Health Visiting Scrutiny
Related scrutiny recommendations
Topic Group Recommendation Crime & Disorder (March 2010) That potential career opportunities for PCSOs are identified by the funding partners in order to retain the investment and skills/knowledge made. (6.2; 6.3) Qualified Social Workers (April 2010) Hertfordshire County Council (HCC) explores ways of encouraging staff in related fields to become social workers (See paragraph 6.4) Child Protection (May 2010) 7.4Home Start also supports parents who are experiencing difficulties in parenting. Home To develop creative responses to Start is an independent charity which offers support, friendship and practical help to partnership working (see families with at least one child under the age of five. Home Start volunteers are paragraphs 7.4, 7.5, 8.1, 8.2, 9.2, usually parents themselves and receive training prior to visiting families in their own 9.3, 9.4, 9.5, 9.6, 9.7, 9.8) homes. When Home Start was introduced there were some concerns about the volunteers not being trained professionals but these fears have been allayed as the scheme has proved successful and developed its reputation.
7.5Agencies highlighted that some parents who are wary of involvement from statutory professionals are readier to accept support from Home Start volunteers. Health
1 visitors are working in collaboration with Home Start on an 8 week pre-natal group in Baldock for women suffering from depression.
8.1Health has expressed a preference for the co-location of social workers on hospital sites. There are a number of advantages, especially when child protection issues become apparent in the postnatal period. In this case the assessment has to be managed very quickly to ensure a baby is kept safe from harm. It was suggested that establishing virtual teams with regular local fora, rather than co-location would help. Better communication with clear targets for response times would ensure more timely discussions and help clarify roles and increase shared understanding.
8.2 Witnesses all agreed that the development of joint networks would provide opportunities to understand roles and responsibilities, to build relationships
9.2 HSCB’s role is to co-ordinate the work of all partners to ensure that children are safeguarded. Serious case reviews are the core business for HSCB; however there is a strong argument to consider cases which fall just below the threshold for lessons to improve future practice for all partner agencies. The topic group heard that the HSCB action plan includes Improving assessments of neglect through use of a specialist tool Agreeing a multi-agency risk assessment process Improving access to expertise from adult services Improving professionals’ response to babies who “fail to thrive”. Ensuring lessons from Serious Case Reviews are included in safeguarding training Members endorse these initiatives. (Recommendations 2, 3 & 4)
9.3 Co-location on its own does not change practice, this requires a shift in culture away from a ‘silo’ mentality to one of joint ownership, joint commissioning of services and structures that support collaborative working. (Recommendations 1 & 2)
2 9.4Clarification and understanding of threshold criteria for accessing services, professionals’ understanding of language used across agencies and an improved understanding of roles across all agencies is still needed. Better understanding is needed of mental health issues and the structure, process and services offered. There can be potential conflict between supporting the rights of the parent with mental health problems while also protecting the child. A Child Needs Assessment form has recently been introduced. Staff need to be encouraged to use this effectively, more training may be needed to support this. Members concluded that there may be circumstances where more flexibility is needed regarding the assessment threshold, when children may be at risk. Members were pleased to hear of partners’ commitment to working together to resolve any issues and learn from other agencies. (Recommendations 1, 2, 3 & 4)
9.5 Local fora can have a beneficial impact where these local relationships are fostered. The development of joint networks provides opportunities to understand roles and responsibilities and build relationships. A number of witnesses suggested that these fora work best when colleagues meet face-to-face rather than virtually. It was felt that despite heavy workloads and time pressures, the benefits of developing joint networks and other interface opportunities outweighed the time taken. Links between managers from different agencies are important as well as those between frontline workers. (Recommendation 1 & 2)
9.6 In recognition of the need to address the needs of both adult and child it was suggested that ‘Team Around the Child’ be changed to ‘Team Around the Family’ as this would reflect the effective engagement of the relevant agencies. (Recommendation 2)
9.7There is a need for Adult Services both in Adult Social Care and also HPFT to become proactively involved jointly with CSF in supporting those families who fall outside the
3 threshold criteria for services. (Recommendations 2 & 4)
9.8If the measures outlined above are introduced, this has the potential for streamlining some procedures. (Recommendations 1, 2, 3 & 4)
Maternity Services Review (April 4.2 ENHT hold regular meetings with commissioners to discuss maternity services, 2010) however these are not formalised as they are at WHHT. In addition there are monthly East & North Hertfordshire NHS meetings to discuss the entire ENHT contract for maternity services. Such meetings Trust (ENHT) and West also take place with WHHT and all the other trusts from which NHS Hertfordshire Hertfordshire Hospitals NHS Trust commissions services. Although maternity services are not the only focus, issues (WHHT) (here referred to as the relating to maternity are addressed, with particular reference to performance and “Hertfordshire acute trusts”) financial issues. The commissioners have been part of all service consultations address, as a matter of urgency, and steering groups over the last six years. NHS Hertfordshire regularly attends and the delivery of services to achieve contributes to the reconfiguration implementation group which meets monthly and is equity of provision across the involved in sub groups looking at models of care and workforce developments. There county (see paragraphs 4.2, 5.3, are many other groups and service developments within maternity which the NHS 6.3, 7.5, 7.6, 8.1) Hertfordshire have actively participated in e.g. antenatal screening. Alongside the formal meetings that exist, there are open communication channels between the Trust and NHS Hertfordshire Commissioners, where both are able to pick up the telephone for help, advice or clarification of issues.
