Health Visiting Partnership Consultation

WCC and South Warwickshire Foundation Trust released a consultation on a proposal to enter a formal partnership arrangement known as a Section 75 Agreement for the future delivery of the 0-5 Public Health Nursing Service. 

The consultation aimed to hear the views and feedback on the proposal which sought to link Health Visiting services more closely with others that support the health of children and their families. This included detailing:

• Our rationale for the proposal
• Meaning of the agreement and implications.
• Potential benefits and their relative importance.
• Equality Impacts
• Wider views on how services users access the service and feedback on service access/communication.

The target audience for this consultation was current and previous users of the health visiting service or family nurse partnership, the general public, healthcare professionals, professionals working in related areas.

In addition to the survey, focus groups were held with young mothers, parents of SEND children and care leaver parents.

In total there were 236 responses to the online survey. 70.3% strongly agreed or agreed with the proposal, 18.6% neither agreed or disagreed and 10.2% strongly disagreed or disagreed.

Focus groups and drop-in clinics generated a further 18 participants.

Key themes regarding agreement with the Section 75 included:

• Continuation of service delivery from a provider who already know local families well. Providing stability and a longer-term agreement than traditional commissioning approach.
• Collaboration and a shared organisation vision.
• Partnership across 0-5 services.
• Operational benefits for families and staffing working closer together.

Respondents noted that the agreement needs a clear vision and a transformative, open relationship between organisations to ensure change occurs. There was a clear theme for services supporting 0-5s communicating well with each other with a strong emphasis on ensuring true integration is realised beyond words and embedded in the day-day processes of health visiting work.

There were concerns regarding perceived negative impacts of the arrangement such as loss of service provision and resources for the health visiting service. It was repeated that the Section 75 must not lead to loss of the key prevention elements of the service. Whilst integration was noted to be a good thing there was also comments that each service needs to retain its individual role and specialism and remits do not become blurred.

The arrangement requires clear outcomes, and monitoring of how well integration is working with specific measurables in place.

There was a clear emphasis that tangible aspects of the service needed to change for integration to work; all partners need to be strategically on board with the vision and work together to achieve the same goals.

Services listed as needing closer working relationships to support a holistic offer of support alongside Health Visiting were:

• Early Help
• Children Social Care
• GP practices
• Midwives
• Local community provision through charities and community centres/groups.
• Paediatrics
• School nursing

Participants stated some uncertainty about the partnership approach and stated that  clear evidence of what would be different because of this working arrangement needed to be made clear.

The Section 75 arrangement was seen as a better mechanism than a contractual arrangement in bringing about change.

Respondents commented that it was crucial to keep front and centre the role skilled health visitors play around prevention of ill-health, and in delivering the healthy child programme. Work around the mandated contacts needs to be protected and if changed in any way, very well justified.

The Section 75 needs clear objectives, monitoring and scrutiny of the progress towards the aims of the partnership that are set out from the start.

Respondents who disagreed or strongly disagreed with the proposal were asked to what extent did they agree with the alternative – going out to tender.

Only 18.9% of those responding to the question strongly agreed or agreed with going out to tender whereas 44% either disagreed or strongly disagreed with going out to tender. The main reason for disagreeing with this approach was that it was likely to cause disruption and instability to staff working in the service and service users, with tendering seen as a lengthy and costly process. Additionally, concerns were raised that another provider may not have the local intelligence and relationships that SWFT has within the health system of the County. Conversely some respondents commented that seeking an alternative provider may lead to greater value for money, innovation, quality and improved performance.

Feedback on proposed benefits:

Of the proposed benefits of the Section 75 that were listed in the consultation, the benefit with most agreement was ‘Getting the right level of support for your needs, at the right place, at the right time’ with 98.3% of respondents saying this was very important or important to them. The top 3 overall were:

1. Getting right level of support for your needs, at the right place, at the right time.
2. Strong links and connections between different services such as HV, early help, mental health support and SEN services.
3. Easier transition/referral(s) between the services offered for parents and children aged 0-5.

An additional theme that was repeated was the need for shared information systems in order to accelerate timely and joined up care. Many respondents felt IT and data processes were not being used most effectively for the service user and receiving the right level of support at the right time.

Respondents commented that equally as important was enabling an environment that fosters easier communication between services both formally and informally.

In working towards a Section 75 respondents noted that this was a timely chance to improve communication about the service offer to families, how support is offered, where and by whom. Additionally it was emphasised that information is clear, easy to find and if not families can easily talk to someone.

Respondents commented it is important that any agreement continues to place the focus on prevention and early intervention and that as much as possible to not lose sight of this important role health visitors have.

In sharing resources, expertise and working closely with another organisation it was noted that this still needs to have rigorous oversight to ensure the appropriate practitioner supports the relevant need as opposed to inadvertently leading to more connections and referrals for a family which may be confusing.

