Brent proposes to combine Health Visitor and School Nurse services

A paper going to Cabinet on Monday proposes the procurement of a new 'joined up' 0-19 Health Visitor and School Nursing Service with a combined value of £6.6m.

Currently the Health Visitor and Family Nurse Service is provided by London North West Healthcare Trust and School Nursing by Central London NW Healthcare Trust.

There have been concerns, some of which I voiced in a delegation to Cabinet, about the lack of continuity between health visiting and school nursing, at the point where children start nursery. Early Years practitioners have found children arrive at nursery or reception with specific special needs that they haven't been informed about in advance.

One of the issues has been that engagement with health visitor services is not mandatory and that missed appointments are not followed up. Health Visitors are often the first people to become aware of a family's other needs. The paper LINK states: 

...The successful Provider will be required to demonstrate how their services and the staff teams employed will be pro-active and engage with families and their under 5s to support health needs and link into wider issues including housing, education, childcare, welfare and poverty. 

The service to be procured as outlined in this report will lead to the delivery of the Healthy Child Programme - the early intervention and prevention public health programme issued by the Department of Health which lies at the heart of universal services for children and their families. The early years are a crucial stage of life, and this service will provide an invaluable opportunity to identify families who are in need of additional support and children who are at risk of poor outcomes. 


To improve continuity across the services and age ranges, the Council is planning to combine health visiting and school nursing service so that professionals will be able to continue to work with the same children for a longer period of time rather than passing them to another service as they get 
older. This will improve the continuity for children and young people and their families. 

By commissioning these services together professionals will no longer be bound by the traditional age ranges of services, and both children and families can benefit by receiving support from the same professional for longer. It will also be expected to realise efficiencies through economies of scale and overhead and management costs. 

 The 'efficiencies' referred to in the last sentence are clearly something to scrutinise in the context of the impact of cuts on services but the joined up approach is something to be welcomed. The health of Under 5s was a matter of great concern in a report to Cabinet in January this year LINK.

There are an estimated 24,600 under 5s in Brent, an increase of 2,500 on 2010, but the rate of increase is expected to slow over the next few years. The resident population of 0-19 year olds is expected to increase by almost 10% over the next 5 years.

The new combined contract would start on April 1st 2017.

Good News and Bad News on Under 5s Public Health in Brent

Tomorrow's Cabinet meeting will be discussing the 2015 Public Health Report on Under 5s and their mothers. Brent has been responsible for the public health of under 5s since October 2015 and the report gives a mixed picture.  Tooth decay and obesity are high but fewer mothers smoke in pregnancy.  The number of Unders 5s in the borough that has been rising in recent years and produced a crisis in school places, is flattening out and perhaps declining.

However the general fertility rate remains higher than the Inner London, Outer London and England average. In ethnic terms the number of white births is the highest but it is not broken down into different groups as other births are. Teenage conceptions are lower than the London and England rates and in long-term decline. Worryingly, Brent infant mortality is on the increase against the London and England trend.

Obesity rates in Reception classes are rising and well above the England rate. Tooth decay in under 5s is the second highest in London and the most common reason for non-emergency hospital admission for 5-9 year olds.

A note of caution, although the charts give a summary it is also important to read the commentary. The full report is HERE.

Pertussis better known as Whooping Cough

A further item on the Cabinet agenda is the commissioning of Health Visitor and Family Nurse Partnership and a promise to review current arrangemtns and consider future models. Clearly the School Nurse service should also be included in any review.