Service Design

Date of implementation

1 April 2017. Stages of project outlined above in brief.

EIR completed by: Name:

Tel:

Tanya Procter

Internal: 22352 | External: +44 (0)330 22 22352 | Mobile: 07736 126 060

1. Decide whether this report is needed and, if so, describe how you have assessed the impact of the proposal.

In the planning stages of the Healthy Child Programme redesign we undertook a stakeholder map to identify those that would be affected by the redesign (figure 1, see below). The stakeholder map included children and young people aged 0-19, their parents and carers, those who work or could work with them, locally elected members, peers and volunteers.

In order to consider how our stakeholders might be affected we undertook a number of key review tasks:

A desk review of the national Healthy Child Programme against our current commissioned service.

A desk review of guidance and literature. This included the recent Early Years Needs Assessment undertaken by West Sussex Public Health Research Unit as well as a national rapid review of the Healthy Child Programme 0-5.

A review of local practice elsewhere in the country.

This initial desk-based work informed the development of methodology and process for our stakeholder engagement process. We developed a script that was then used to shape questions for surveys and to guide group discussions and focus groups. Highlights of the process are included below (figure 2).

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Figure 1, Stakeholder map

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Figure 2, Summary highlights of stakeholder engagement

2. Describe any negative impact for customers or residents.

We are taking a co-design and co-production approach with extensive and active engagement with current and potential future service users and service providers. This will include parents of children with SEND, young carers, looked after children,

children and families living in disadvantaged areas, children aged 5-19 and parents of children aged 0-19, as well as pregnant women. The HCP is a programme that supports improved public health outcomes for children and young people aged 0-19. It is a

progressive universal service, where all children and young people (and parents of children under 5) receive an offer, and those that are assessed as requiring more, receive an increasingly targeted and specialist service. It is not envisaged that the service design will have a negative impact on any people, particularly those with protected characteristics. Indeed it is envisaged that the new service design will address a number of gaps in current service provision that have been identified (see section 3

below). The current total budget for the HCP 0-19 is £13,249,000, funded from the Public Health Grant. National reductions to the Public Health Grant allocation will see the financial envelope available for the HCP reduce, with exact future funding to be

confirmed. We will seek to mitigate reductions in funding availability by identifying opportunities to integrate services and reduce duplication.

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3. Describe any positive effects which may offset any negative impact.

The stakeholder engagement process identified a number of gaps within the current HCP commissioned service. These include: Health visiting teams currently only have an identification role in the perinatal mental health pathway.

Only 30% of West Sussex teenage parents are supported by the FNP; there is currently no consistent pathway for the other

70%.

No universal provision between 2.5 and school entry.

No commissioned HCP in special schools, for young people over 16, attending private schools or being home educated.

We were also asked to address the following: Develop transparent pathways, clear referral criteria, a single point of access (at sub-safeguarding level) and a lead

professional role to coordinate support and services.

Move away from signposting towards doing and resolving.

Improve information sharing between professionals.

Maintain progressive universal model with enhanced support at all transition points.

Increase support for emotional health and wellbeing need (for parents and children and young people) within a robust pathway.

Develop a WSCC offer to schools, including supporting the development of school based health services and enhance Find It Out model where these would help to address access issues.

Provide consistent local information online, to enable access out of office hours, and to have clear access to service pathways.

4. Describe whether and how the proposal helps to eliminate discrimination, harassment and victimisation.

As a universal service, all parents of children under 5, children and young people 0-19 receive a service. The HCP is able to act as the early eyes and ears to support referrals and support from other services as required. The new service specification will be outcome based with KPIs that monitor use of services by users, including those with protected characteristics. The new

service model will integrate with other services for families with children aged 0-19 where it makes good sense to do so, resolving current gaps and duplications between services, being needs led and outcomes focused and placing children, young people and their families more firmly at the centre.

Learning from a recent Early Years Needs Assessment has been fed into the HCP service design. The needs assessment included qualitative research with teenage parents (who raised concerns that they were currently discriminated against due to their age) and Eastern European parents (who had difficulties accessing primary care in particular and did not feel that services for young families met their needs). Both of these findings will be taken into account in the service design.

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Gypsy and traveller families do not always access health visiting services, and as many children from these communities are home educated, they often miss out on the HCP offer for older children and young people. The service design targeted schools where some gypsy and traveller children attend. This will ensure that the voice of these families informs the co-design.

Younger children who are adopted may not currently receive their entitlement to the 5 mandated visits of the HCP, and their parents could possibly also miss out on the necessary support. This could potentially discriminate against gay, lesbian and transgender parents who have chosen to adopt, as well as children who have been in the care system and may be vulnerable in

a range of ways. The stakeholder engagement included meetings with social care teams including adoption and fostering to test this theory.

5. Describe whether and how the proposal helps to advance equality of opportunity between people who share a protected characteristic and those who do not.

The HCP is a progressive universal service with all children, young people and their parents receiving a universal offer and assessment, and those who require it receiving a more targeted and specialist service. Previous sections have identified gaps in

current service provision, and outline plans for resolving these. One of the aims of the new HCP service model is to strengthen pathways between services, identifying opportunities for

integration where they exist. The purpose of this is to minimise disadvantage, ensuring that service provision is fair and equitable and that those service users that require it receive an enhanced offer.

6. Describe whether and how the proposal helps to foster good relations between persons who share a protected characteristic and those who do not.

The Healthy Child Programme is a progressive universal service which means that everyone has some contact with the service, and that some children and young people will receive a more targeted and specialist service. This is a strength of the current

service and will not change in the future. Uptake figures for universal health checks are higher for targeted and specialist families than they are for universal families and we would aim for this to continue to be a focus.

7. What changes were made to the proposal as a result? If none, explain why.

The findings of the stakeholder engagement process are being fed into the development of the HCP service model, which we will co-produce with service providers.

8. Explain how the impact will be monitored to make sure it continues to meet the equality duty owed to customers

and say who will be responsible for this.

We are following a co-design approach for the service design and will require successful provider(s) to co-produce the new service in collaboration with service users. We will ask potential providers to set out their plans for co-production as part of the procurement and tender process.

We are developing an outcomes framework in order to be able to monitor impact of the new HCP service model.

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To be signed by a Director or Head of Service to confirm that they have read and approved the content.

Name

Alison Nuttall

Date 26/05/16

Your position Head of Commissioning, children, young people and working age adults