Wrexham County Borough Council Agenda Item No._____

DRAFT AGENDA ITEM NO

REPORT TO Healthy & Active SCoG

DATE: 3 September 2007

REPORTING OFFICER: Jerry O’Keeffe, Health & Well Being Development Officer

SUBJECT INFO Shop / INFO Outreach

1 . PURPOSE OF THE REPORT

To provide SCoG with a draft business case to support the sustainable development of the INFO Shop and INFO Outreach services.

2 . EXECUTIVE SUMMARY

2.1 The INFO Shop on Chester St. in Wrexham was opened in September 2001 to provide a comprehensive information service to young people aged between 11 and 25 years of age. The service was extended to include a sexual health component in 2004. The professional support is provided by the Conwy & Denbighshire NHS Trust and the pharmaceutical materials are funded separately by the Youth Service of the Council.

2.2 The INFO Outreach project was approved as a pilot scheme by the LHB in October 2006 and has been delivered in Darland School, Rossett from January 2007. The scheme is essentially a satellite of the INFO Shop and offers a drop-in facility for the pupils for one hour per week. In summary, the scheme aims to respond to the health and social topics which form barriers to effective learning. The school nurse, youth worker and other professional colleagues aim to resolve any immediate issues or refer the pupil to a partner organisation. The project is delivered utilising existing NHS Trust and Council staff resources and the pharmaceutical products are sourced from available stocks held by the partners.

2.3 A recent report was taken to the project steering group at Darland which describes an evaluation of the project at the half-year stage. The report is attached as Appendix 1. The evaluation, when combined with the published evidence, supports the school as a medium for the delivery of health services to young people. The available evidence strongly suggests that young people do not have the confidence to engage with primary care and the community pharmacy service. This is further borne-out by the statistics around unintended conceptions and the incidence of STI’s, the prevalence of eating disorders, smoking, alcohol misuse and other health issues concerning young people.

2.4 The Sexual Health Planning and Co-ordination Group has been tasked with reviewing the current position in respect of sexual health services to children and young people and make recommendations in response to key, flagged action 2.46 of the NSF for Children, Young People and Maternity Services. This requires partners to ensure that young people have ‘rapid access to confidential contraceptive and sexual health service, including emergency hormonal contraception….’ The Sexual Health Planning and Co-Ordination group, having considered the evidence take the view that this can be achieved by ensuring that the sexual health component of the service provided by the INFO Shop and the INFO Outreach service in each of the Council’s secondary schools, is delivered as sustainable services and resources must be found to ensure that this happens. The Sexual Health Planning group acknowledge the GU/FP Service Integration agenda. There must be a closer engagement with the work of this group to ensure that the agreed service model provided for adolescents, accords with the evidence and the recommendations of the Sexual Health Planning and Co-ordination group

2.5 To support the above proposal, a draft business case has been prepared and is attached as Appendix 2

3 . RECOMMENDATIONS

That SCoG approves the contents of the report and the attached Business case.

4 . REASONS FOR RECOMMENDATIONS

a) Work to address the factors which contribute to the health status of adolescents, must be supported by evidence-based practice. b) To meet the requirements of flagged action 2.46 of the NSF

5 . BACKGROUND INFORMATION

NSF for Children, young people and Maternity Services : Standard: Promoting Health & Well Being.

2 Appendix 1

Darland INFO Outreach Project Evaluation Report June 2007

PURPOSE OF THE REPORT

To evaluate the pilot INFO Outreach project based at Darland school and to highlight both the funding pressures and developmental needs of the service.

BACKGROUND INFORMATION

There is an abundance of evidence which identifies the school as an ideal setting to promote the health and well being of children and young people and this is the main driver behind the development of the concept of the ‘Healthy Schools’ programme which is being implemented across the UK. The INFO Outreach pilot scheme is fully supported by the Wrexham County Borough Council and Wrexham Local Health Board. It is recognised that the pilot is essentially an extension of those services which are available at the INFO Shop located in Wrexham Town Centre and any additional costs incurred would be met from existing resources. The scheme is based on similar models which have been successfully developed in other areas in England and Wales, although considerably enhanced by the range of topics being addressed and the availability of specific medications via agreed Patient Group Directions (PGD’s). The current scheme involves the delivery of a drop in facility once a week during the school lunch hour, staffed by a school nurse, health visitor and youth worker. The scheme expands the role of the above professionals as independent practitioners and as part of a unique team, enabling young people to access support and advice on a range of health and issues perceived as barriers to effective learning, ie lack of confidence, low self esteem, bullying, family issues etc.

The sexual health element includes the provision of condoms, emergency hormonal contraception (EHC), pregnancy testing and education around a range of related matters. The scheme also enables young people to benefit from smoking cessation services supported by the availability of nicotine replacement therapies (NRT) which the health visitors can also prescribe. All services are delivered within existing guidelines and protocols. It is envisaged that the initiative, if proven to be successful will be rolled out to all secondary schools across Wrexham within the context of a review of such services to young people.

