Children’s nurses consultation help

WE URGE ALL OUR SUPPORTERS TO RESPOND TO THE CONSULTATION
Please follow this link to the Council consultation and read our point by point guidance – see below –  to help you.

We have drawn on the experience of a range of professionals and campaigners

THE CONSULTATION CLOSES ON SUN 21 AUGUST AT 11.59PM – IT HAS BEEN EXTENDED BY ONE WEEK. PLEASE COMPLETE BY THEN

 

GUIDANCE TO CONSULTATION IN BRIEF – CLICK HERE FOR WORD DOCUMENT

Council proposals in blue	Save Lewisham Hospital campaign says:
COUNCIL PROPOSALS FOR HEALTH VISITORS PROPOSALS 1-6  – they are not numbered by the Council	Strongly disagree Health visitors and health visiting services should not be reduced because they provide an essential service for children’s health and well being age 0-5.
COUNCIL PROPOSALS FOR CHILDREN’S CENTRES We are looking at how we can continue to make better use of our Children’s Centres in future, including what services they could provide, and where these are provided from. Please tell us how you feel about the following proposals: Co-locate Children’s Centres with other health and education services	Neither agree nor disagree. Without further detail this is not clear. Health facilities for children’s and families need properly purposely provided buildings with proper facilities.
Integrate the one-to-one family support service provided by Children’s Centres with our health visitor support for vulnerable families.	Neither agree nor disagree. This is unclear.
COUNCIL PROPOSALS FOR SCHOOL NURSES
COUNCIL PROPOSAL 1, beginning… School nurses currently offer a health assessment to children when they enter primary school. In future, school nurses might provide a combined assessment for reception …	Agree if properly resourced and NHS provided.
COUNCIL PROPOSAL 2, beginning… MyTime Active currently deliver a weight management programme for children in Lewisham…	Agree if properly resourced and NHS provided.
COUNCIL PROPOSAL 3, beginning… The school nursing service currently plays a key role in safeguarding and child protection. n future, we will continue to require school nurses to undertake health assessments…	Agree We support this if there are adequate resources.
COUNCIL PROPOSAL 4,  beginning… The school nursing service currently supports the health and emotional wellbeing of children and young people through school drop-ins, appointments and health promotion  work…	Strongly disagree It is known that the numbers of young people attending A&Es from schools in mental health crises has increased greatly. Early intervention services such as school nursing are vital in this context.  The proposed cut of 22% as is planned, is dangerous.
COUNCIL PROPOSAL 5 beginning… School nurses also provide support to children with long term conditions and disabilities. In future, a dedicated nursing team, supported by community children’s doctors, and disabilities in schools…	Strongly disagreee because this service already exists
COUNCIL PROPOSAL 6, beginning… The school nursing service currently delivers immunisations to school age children. In future, immunisations will continue to be provided in schools but might be delivered by a different immunisation team.	Strongly disagree There is no reason for this change as the school nurse team is already providing a good service. They know the schools and as well as providing the immunisation service can pick up on vital wider issues which young people may present in these contexts.

 

FULL BACKGROUND TO COUNCIL CONSULTATION AND DETAILED GUIDANCE

The basis for the consultation is a £2m cut
Health visitor and school nurse funding has recently transferred from the NHS to Local Authorities- who are suffering massive government cuts in funding.

In Lewisham there will be an assumed financial cut of £2m from a budget of £9.1m (£7.35m for Health Visiting and £1.75m for school nursing).

This represents a cut in funding of 22%. It is just not possible to provide the same standard of care currently delivered.

The council has not conducted, or made public, a risk or needs assessment of these proposals. 
This is unfair on children, suggesting cuts without knowing the potential impact on their lives, and asking people to give feedback without advising them of the possible consequences.

Further, the Council does not mention their recent consultation, which sought to de-register 13 of 17 Children’s Centres from Ofsted.  So while this consultation wants to increase the children’s centre workload, another consultation is cutting their budget and their ability to accept referrals for vulnerable children.

The Council itself acknowledges greatly increasing need:

• Increase in local birthrate to over 5000 per year;
• Increase in numbers of vulnerable families – where 400 children require child protection plans compared to 300 only a few years ago.
• The Council states that the numbers of children on the targeted health visitor caseload for health visiting has increased to 2000.
• Thresholds for social work intervention are rising, placing greater responsibility on health visitors and school nurses.

