Agenda item

This is the fifth report submitted to Panel as a commissioning update on HCRG Care Group (HCRG Care Services Limited)’s delivery as the prime provider for integrated Health Care and Adult Social Care Services for the B&NES locality.

At the request of Panel this update report will concentrate on the key theme of Children’s Health Services in B&NES.

The Director of Children’s Services introduced this report and highlighted the following areas within it to the Panel.

HCRG Care Group deliver a wide range of Children’s Community Health Services in B&NES which is jointly commissioned by the Council and Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group and is routinely performance managed by both public health and specialist commissioning.

Leaders of HCRG Care Group Children’s Services have a well-established culture of close collaboration, partnership and multi-agency working. Between

regular commissioner led service level performance meetings, both Public Health and Complex Care and Targeted Support commissioning functions regularly ‘deep dive’ to maintain a continuous cycle of service development. Representatives from the Group also regularly represent children and young people’s health at a wide range of local system forums including the B&NES Community Safety and Safeguarding Partnership (BCSSP), the Youth Offending Board and the Special Educational Needs and Disabilities Strategy Board, among many others.

Prior to the onset of the COVID 19 pandemic, performance across both specialist and universal services was very good. NHSE have provided over the past two years centralised sets of guidance throughout the pandemic via a series of Community Service Prioritisation Frameworks. These frameworks have advised on which services to suspend, and which must continue to ensure that rigorous safeguarding principles are maintained, particularly for vulnerable groups in both identifying these groups and maintaining contact and support for those identified.

HCRG Care Group have consistently applied the prioritisation frameworks and in many cases staff, particularly in the Community Nursing and Psychology service which supports children and young people with complex health needs and their families and carers, have gone beyond the guidance issued by NSHE to support vulnerable families on their caseload, delivering food parcels and vital medicines and offering critical emotional support to families. The Children Looked After health offer has also been prioritised to ensure that all Initial Health Assessments have still been carried out face to face and in a timely way and that Review Health Assessments have been routinely completed.

As with many other health services across all age acute and community health sector, all B&NES Children’s Community Health Services have experienced some disruption to normal service delivery during the pandemic, particularly those that require express face to face consultation such as audiological services. There has also been a marked increase of referrals into several specialist services during the period of the pandemic with a corresponding increase in requests for Education, Health and Social Care Plans coming into the Education Service in the Council.

The School Nursing Service provides universal access to health advice and support for school pupils and college students. The school nurses also work closely with the mental health support in schools’ teams provided by Child and Adolescent Mental Health Services (CAMHS) and support access to, or advice from, specialist CAMHS. The school nursing service facilitates the ‘FRIENDS’ programme in selected primary school classes that include pupils with high levels of anxiety.

The Senior Commissioning Manager for Complex Care & Targeted Support added that the report had been produced collaboratively and that she would like to praise the work of the Children’s Community Nursing and Psychology Service in particular who provided extra support for families with CYP with complex needs.

Councillor Liz Hardman referred to Appendix 1 and asked if further comment could be given on how the school nurses work with CAMHS and more information about the FRIENDS programme.

The Senior Public Health Commissioning and Development Manager replied that the school nurses work closely with the mental health support in schools’ teams provided by Child and Adolescent Mental Health Services (CAMHS) and support referral to, or advice from, specialist CAMHS. 

She said that this includes developing safeguarding plans that include EHWB needs and referring on for specialist interventions when required from CAMHS, Psychology and Psychiatry etc. She added that the service also promotes a whole school approach and works with leadership teams to promote positive mental health in schools and attends assemblies and parent/group sessions. 

She informed the Panel that FRIENDS is a resilience intervention proven to reduce anxiety and depression and promote positive mental health. Based on Cognitive Behaviour Therapy (CBT), FRIENDS has been recognised by the World Health Organisation as the only evidence-based programme effective in reducing anxiety as a universal and targeted intervention (WHO, 2004).

She stated that the service provided 7 courses in schools in 20/21 and feedback showed that 92& of children reported a positive experience of the course with 71% of children reporting that they used FRIENDS skills often to make positive choices.

She added that all schools have a named school nurse and contact is based on need so all secondary schools have access to a regular drop in session for children and young people and school nurses respond to referrals and maintain regular contact with schools.

