As part of our 10 years of children's public health in local government interviews, Lincolnshire Council's Chief Executive Debbie Barnes and Director of Children’s Services Heather Sandy, discuss how insourcing health visitors and school nurses has enabled the council to focus services on the needs of children in a way that would never have happened previously.
"We transferred health visitors and school burses into the council and haven't looked back."
Debbie Barnes had recently been appointed Director of Children’s Services at Lincolnshire County Council when public health moved into local government.
“I saw it as a great opportunity,” said Ms Barnes, who has now become the Chief Executive. “Firstly, there is a lot of overlap. For example, in social care we work with vulnerable people and public health focus on addressing health inequalities so you can immediately see how the two complement each other.
“I also thought it provided a great opportunity to develop an approach to public health that was much more responsive to local needs. I have a background in nursing, and we know the NHS is a national health service, whereas in local government there is a much greater flexibility to target what you do.”
When public health had first moved across, Lincolnshire had taken the decision to place it in the adult social care directorate. To ensure integration with children’s services there is a lead for children within public health and children services were assigned a dedicated public health consultant. However, this was just the first step in a longer integration journey, which eventually led to the council transferring more than 120 health visitors and school nurses plus team managers and support staff from the community NHS trust into the council itself in 2017.
“It wasn’t without pain, and it took some time – the cultural shift as a result of the move into local government was difficult for some staff, but it was without doubt the best decision we ever made. It has allowed us to integrate services in a way we never have been able to otherwise,” Ms Barnes added.
‘We can prioritise children better.’
The move meant Lincolnshire could co-locate health visitors and school nurses within the wider children’s services team, while continuing to see families and deliver clinic sessions in our children’s centres.
Heather Sandy, who is now the Director of Children’s Services, said: “When we looked at children’s public health nursing, we could see immediately there were some major challenges. For example, while health visiting teams had been encouraged to work from our children centres prior to the transition, not all did which was a lost opportunity.
“Now it is completely different. In addition to home visits, health visitors work primarily from children centres and they sit alongside social workers and early help staff in locality teams. It makes referrals seamless. But it goes further than that - simply being able to have conversations and discuss cases with an early help or social work colleague, or undertake a joint visit if they are worried about a family, has many benefits for families and practitioners. And it actually helps to destigmatise early help because health visitors are so trusted.”
Having health visitors in-house also meant the council could take the decision not to deploy health visitors into the Covid vaccination programme. “We looked at it and we were worried about the families with young children missing out on vital support,” said Ms Sandy.
“Many were really isolated and struggling and we decided it would be simply too much of a risk to deploy on the vaccination programme. It did not affect our vaccination rates and, of course, meant we could keep services running. Only those who worked part-time ended up supporting the Covid vaccination programme - and only then if they were doing it in their own time.
“With the best will in the world, the NHS struggles to focus on children as so much attention is on adults and acute care, but having our 0-19 service integrated with the wider children services workforce now means we can prioritise children in a way we could not have under the old system.”
Becoming more efficient
Like all areas, Lincolnshire has had to cope with the squeeze on resources and recruitment problems in both health visiting and school nursing. To help address this, it has taken a number of steps.
Alongside health visitors, it has recruited children’s nurses into the health visiting teams and increased the number of family health workers to support delivery of the healthy child programme and working to support families needing advice on weaning, sleep and breast-feeding, for example. “The health visitors are always on hand if there is anything more complex that needs to be discussed. The team have really welcomed the move,” Ms Sandy.
With school nurses, Lincolnshire took the decision to move them outside of schools and into the locality teams and rename them children’s and young people’s nurses. Schools, GPs, social workers, health professionals, parents and carers and young people themselves can refer into the service via the single point of access, something else Lincolnshire introduced to improve access to the 0-19 service.
Alongside that, extra emotional support has been made available to pupils with the development of a new service, Healthy Minds Lincolnshire, together with an online resource that provides support and advice for children, young people and their families.
“School nurses were spending a significant amount of time trying to support children and young people with their emotional and mental health wellbeing without necessarily having the expertise to fully support them or having anywhere they could refer them onto. We have also made sure pupils have a clear pathway into our sexual health service – another key requirement for pupils, but lots of them were telling us that they did not necessarily want to go direct to a school nurse.”
As a result, the council enhanced the commissioned sexual health offer by providing more outreach services for young people, meaning the nurses can focus more on delivering their public health role.
‘Much more to come.’
Despite the achievements so far, Ms Barnes believes there is still much more to come. “The benefits of having children’s public health in local government have been huge and we think how we have structured it has given us even bigger advantages. I know other councils have tried different approaches, but this really suits us.
“This should just be the start though. The public health team has so many skills and so much knowledge from which we can benefit. One of the aspects that we have been a bit slow on the uptake with is using their expertise in data. They have some great data analysts, but it is only recently we have really sought their help.
“We spend huge amounts on home to school transport, but with their input we have been able to make significant savings by adjusting routes and getting families to make use of personal budgets where some of the trips ending up costing us significant sums. It just shows the potential that is there.”
Please note this is an independent article. The content and views reflected within are those of the named contributor and not necessarily those of the LGA.
