Children and Young People’s Health Support Group/Child Health Commissioners’ Group Joint Meeting – Wednesday 23 April 2014
Present
Malcolm Wright – Chair, Chief Executive, NHS Education for Scotland (NES)
Karen Anderson – Care Inspectorate
Jim Beattie – NHS Greater Glasgow Clyde
Mike Bissett – NHS, Consultant Paediatrician, Royal Aberdeen Hospital for Sick
Children
Mary Boyle – NES
James Cannon – NHS North of Scotland Regional Planning Group
Jim Carle – Disability Champion and Child Health Commissioner, NHS Ayrshire and
Arran
Lawrie Davidson - Care Inspectorate
Jean Davies – Strategic Paediatric Educationalists & Nurses in Scotland (SPENS)
Linda de Caestecker- Public Health
Rod Duncan – Scottish Committee on Surgical Services
Zoë Dunhill - Action for Sick Children Scotland
Andrew Ecclestone – NHS Dumfries and Galloway and Royal College of Paediatrics
and Child Health
Gavin Fergie – Amicus the Union
Catherine Gorry- NHS, Speech and Language Therapy
Jacqueline Lamb – Children in Scotland
Carrie Lindsay – Fife Council, Association of Directors of Education Scotland (ADES)
Rosemary Lyness – NHS Directors of Nursing
Ali MacDonald, NHS Health Scotland
Daniel McKeever – Association of Directors of Social Work
Fiona Nicolson - Quarriers, Community Care Providers
Brenda Renz – Consultant Psychologist, NHS Greater Glasgow and Clyde.
Jacqui Simpson – South East and Tayside (SEAT)
Caroline Selkirk, NHS Tayside
Judy Thomson- Director of Training for Psychology Services, NES
Professor George Youngson
Child Health Commissioners
Sally Egan - NHS Lothian , Chair of Child Health Commissioners’ Group
Mandy Brotherstone – NHS Borders
Emelin Collier – NHS Western Isles
Kathy Collins, National Services Division
Gary Dover – NHS Greater Glasgow and Clyde
Kay Fowlie – NHS Tayside
Susan Manion – NHS Fife
Geraldine Queen – NHS Lanarkshire
Scottish Government
Judith Ainsley – Early Years Collaborative
Jan Beattie, AHP Officer for Primary Care
Julia Egan- Chief Nursing Officer Directorate
Bob Fraser – Getting it Right for Every Child (GIRFEC) Health Adviser
John Froggatt – Deputy Director, Child and Maternal Health
Dr Kate McKay –Senior Medical Officer
Emily McLean- Policy Officer, Child and Maternal Health
Jane Reid – National AHP Clinical Lead for Children and Young People
Mary Sloan – Policy Manager, Child and Maternal Health
In attendance
Professor James Ferguson
Peter Doran
Dawn Moss- NHS Borders
Apologies
Fiona Dagge- Bell, Healthcare Improvement Scotland
Lorraine Currie NHS Grampian
Deirdre Evans, National Services Division
Bernie McCulloch- MCQIC
Peter Fowlie - RCPCH
Alexandra Little – NHS Dumfries and Galloway
Zelda Mathewson – NHS Tayside
Dr Sarah Taylor – NHS Shetland
Sally Amor – NHS Highland
Neil Hunter – Scottish Children’s Reporter Administration
ITEM 1 WELCOME AND APOLOGIES
1. Malcolm Wright welcomed everyone to the meeting, in particular the new members, those representing members and the presenters. He also acknowledged those who had sent apologies. He concluded his introduction by saying he was heartened by the large number of members from both groups who were able to attend.
ITEM 2 CHILDREN’S WORKFORCE
2. Malcolm opened the item by mentioning that the Support Group had discussed children’s workforce issues several times, in particular succession planning, governance, training and the role the Support Group should play. He went on to say that John Froggatt had been considering all the issues, including community child health, District General Hospitals, health visiting implications of the Named Person provisions in the Children and Young People (Scotland) Act and has been trying to secure resources.
