Review of Public Health Nursing Services for 0-19 year olds in Hull
Information Document
- What is this consultation about and why are we doing it?
This consultation focuses on public health nursing services in Hull – those traditionally provided by health visitors and school nurses for all children and young people, from pregnancy and birth, through to19 years of age and in addition how we can improve oral (teeth and mouth) health. This pack aims to give you all the information you need to help you understand the services provided now and why we want to change them.
Hull City Council and local NHS organisations are seeking your views to help shape the future design of health services for children and young people (CYP) in Hull. We want to make sure that these services deliver what is needed in the future.
Services for children and young people in Hull are provided by many different organisations. This includes the NHS – hospitals, GP surgeries and health centres, health visitors; Hull City Council – schools, social care, dentists, youth services, children's centres; the voluntary sector – child care, support groups for children and parents. All of these services need to work well together so that children, young people and their families get the right service at the right time, to keep them healthy.
2. Who are the services for?
These services are for all children and young people living in Hull, from pregnancy to 19 years of age. Hull has a young population with worse health and wellbeing than the average for the whole of England.
3. Health and Wellbeing of Children and Young People in Hull
The Health and wellbeing of children in Hull is generally worse than the England average, particularly in relation to:
- The number of children who are obese 9.7% of children aged 4-5 years and 21.0% of children aged 10-11 years are classified as obese
- Hull has lower rates of breastfeeding, and higher numbers of women who smoke during pregnancy.
- The admission rate to hospital for injury in children and young people are higher than the England average
- There are more children living in poverty
- Hull has higher pregnancy rates in under 18 year olds, a higher number of teenage mothers, poorer sexual health.
- Children in Hull have poorer dental health
- Higher numbers of young people aged under 18 admitted to hospital with alcohol specific conditions
Higher numbers of young people aged 10 to 24 years admitted to hospital as a result of self-harm
Hull Child Health Profile (2014):
4. What are Public Health Nursing Services for 0-19 year olds?
Public health nursing services for children and young people are mainly delivered through a national programme, called the Healthy Child Programme. In April 2013 Hull City Council became responsible for providing the Healthy Child Programme (through school nursing services) to all 5-19 year olds. From October 2015, the Council will also be responsible for providing the Healthy Child Programme (through health visiting services) to all 0-5 year olds in Hull.
The 0-5 years Healthy Child Programme is a universal public health service available to all families and it aims to:
- help parents develop a strong bond with children
- encourage care that keeps children healthy and safe
- protect children from serious diseases, through screening and immunisation
- reduce childhood obesity by promoting healthy eating and physical activity
- encourage mothers to breastfeed
- identify problems in children’s health and development (for example learning difficulties) and safety (for example parental neglect), so that they can get help with their problems as early as possible
- make sure children are prepared for school
- identify and help children with problems that might affect their chances later in life.
The 5-19 years Healthy Child Programme is a public health service and involves school nurses working in partnership with others to:
- promote health and to reduce the risk of accidents happening
- carry out a range of health development reviews, including school entry, year 6/7 and mid-teen health review
- carry out the National Child Measurement Programme (NCMP) for measuring children’s height and weight; provide targeted support for children and young people who are vulnerable and at risk; provide support for a range of health issues including sexual health and contraception, drugs, alcohol and smoking, emotional health and wellbeing
- safeguard children; provide hearing and vision screening as well as reviewing and providing immunisations.
5. How are universal services provided now?
In Hull, the Healthy Child Programme, is currently provided through three key services:
- 0-5 years health visiting service, commissioned by NHS England, provided by City Healthcare Partnership
- 5-19 years school nursing service, commissioned by Hull City Council, provided by City Healthcare Partnership
- Family Nurse Partnership (FNP), commissioned by NHS England, provided City Healthcare Partnership. FNP works intensively with under 18yr old girls who are pregnant for the first time.
Some other services, related to the Healthy Child Programme, are also provided separately, these are:
- Oral health promotion services including tooth brushing scheme in nurseries and schools, resources for schools to teach children about keeping teeth healthy, and a dental survey, commissioned by Hull City Council, provided by City Healthcare Partnership. We are reviewing our approach to oral health and considering additional improvements we could make.
- Injury Minimisation Programme for Schools (IMPS) commissioned by Hull City Council, provided by City Healthcare Partnership.
- And some services to support domestic violence services and increasing breastfeeding.
6. Why are children's health services changing?
Some of the existing health services for children and young people, are reaching the end of their contract terms. We must therefore review how well these services are meeting the needs of children and young people and look at how we can improve services for the future. In addition to this, responsibility for commissioning or buying some services is changing, so there are new opportunities to improve services.
