Middlesbrough Primary Care Trust

1. Middlesbrough Primary Care Trust Prevention – Children protected and well looked after

2. Who we are –  Peter Kelly, Director of Health Improvement and Public Health Louise Wallace, Head of Planning (Health Improvement)

3. Key Drivers NHS Plan – Health Inequalities Children Planning and Priorities Guidance – • Improvement, Expansion and Reform 2003/ 2006 South Tees Child Protection Guidelines Laming Report – Victoria Climbiè Children Looked After – National Guidance 2003 Emerging Children’s National Service Framework Supporting Families (DoH) 1998 Sure Start Children’s Act

4. Services for Children and Families provided by Middlesbrough PCT Health Visiting (approximately 60 staff) School Nursing (approximately 30 staff) Physiotherapy Speech and Language Therapy Contraception and Reproductive Health Child Protection Named Nurses

5. Redesigning Services Main motivation – ‘To provide an excellent service to all patients’ Duty of PCT to improve health of local people and reduce health inequalities Belief that redesigning services will strengthen opportunities to support families in their own communities preventing crisis

6. Public Health Nursing Health Visitors and School Nurses should be: ‘Preventing ill health and promoting health for individuals, families and communities.) (Botes 1998) Evidence to support this (Acheson Public Health Report 1998): – Inequality in health is related to poverty – recognition of the social factory influencing health – work with families to enable them to improve the future generation’s health

7. Current Model Health Visitors practice-focused School Nurses link to cluster of schools West Middlesbrough Neighbourhood Trust’s School Nursing team Six Sure Starts Acute operational issues

8. Inequality in Current Service Provision Health Visitors workload – • Historical allocation • Provision bears some relationship to volume – but does not relate well to need

9. Examples Number of patients per Health Visitor varies from: 2600 : 1 – 6900 : 1 Number of ‘needy’ children per Health Visitor ranges from: 8 : 1 – 44 : 1

10. Examples Number of families with cause for concern ranges from: 3 : 1 – 100 : 1 Inequalities Post natal depression Immunisations

11. The Local Service 27% of the Health Visiting and School Nursing workforce retire within five years Have a multi-skilled workforce (21 different recognised qualifications/ skills) Acute problems in some practices

12. GP practices in Middlesbrough are not equally spread Families registered with GPs are scattered across the town The Health Visitor can visit every area in one week Targeting resources is very difficult

13. Options Re-distribute existing workforce Level up the workforce Do nothing Change model of service delivery

14. The Re-distribute Option Move Health Visitor from five or six practices with ‘best provision’ to those five or six with poorest provision

15. The ‘level-up’ Option 7 extra HVs takes everybody up to median (224K) 18 extra takes everybody to upper quartile level (576K) 61 extra takes everybody to best level (1952K)

16. Do Nothing Option Inequality in provision will continue System remain inflexible, continue to be difficult to cover maternity leave, sickness and vacancies Risk to patients Risk to health visitors

17. The Proposed Public Health Model in Middlesbrough Health Visitors will move from GP bases Locality bases will be set up Shared/ Community caseloads will be implemented with full team involvement All families will have a named Health Visitor Equity within caseloads will be a priority

18. Issues that can be addressed in the Locality Teams Equity Communication Immunisations Flexibility Understanding and responding to need Partnership working with other agencies

19. What are the benefits of new Model? Staff will complete a Health Needs Assessment of a community, identifying issues for those in areas with high Child Protection rates Staff will be working on the ground more closely with other agencies such as Social Services and Sure Start Staff will be easily accessible, drop in services etc. Prevent crisis before it occurs Understanding and responding to need Partnership working with other agencies

20. Other PCT Services to compliment the Model Child Protection aims to protect children, but also tries to keep families together. This is a Key Issue in the Children’s Act Child Protection nurses offer advice, supervision and support to colleagues within MPCT Offer advice to ensure appropriate use of multi-agency services

21. Strategically, Peter Kelly is named Director within MPCT for Children’s Services and Child Protection Led for MPCT on South Tees Area Child Protection Committee Chair of Internal PCT Child Protection Committee involving managers and clinicians. Key area of work for this group is to implement Laming Report recommendations

22. Middlesbrough Primary Care Trust aims to provide an adequate, accessible and timely therapeutic service for Child Protection to ensure the long term emotional well being, mental health and welfare of children

23. Other Services Chris Nugent (HV) appointed as PCT Co-ordinator for Children Looked After Based with the Leaving Care Team in One Stop shops, to be accessible to young people Health Assessments offered by PCT 0 – 5 years every six months 5 – 19 years every year

24. Conclusion Prevention is better than cure Targeting service at need Working closely together in a multi-agency, multi-disciplinary way Good communication Open, accessible staff Excellent processes and procedures to ensure Children are protected and Well Looked After