3. John began by saying discussions had been taking place for some time and he acknowledged he still had to have further discussions with the Royal College of Paediatrics and Child Health (RCPCH) on a vision for the paediatric workforce. He went on to say that in theory he was considering everything and wasn’t considering any service in isolation. He was trying to paint as simple a picture as possible as a basis for moving on. He suggested community child health touched all the items on the agenda. He thought there were 3 elements to managing the complexity of paediatric services – Workforce, Practice and Systems. A lot of work was ongoing and he hoped to provoke thought and discussion with the aim of improving care for children and young people.
4. He considered the 3 basic elements were the keystones for community child health with all 3 elements being critical. Any review of the paediatric workforce should include social work and social care professionals. Psychology should also be included – supervision of the Family Nurse Partnership is assisted by psychology.
5. John went on to say Practice was critical. Improvement science and patient safety must be embraced. Practice must be evidence based and thought given to how to ensure best practice. All practitioners need to be supported. Practice should look at effectiveness and the empowerment of staff – everyone should be enabled and empowered. In these times of austerity, the optimum use of resources is needed.
6. Systems are always changing. Local authorities, the Third Sector and the NHS all use different systems. The Health and Social Care and Children and Young People Acts are critical to systems. It is vital to get the best data and information possible. A lot of data is available but it needs to feed into practice quickly. Every pound must be well spent.
7. Workforce element - numbers are important but other issues are also important, eg skill mix. The bottom line is resources – the most important resource is the staff. John cited an example in fertility services - embryologists are needed to deliver the service but there are few embryologists in Scotland. Services need the right skills and expertise.
8. Both the Support Group and the Child Health Commissioners’ Group need to think about how they can take all the strands of work forward cohesively.
9. During discussion it was pointed out:
· Paediatric workforce was bigger than the community child health specialty. All services outwith acute services should be looked at and they need to be integrated and delivered in multi-disciplinary ways
· The Children and Young People Act shows the Government is committed to developing and supporting families in communities
· Information sharing for the Named Person will be OK within health but more difficult with the Named Person in education
· This work will support the Children and Young People Act. Cultures, systems and practice, in particular the Named Person functions, will have to change
· The Named Person functions are likely to come into force in 2016
· Social work is very important, as are health visiting and school nursing
· The Health and Social Care Integration Act will make integration with social work and other services happen. There will need to be models of robust supervision and practice, and all services will need to think about workforce
· The first step on a child’s journey is important. Children and their parents/carers need to be able to find their way round the system easily, the Acts might help
· The RCPCH young persons’ group isn’t aware there are school nurses – health structures need to be visible. GPs need to be well informed too
· Health in education is wider than the school nurse – need to work with education colleagues including educational psychologists re Curriculum for Excellence for health improvement. Health professionals don’t understand Curriculum for Excellence
· Curriculum for Excellence is a driver for improvement – health and wellbeing is strongly promoted with partners
· Education Scotland could be a partner to support teachers. The CYPHSG and Child Health Commissioners could work with Education Scotland
· Pathways are being developed in education
· There needs to be appropriate triage out of acute services
· Because there is no competency framework, nurses are doing paediatricians’ work – paediatricians should work with nurses, AHPs etc to empower them
· There will have to be a culture change to establish proper partnerships. The culture between children’s and adult services is very important but very different just now
· What the Third Sector can bring needs to be considered – NES are thinking about GP awareness of the Third Sector
· All the strands of work, eg prevention, Developmental Dysplasia of the Hip, child death reviews etc, will feed into practice, including maternity services, early years, educating older young people to prepare them to be parents etc
· A group will be established, similar to the Specialist Children’s Services Monitoring Group, to pull all the strands together to develop a coherent work plan in the context of community child health
· Although resources are being sought, effective use of current resources is also important
· Resources are moving into early years in Boards – a lot of work is being done already.
10. Malcolm summed up by saying it was exciting times within child health due to the Early Years Collaborative and the developments around health visiting. He also confirmed the meeting was supportive of a Group being established to support and implement workforce initiatives.