 ROYAL COLLEGE OF PAEDIATRICS AND CHILD HEALTH – 15 July 2016
‘Child wellbeing in the UK ranks a poor 16th out of 29 income rich countries… breastfeeding rates are deemed the worst in the world, it is highly concerning to learn that of the £50.5m [public health] spending reductions planned for 2016-17 by local authorities, the biggest single area affected was services directly aimed at improving the health of children and young people…’

‘It is vital that [public health] services provided by local authorities such as health visiting, school nurses and weight management programmes are protected. Without them, obesity rates will rise… health costs will spiral, breastfeeding rates will fail to get better and thousands of babies each year will miss out on the many benefits it provides. In addition, obesity prevention, school nurses and health visitors are all important in the prevention and early detection of mental health problems, so these services are vital for maintaining both the physical and mental health of our children.’
Letter from RCPCH to the Health Service Journal 15 July 2016

 

DETAILED POINT BY POINT CONSULTATION GUIDANCE

Council text is in blue Save Lewisham Hospital Campaign help text in black

 

HEALTH VISITORS 

The Save Lewisham Hospital Campaign says:

• Health visitors are experienced nurses and midwives with a post graduate qualification in public health nursing.
• Health visitors offer health care from early pregnancy until a child is 5, particularly supporting successful breast feeding, good parenting and child development. Health visitors provide a service that can be accessed easily without a waiting list for an appointment
• The Council description (see below) does not mention ante natal care.

• Health visitors do a lot of safeguarding work – early detection and intervention- and work very closely with social work colleagues. This work requires a high level of skill in communication, child development knowledge and knowledge about public health issues including domestic violence.
• Health visitors give advice on a whole range of issues from caring for minor illnesses to caring for children with chronic illness and disability.
• Their nursing and midwifery backgrounds and the extra course in public health nursing equip them for this role.

The SLH campaign strongly disagrees, we say:

• The early years are the most crucial time for children – the first 1000 days – conception to age 2 – is recognized by government as vital, so to cut ante-natal visits to just the ‘vulnerable’ is dangerous.

 

• The whole rationale behind health visiting is to provide a whole population service, which is how vulnerable families are identified and any health needs which need addressing. How can it be known who is vulnerable if health visitors are not routinely visiting parents? Every contact counts.

• Vulnerability can occur at any time to anyone. For example, post-natal depression does not obey vulnerability criteria. Parents who need support will be missed if only a small number are offered home visits and this may have tragic consequences.

• While groups may be good for socializing, mothers who are at most risk are least likely to attend or participate in a group- because of anxiety, confidence or language barriers. A group is never the best context for identifying and discussing sensitive issues, where people may fear being judged.

• Post-natal depression – a significant part of a health visitor’s role – could be missed if women only have the option of attending a group.

The SLH campaign strongly disagrees, we say:

• If all child health clinics are done in children’s centres the important partnerships between GPs and practice staff, developed over years to help identify and safeguard at risk children will be broken up.

• Children, at present, go to their GP practice for immunisations as part of the Healthy Child Programme. By going to a Children’s Centre clinic, they will once again meet yet another unfamiliar person – this increases the risk of missing concerns.

• The Council is increasing the workload for Children’s Centres. But at the same time, it is planning to de-register 13 of 17 children’s centres from Ofsted, because of further budget cuts demanded by the government.  Once de-registered, these centres cannot support vulnerable families

The SLH campaign strongly disagrees, we say:

• The Council assumes the government will back the dropping two of the five mandatory health checks for under-fives. This proposal rests on an assumption which may not happen and which is financially driven in the first place.  At present, there are 5 mandatory checks, children in Lewisham should be entitled to them.
• All children should have access to evidence based health care. It is not always evident which children are vulnerable as they can become vulnerable at any time, so ongoing assessment is essential. The NHS was founded on universal health care ‘from the cradle to the grave’ so why should many children miss out on their check?
• As a society we should class all children as vulnerable – to air pollution/accidents etc. as well as poverty/domestic abuse/substance misuse. There is no one assessment tool that can identify all vulnerable children. Classifying some children as non-vulnerable is a subjective decision denying most of them access to an important check.

The SLH campaign strongly disagrees, we say:

• The breastfeeding network do an excellent job with the help of almost 30 unpaid volunteers who are committed to promoting breastfeeding.
• Health visitors and midwives already have huge workloads and will not be able to take on the management of this large group of volunteers.
• Breastfeeding saves the public purse a huge amount of money in reducing the need for health care as breastfed babies have less gastrointestinal infections etc.