Concerns with a Section 75 Agreement:

Respondents commented that having some duplication may be necessary particularly if services are doing a similar area of work but approaching it from different viewpoints. For example, with sleep, early help may take a different approach to health visiting. Comments noted the need to consider the actual content of what each service offers and how it is different, rather than viewing duplication by a general theme.

It was noted the Section 75 required strategic buy-in from all the relevant partners health visiting works with, so that they are jointly on-board with the vision and committed to working in this way.

Given the priorities of NHS providers and local authorities may often diverge, respondents comments on the need to ensure a common understanding of the arrangement and utilise each other’s strengths.

An overarching theme was concern about having adequate resources to deliver this arrangement both staffing and financially.

Both professionals and service users strongly stated that the agreement should not lead to a reduction in financial resources or impacts on service resources. Concerns were expressed that integration was a way to reduce costs with the result being poorer experience, outcomes and service for families. The use of skill mix ( utilising different roles to carry out usual health visitor functions) and doing things differently should undergo a rigorous process to identify any clinical risks this may entail.

Professionals noted that clear governance arrangements are needed to make the proposal work, regularly reviewing whether the aims of the S75 are on track and specific measures put in place if not.

Respondents placed emphasis on need for effective IT systems to make integration truly work and robust interoperability between services and systems.

Professional respondents clearly stated that during each stage of the development of the proposal, should it be approved, staff need to be actively engaged with, have their views considered and are a key part in the design of the service.

A key communication message was highlighted in that although SWFT deliver the service it needs to be made clear that all Warwickshire families can access the service not only those who have given birth through South Warwickshire Foundation Trust.

Additional benefits were noted by respondents regarding the flexibility and adaptable planning approach the Section 75 may provide as opposed to waiting for contract renewal for larger changes to the service which may lead to better outcomes.

Comments regarding the future design of the Health Visiting service:

45% of respondents answered this question.

The key themes were:

Face-face contact including drop-in clinics was  identified by respondents as a critical aspect of the health visiting service.

There was a theme regarding the importance of home visiting to pick up needs which aren’t as obvious over the telephone these included:

• Maternal mental health,
• Domestic abuse,
• Building trusting rapport with mother, baby and family.

There were mixed responses about Chat Health with some indicating they have used the service and have found it invaluable but that it needs promoting more. Others felt uncomfortable with receiving advice via text.

A blended approach to delivery which included aspects of webinars, Microsoft Teams and online website access was seen as a useful approach to service delivery but this needed to be carefully designed so that hidden needs were not missed.

Both service users and professionals provided ideas around the schedule of mandated reviews and options for re-designing so that they are more impactful and delivered at the right times for families as opposed to those set out in the healthy child programme which at times do not reflect the realities of families lives.

Respondents said they would like information regarding the mandated contacts, what to expect, when, and what is covered prior to visit and visible online.

Use of social media was seen as a positive for many families as an easy way to access information they required.

Respondents felt further information regarding what support and how to access it outside the mandated reviews would be useful such as groups, clinics and more informal support, which sometimes the timeframes of the mandated reviews didn’t meet.

If you would like to read the full reports on the consultation feedback please click on the links below. (These will open in a new window).

Analysis Report - Survey responses
SEND Carers Discussion Group Summary Report
Care Experienced - Discussion Group Summary Report
Family Nurse Partnership - Focus Group Summary

Since the public consultation the Council have been working with South Warwickshire University Foundation Trust to develop and plan for the Section 75 Agreement. In developing and working through this agreement, challenges were uncovered around delivering the current service model within the available budget. As a result of these identified financial pressures both partners have agreed that it is not possible to progress the Section 75 at this time. Further time is required to work through an acceptable resolution, which provides a sustainable service delivery model for Warwickshire families for the long-term and importantly does not adversely impact service users.

An 18-month extension to the existing contract has been agreed to enable partners to complete the required work and establish the best route forward for the service. In the first instance and in recognition of the consultation results, it will be our priority to find ways to deliver the service within the allocated budget so that the Section 75 can progress.

Additional actions and next steps which have been initiated from the consultation are:

1. Establishing an integrated working group with early help, early years and children and family centres to review offers of each service, reduce duplication and identify ways to work more collaboratively together throughout a family’s newborn journey.
2. Taking on board the ways in which service users prefer to access the service, what is missing and the best methods for delivery. This has been included within the development of the service specification for the future health visiting service.
3. Creating and communicating clear journey of care pathways for families so they can easily understand what to expect, when and from which service during the 0-5 years; and where to go if require further support.
4. Reviewing and establishing integrated pathways for delivery of school readiness and the 2-2.5-year review.
5. Developed a robust governance and monitoring arrangement for the Section 75 should it go ahead.

Results of the public consultation will continue to inform the development of the future delivery model of the Health Visiting service.