ITEM 3 : DISBANDING THE SPECIALIST CHILDREN’S SERVICES MONITORING GROUP
11. Caroline Selkirk spoke to the Group about the aims of the Specialist Children’s Services Group, which she chaired. These had included developing robust services and national MCNs. The Group received funding over 3 years (£32 million, April 2008 - March 2011) and were keen to see this translate to the frontline, which they are now seeing, for example more children are now having care provided in their own home or close to home and professionals are working closer to provide network services. An example of demonstrating where this money has been used would be Cancer services, where £1 million was spent. The Group has now come to a natural conclusion. The Chair thanked Caroline for chairing this Group and stated that Robert Stevenson’s role should be acknowledged as well.
ITEM 4: HEALTH VISITING / SCHOOL NURSING
12. Julia Egan began with thanking all the people that had been involved in this work. 4 sub-groups had run from October – April.
13. CEL 13 in July 2013 reverted back to the terms school Nursing and Health Visiting. Julia went on to report that she had undertaken a scoping exercise. Following this 10 recommendations were agreed by SEND, which included a waiting caseload tool for Health Visitors and a re-look at education and training.
14. A national group is chaired by Rosemary Lyness. All 14 Boards were represented on the sub groups, along with NES, ISD, Unite (and other professional bodies), Scottish Government and academia. An agreement has been secured by all parties and this was to be presented to SEND on 25 April 2014.
15. There have been meetings with Department of Health, looking at assessment tools, child protection and data protection. An external consultant also participated. This looked at refocusing Boards on how data is gathered.
16. The waiting caseload tool is based on population data. There is one UK-wide tool which 2 Boards have trialled. The tool has indicated a shortfall of resources, data will be presented to SEND on Friday. Tools will sit with directors of Nursing.
17. The second group looked at a Universal Pathway for child health assessments. The group recommends a total of 8 visits. There will be a minimum of 6 face to face visits, contact will begin antenatally. This links in with Hall 4. The Health Plan Indicator (HPI) will be defined and what is meant by additional. Underpinning this is an evidence paper which gives clear messages and validates the pathway. The pathway is based on progressive universalism and where to target resources.
18. The third group looked at education - what needs to be in the curriculum and what needs to be done to make it fit for purpose. Mentorship was discussed.
19. Pump-prime funding has been secured for education from September–January next year. A governance group chaired by NES will oversee this. This will be rolled out across boards over 2-3 years. An advanced nurse band 7 role is just being finalised.
20. Another group looked at School Nursing. This has been more challenging as there are very different roles being carried out and so the range of training differs. The focus of their roles include: mental health, wellbeing, drug misuse and child protection. Robust outcomes are needed for these areas.
22. Recommendations to SEND are :
• Adoption of national Caseload Weighting Tool
• Adoption of national approach by NHS Boards to HV role, assessments, data collection
• Proceed to implementation / governance of revised education programme
• National research and evaluation
• School Nursing Group to continue to September
• National Implementation group
23. In the discussion it was stated:
· visits made by Health Visitors will make a difference in early intervention.
· Immunisation there are 3/ 4 roles: Band 6, Staff Nurse and Early Years Support Worker. Immunisation is undertaken by the staff nurse. The public health role is done by the Band 6.
· The shortfall in resources indicated by the caseload waiting tool was further discussed. NHS Lothian has a 5 year plan for recruiting Health Visitors and that the NRAT (National Risk Assessment Tool) was used.
· General Practice is also struggling. GPs and Health Visitors have a key relationship with families. Primary care are introducing contracts to deal with some of the inequalities.
· Issues in Midwifery should not be overlooked.
ITEM 5 ALLIED HEALTH PROFESSIONALS’ CHILDREN AND YOUNG PEOPLE’S SERVICES PLAN
24. Jane Reid, Allied Health Professional National Lead for Children and Young People, began by saying that the Allied Health Professionals’ (AHPs) Children and Young People’s Services Plan links to the Workforce and Health Visiting/School Nursing items which had just been discussed. Jane went on to say that CEL 27 (2012) launched a National Delivery Plan for AHPs which is an overarching framework with specific actions to bring about transformational change for children and young people. It introduced an evidence-based equitable and sustainable model of consistent and expert practice. Thought needs to be given to how AHPs work with families and the culture needs to be considered too, to move more to prevention and to work more closely with education, Health Visitors and school nursing colleagues.