7. What will an integrated universal service for 0-19 year olds do?
As part of the overall service review we aim to develop an integrated children and young people's public health service for 0-19 year olds in Hull, bringing together existing services where possible.
The Healthy Child Programme will be delivered by a team of qualified and skilled Public Health Nurses with a mix of skills and competencies. Teams will be expected to focus their efforts around a number of important 'touchpoints' in a child's life – including birth, starting school, moving to secondary school and starting work, in order to improve health outcomes.
The new delivery model will:
- Set out clearly the health improvements that need to be achieved
- Identify the key ‘touchpoints’ for 0-19 year olds, where Public Health Nursing Teams (made up of Health Visitors, School Nurses and Family Nurses) will assess the needs of the family, deliver help and support or identify children and families who are at risk and need early help from another service
- Promote Public Health Nurses as key to access a range of specialist services
- Encourage public health nurses to share their skills across all services working with 0-19 year olds so that care is seamless and public health nurses can share their knowledge and expertise
8. What health outcomes are we trying to achieve?
We want the delivery of an integrated public health nursing service for children and young people to:
- Improve life expectancy and healthy life expectancy
- Reduce numbers of mothers who smoke at the time of their delivery
- Increase the number of mothers who start to breastfeed and increase the proportion of mothers who breastfeed for 6-8 weeks or longer
- Improve the earlier identification and prevention of obesity in children
- Improve school readiness
- Reduce the rates of tooth decay
- Improve rates for immunisation uptake
- Reduce school absence due to poor health
- Access hearing, vision and weight screening and identify problems early
- Improve mental wellbeing
- Promote bonding and attachment
9. Promoting Social Value
The Public Services (Social Value) Act of 2012 means that public bodies (such as local councils) have a duty to consider how the services they buy might improve the economic, social and environmental well-being of the area or add social value.
So when we buy children and young people's services, we need to consider how the money will produce wider benefits to communities and people in Hull. As an example, one way to add social value would be to buy a service which is committed to employing people who have been out of work for a long time. It might also be about supporting local voluntary or social enterprise organisations in the local area.
10. Glossary
Commissioner: responsible for planning and buying services.
Commissioning: planning and buying services by assessing the needs of the population; prioritising outcomes; managing service providers; measuring impacts and planning next steps.
CYP: children and young people.
Early help: where services help and support people earlier to prevent problems from getting worse and to reduce the need for more intensive services later on.
Integrated: where services are joined up; reducing duplication; improving the experience of service users.
National Childhood Measurement Programme (NCMP): national programme for measuring height and weight of children in reception year and year 6 to help us monitor overweight and obesity rates.
Outcomes: the broad changes that we want to achieve for children and young people as a result of the services that we offer.
PSHE: Personal, Social and Health Education programme taught in all schools.
Provider: responsible for putting in place services for the population.
Public Health Nurses: health visitors, school nurses, family nurses and other practitioners working with them to improve the health of children and young people.
Specialist: services provided for people with significant or complex health needs, provided by experts.
Targeted: services which are available to people in greater need of help and support.
Tender: documents that outline how a provider is able to meet the requirements for a service being commissioned.
Touchpoints: age or stage of development of a child where public health nurses can make a difference if they visit children and young people or offer other services to review their health and wellbeing.
Universal Health Services: services that are available to all people and aim to improve health.
11. Frequently Asked Questions
Is anything excluded from this review?
We are keen to hear all views focussing on public health nursing services. Due to the changes that took place in the NHS and Local Authorities in April 2013 there are some areas of Children’s Services which are commissioned by NHS Hull CCG rather than by Hull City Council. If any of your comments relate to Children’s Services that are not commissioned by Hull City Council, we will ensure your feedback is passed onto the organisation responsible for these services.
Why are services being redesigned?
Existing service contracts are due to end. Our procurement rules will not permit any further contract extensions beyond this time without a tendering process being conducted. As part of the tendering process, we wish to use the opportunity to review, reflect on and refine our local services.
Will there be any more money available?
This review is designed to help ensure the best use of all available resources to provide care of the highest standard to deliver the best outcomes for children and young people.
How are you consulting on oral health?
A local oral health action plan has been produced following discussion and input through the Oral Health Advisory Group involving local partners and dentists. We are asking people to comment on the draft plan by sending responses to by 17 July 2015 at the latest. For a copy of the plan please contact us at the above email address. To access the oral health survey please click here.
What about water fluoridation?
We are not currently consulting about fluoridating the water in Hull, if this is an option in the future we will undertake a full and separate consultation exercise.
12. Contact details for further information about this consultation:
Rachel Iveson, Public Health Lead (01482) 616097
Vicky Harris, Assistant City Manager Public Health (01482) 616121