PROGRESS TO DATE

3 The scheme started at the end of January 2007 during the lunch hour each Monday and can be described as a success in terms of the number of young people accessing the service. The project is an invaluable resource made possible by the support from the school. Currently the sessions are run by a school nurse, health visitor and youth worker. The adolescent smoking cessation specialist is often available and if not a referral system is in place for young people wishing to see her. To date (Jan – April 2007), 210 young people have attended the outreach session, with a total of 280 enquiries dealt with, clearly showing the need for such a service.

STATISTICAL BREAKDOWN from end of Jan to April 2007 (NB The school was closed for 3 Mondays in April)

GENDER

Female: 113

Male: 97

11-12: 1

13 -15: 185

16: 24

All identified themselves as `white European`

DESCRIPTION OF ENQUIRIES:

 Employment/Training 4  Family and Relationships 12  Health Issues 48  Periods 1  Condoms 103  Personal support 2

4  Supporting a friend 33  Eating disorders 1  Alcohol 3  Smoking 49  Drugs/substance misuse 3  Contraception 20  Referral (see below) 1

TOTAL NUMBER OF ENQUIRIES 280

REFERRAL/SIGNPOSTING

Young people inevitably present with a range of enquiries which are normally dealt with at the time, or when appropriate, are referred to other agencies via. a referral and signposting mechanism established for those enquiries which can’t be dealt with within the drop in setting. All enquiries are monitored using the current INFO Shop monitoring tool for statistical purposes, which also identifies any emerging themes.

EMERGING ISSUES

 The lack of available and appropriate space is of immediate concern. The majority of the consultations with young people are of a confidential nature and all workers have expressed their concerns that this is being severely compromised due to lack of space, which in turn, has a ‘knock on’ effect on the quality of service delivery. There are some young people who are comfortable discussing issues of a confidential nature in front of their peers but others that clearly are not.  Lack of time has often been raised as an issue, however it has been agreed that approval `slips` are available for pupils needing to be excused from class for short periods, acknowledging the fact that this is done without compromising the teaching responsibilities of the school.  Due to such time constraints and the lack of available, confidential space, young people are not comfortable being seen in a room where other young people are being seen and are on occasions, being turned away. This needs to be addressed in the current pilot and such issues carefully considered before rolling out similar pilots in other schools.

EXIT SURVEY

5 To gain the feedback of young people an exit survey was undertaken using an approved tool currently used by the INFO Shop. The survey was carried out over the last 2 weeks of April 2007 and involved 30 young people who completed exit survey questionnaires. The feedback was extremely positive from all who took part in the survey, with young people stating that they were very happy with the staff, who they found approachable and friendly, that the service and available information was very useful and that they would recommend the service to friends. As predicted, comments were made about lack of space. Its clear therefore, that the pilot in Darland is successful in terms of young people attending the drop in and the motivation and commitment by the staff responsible for delivery of the sessions

An additional comment from a young person was found on the local BBC website in which she talks about what the service is and when it talks place in the school, although she states “you can go and speak to them about all sorts of things, sex, drugs, smoking, homelessness” She adds that this shouldn`t be in their time as “we need to get our dinner” and goes on to say that a youth worker should be available in the school to talk about such things and do sex ed.

RECOMMENDATIONS a) Short Term

 That consideration be given to provide an additional lunch time drop in session to meet the needs of the young people and ensure provision of adequate, confidential space.  That consideration be given to increasing the time of each session to 2 hours.

 Pharmacy costs need to be properly resourced as condoms, pregnancy tests and EHC etc are supplied by the INFO Shop, placing a strain on the already reduced pharmacy budget. b) Long Term

 That a preferred service model be fully costed, based on the findings of the existing pilot scheme and the on-going work of the INFO Shop. It is suggested that this should mean a minimum of 2 sessions per week of a 2 hour duration and appropriate accommodation is essential. Consideration should also be given to school holiday cover.  The reconfiguration of sexual health and other related services providing support to children and young people should be taken forward by the Council and the Local Health Board as a high priority. The desired outcome should be the delivery of evidence-based

6 services which engage young people with appropriate services in appropriate settings.

Martine Vout 1/5/07 2007

Appendix 2

Draft Business Case INFO Shop / INFO Outreach

7 Service Specification

A INFO Shop

The sexual health clinic should be available for 2 Hours x 2 days per week including Saturday mornings (including preparation time). The service should include full professional cover and properly resourced pharmaceutical materials including condoms.

Costs :

a) Staff (Admin Support) ……………. b) Pharmaceutical materials ( including condoms) -……….

Total Estimated Cost = £……

B INFO Outreach

The service should be offered to each of the Council’s secondary schools within an agreed specification which involves a commitment by the school to provide appropriate accommodation which observes the confidential nature of the service. It is recommended that the service will provide 2 x 2 hour sessions per school per week (term time). The INFO Shop will provide continuity at the weekends and in the school holidays.

Costs:

a) 3 x part time youth workers (incl. On-costs @30%) = £32.276 b) 3 x part time school nurses (incl. On-costs @25%) = £28,520 c) pharmaceutical materials @…..per school x 8 schools = (staff costs are at 80% to reflect term time)

Total Estimated Cost = £……

Total Annual Budget = £…….

C NEWI / Yale College

Between them engage with 20,000+ students. Consideration should be given to how we might develop an appropriate service across the two campuses.