5.3 From the evidence presented to the group it is clear that Health Visitors are based in a variety of settings across the county. Health visitors are employed by Hertfordshire Community Health Services (the provider arm of NHS Hertfordshire).Where Health Visitors are based at GP surgeries there are frequent opportunities for them to interact with midwives when they visit the practice. When Health Visitors are not located in GP practices communication and the informal exchange of information happens less easily; however, local arrangements are in place to ensure that verbal communication between the two services takes place. This is particularly relevant when there are concerns about safeguarding, birthing issues (e.g. still birth) or maternal health.
4 6.3 For WHHT a challenge is in tackling cross border issues for women living in the area and delivering out of area or vice versa. In terms of cross boundary services it was noted that further consideration and negotiation is needed as to whom should be responsible for the totality of the care package as there are a number of governance issues when different trusts provide different elements of the antenatal pathway e.g. women choosing to deliver at Stoke Mandeville or other locations outside West Hertfordshire need to attend the midwifery clinic for all routine appointments as well as screening and blood tests. They are not able to partake in local ante-natal classes . 7.5 Feedback from the recent consultation with women on the Hemel Birthing Centre and related maternity services suggested that information is not delivered consistently across the county, for example women have expressed ignorance of the birth options available to them (including home, birthing unit or different acute hospital), the type of support available during labour (e.g. birthing balls) and post natal support and advice offered. The Group were concerned that this may prevent some women making effective decisions. It is an area which acute trusts and NHS Hertfordshire together need to tackle jointly and the recently agreed maternity specifications should begin to address this.
7.6There has been an increase in the number of women with a previous history of mental health issues having children. Both Hertfordshire trusts had scored low in their provision of maternal mental health services and work is underway to ensure pathways, policies and referrals are clearly in place. WHHT has recently appointed a Consultant Lead for this area and the Group encourage ENHT to make similar provision. Mental health services should be available both antenatally and post natally. The Group agreed that this was an area that still needed considerable development but that progress is being made in the right direction.
8.1 The Group heard from the Programme Director for Implementing Delivering Quality
5 Healthcare in Hertfordshire (DQHH). It was confirmed that the DQHH was concerned with ensuring that the right services are available in the right place and at the right level. For maternity services this means that wherever the mother has chosen to deliver that this is in an appropriate, safe and accessible setting. Where services have been relocated or centralised consideration needs to be given to what this means for the mother in terms of antenatal care, postnatal care and screening tests. Maternity Services Review (April 5.5 Midwives expressed enthusiasm for holding clinics in Children’s Centres as this would 2010) allow more flexibility with regard to clinic times and make access easier for women, That the Hertfordshire trusts whilst identifying lack of access to the client’s medical records as a major problem. progress addressing the post natal needs of women as highlighted in 7.1 At WHHT meetings between community midwives and the Women & Children’s the recent consultation on the Services team have been formalised. This provides a greater opportunity for key Hemel Hempstead Birth Centre issues about the services to be understood. In response to feedback from women the and related maternity services Trust is now offering a speed booking clinic. This has had varied success depending (5.5, 7.1, 7.6, 9.8) on location; however take up is increasing. A review has been planned to analyse whether the clinic is meeting maternal requirements. After a period without parenting classes (due financial constraints) these were re-introduced in March 2008. The interval allowed the Trust to review previous provision and revise what was offered and in addition a designated lead has been put in place.
7.6 There has been an increase in the number of women with a previous history of mental health issues having children. Both Hertfordshire trusts had scored low in their provision of maternal mental health services and work is underway to ensure pathways, policies and referrals are clearly in place. WHHT has recently appointed a Consultant Lead for this area and the Group encourage ENHT to make similar provision. Mental health services should be available both antenatally and post natally. The Group agreed that this was an area that still needed considerable development but that progress is being made in the right direction.
9.8 An emerging area identified by the Group is the need to reconsider the content, timing
6 and focus of parent education. It is clear that the many women are daunted after the birth of their baby and the needs of the father should be given greater recognition. (Recommendation 5)
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