The SLH campaign strongly disagrees, we say

• Admin staff do a lot of important work, supporting health visitors. Cutting their jobs will mean in effect that health visitors will be doing their own admin work, adding to a work burden that is already too great.
• IT systems need huge investment to improve. Improved IT in the community has been promised for over a decade yet still hasn’t happened.  It seems unlikely to improve while the government is committed to austerity cuts.  Removing the staff before the systems exist is putting the cart before the horse.

 

The Save Lewisham Hospital strongly disagree

• Having a dedicated BCG immunisation team is not a good idea. It is likely to mean lower paid nurses doing a task-orientated role and not knowing the babies that they are immunising.
• The services is also a prime target for privatisation. Immunisation includes assessing a baby and observing parent child interaction and is best done by community nurses who are part of the health visitor team. Every contact really counts as part of an early help pathway.
• This proposal suggests a complete lack of understanding of how vital team work is for children’s health.

The SLH campaign proposes:

• To continue to offer ALL children evidence based health interventions by experienced and properly trained health visitors, nurses and midwives.

• The government’s 5 year expansion programme for health visitors ‘a call to action’ was completed in 2015 and yet a year later local authorities, including Lewisham are proposing to cut the service that has so recently expanded.

• This is a waste of public money and not fair to families and children.

 

CHILDREN’S CENTRES 

The SLH campaign says:
This implies closing either children’s centres or health centres.  It is not clear and has not been stated in the consultation.

The SLH Campaign says:
There is already good partnership working between health visitors and family support workers in Children’s Centres. The change is financially driven and would impact greatly on the health visitor workload.

SCHOOL NURSES

The SLH campaign says:

• The council consultation document grossly underestimates the role of school nurses.
• School nurses are registered nurses who have undertaken additional specialist public health children’s nursing training. They are professionally qualified to work specifically with adolescents in school and youth settings
• School nurses are responsible for mandatory weight monitoring of the entire school aged population 5-11.
• There is a serious issue about what the school nurses are expected to do but cannot because of already insufficient resources.
• The workforce is skilled in the delivery of child health promotion but currently does not have capacity to provide this at a sufficient level for all young people in Lewisham.
• School nurses have many important public health duties including the above and also national immunisation programmes without the resources.
• The cuts in social care funding have led to massive increase in school nurses’ child protection workload (‘safeguarding children’). Their workload has more than doubled in the last three years.
• School nurses also play role in working with secondary school children, picking up emotional health and well-being issues in weekly “drop ins” in schools and youth settings, and liaising with mental health services.
• School nurses liaise with doctors and teachers on children with medical conditions ensuring that children and young people’s access to education is not marginalised.
• They work with the disability services for children in mainstream who have disabilities.
• There is never enough resource or skill level to meet all the demands. 

The SLH campaign says agree:
This proposal is what used to happen routinely, and would be beneficial if properly
resourced and NHS provided.

The SLH campaign says agree:
This proposal could be beneficial as long as it is resourced and remains within the NHS.

The SLH campaign says agree:
We support this if there are adequate resources. If resources are reduced, the ability to meet the statutory duty to attend safeguarding children meetings is threatened.

The SLH campaign says Strongly disagree:

• It is known that the numbers of young people attending A&Es from schools in
  mental health crises has increased greatly. For example, in one local A&E
  the numbers have increased from approximately 1 a day to 3-5 a day.
• Early intervention services such as school nursing are vital in this context.
  The proposed cut of 22% as is planned, is dangerous.
• It is safer that one NHS agency support the emotional health of young people –
  the involvement of too many agencies fragments the service, leading to arguments between services about who is responsible for a child with multiple diagnoses.
• We are concerned at the vagueness of the Council proposals- which say that a
  reduced service ‘might’ be redesigned. It is impossible to comment on
  such vague plans without a public health needs assessment.
• This is indicative of spreading a lower funding resource further.

The SLH campaign says:

• A dedicated nurse team – the special needs nurse team – already exists in this role for over 10 years, providing support and clinical children’s nursing expertise to the school nursing team.
• The proposed cuts reduce, not improve, what already exists.

The SLH campaign strongly disagrees
There is no reason for this change as the school nurse team is already providing a good service. They know the schools and as well as providing the immunisation service can pick up on vital wider issues which young people may present in these contexts. 

The SLH campaign strongly says
Continue to support this service, without cuts, as school nurses are already overloaded and play a vital role in many aspects of child health.

Save Lewisham Hospital Campaign 4 August 2016