Councillor Hardman commented that we know that as a result of lockdowns there are more children missing education and asked to know more about the extent to which we are able to engage with and support those children in the context of increasing numbers.

The Director of Children’s Services replied that in respect of the School Nurse role supporting Children Missing Education, the Nurse works closely with the wider education team to respond to referrals that relate to health needs that are specifically challenging access to education. She added that the nurse often works with other health colleagues to develop a plan that meets health needs alongside the CYP and their family that supports a return to education

Regarding the impact of Covid on Children’s education, she said the return to school in B&NES has been strong, although CV19 infections undoubtedly have has affected overall school attendance. However, there have been isolated cases of children not returning to school for individual reasons.

She stated that in some cases, family members would have been considered Clinically Extremely Vulnerable (CEV) and would have been expected to continue to isolate when there had been an easement of restrictions for others.  When these restrictions and advice no longer applied to the majority, several families found it difficult to accept and wanted to continue isolating, thus refusing to send their child back to school. She explained that this was often due to apprehension around what schools had put in place to prevent the spread of COVID ( eg, open windows, masks, one way systems, increased hygiene, bubble, staggered starts at pinch points, different timetables etc). 

She said that some families chose to EHE as a result and therefore were removed from the school roll and the Alternative Learning Team (ALT) were notified to provide appropriate advice.

She added that where the child remained on roll but was not attending, together, the school and CMES identified those where we felt additional support was required (and continue to do so).  The CMES made calls to those families and talked them through what would be in place to help alleviate their fears.  In addition to this, we offered to take the families out of school hours with agreement from the schools to witness first-hand the things put in place.  We often found that just setting foot back onto the school site gave them the confidence to return to school. We had several success stories by using these options. 

She stated that when there are ongoing genuine issues re health with individuals within a family, we have sought advice from medical professionals and ensured that the headteacher was made aware of this information, allowing them to be fully informed prior to making a decision about appropriate support, onward referrals and coding. We have seen an increase in the number of children requiring a service from our Hospital Education Re-integration Service due to not being able to attend school because of anxiety.

Councillor Hardman commented that the overall response rate in staff engagement fell from 73% to 44% as a result of the pandemic and asked would the rates be expected to recover this year.

Val Scrase, Managing Director, B&NES Community Services, HCRG replied that workforce surveys are completed annually, and we would normally expect greater uptake. She added that the engagement score, which is a measurement of positive feedback - has been very good over past 3 years and maintained this year.

Councillor Ruth Malloy asked how many Mental Health First Aiders there were within HCRG.

Val Scrase replied that she did not have those specific figures to hand.

Councillor Malloy asked if the term ‘restorative supervision’ could be explained further.

Val Scrase replied that regular supervision for staff is promoted to take place at least once a month and that restorative supervision is used for staff who may have more complex cases and need additional emotional resources / therapy.

Councillor Andy Wait commented that he was concerned with the performance in year 2021-2022 for quarters 1-3 with regard to Community Paediatrics Referral to Treatment - % seen within 18 weeks.

The Senior Commissioning Manager - Complex Care & Targeted Support replied that they wanted to show the amber figures in context and said that the pandemic had been a factor. She added that there has been an increase in the complex needs being identified and that SENCO’s were picking up issues as children return to school. She said that families were also choosing to live in B&NES because of the services we provide and that the CCG have committed additional resource to attempt to return the figures to their previous levels.

Kevin Burnett asked if schools do still have school nurses attached to them.

The Senior Public Health Commissioning and Development Manager replied that they do and that a good relationship exists across all schools.

Kevin Burnett asked if there were any workforce surveys pre-Sept. 2021 and if yes, how do the results compare.

Val Scrase replied that annual surveys take place and acknowledged that the response was lower than previous years. She added that they do also look to hold wider engagement exercises.

Councillor Liz Hardman commented that she would welcome the Panel receiving a more in depth report into Children Missing Education.

The Panel RESOLVED to;

i)  Note the content of the report and identify any areas of focus for the next update report due to Panel.

ii)  Confirm the arrangements for HCRG Care Group 6 monthly commissioning report as Panel is now alternating between a focus on Adults and Children’s.