As part of our 10 years of children's public health in local government interviews, Barnardo’s Director of Health, Rukshana Kapasi, discusses how children's public health moving to local government has encouraged innovation and more integrated support for children and young families.
"Public health has embraced the voluntary sector - but we need to go further."
Rukshana Kapasi has watched the impact of public health moving to local government from the outside. As director of health at Barnardo’s and a board member of a community NHS trust, which provides health visiting and school nursing services, she is acutely aware of life as a provider of services.
Barnardo’s has around 10 healthy child programme contracts with councils, including two large ones with Birmingham and Essex councils. In each they are not the lead provider, but instead work in partnership with either an NHS trust or private provider.
“It’s really been quite innovative in places,” she said. “We have used volunteers, early years practitioners and family support workers to work alongside health visitors and school nurses. Often it is to help address problems recruiting nurses to roles so services have had to change the skill-mix of the teams.”
Benefits of working with the voluntary sector
But Ms Kapasi said it has not all been motivated by the need to plug gaps. “I would say councils also understand the need to integrate services and look at the wider determinants of health in a way in which I am not sure the NHS would have done. So, our staff have been able to bring in expertise in areas such as domestic violence, welfare benefits and perinatal mental health.
“We’ve also worked with our corporate partners to provide things such as free school uniforms, food vouchers and recycled computer and IT equipment. It has enabled services to provide more holistic support to families addressing some of the root causes of poor health such as poverty.”
Beyond the healthy child programme, Barnardo’s also has a handful of contracts with integrated care boards that span children’s health. This includes one in South Yorkshire called Bumps, Birth and Beyond where peer support educators have been trained to do outreach work with young mothers and another project in Buckinghamshire involving women’s health workers who provide support before, during and after pregnancy in deprived areas.
Ms Kapasi said: “Health literacy is a big focus in this sort of work. Helping people navigate the health and support system. I am seeing a lot of willingness to innovate – directors of public health are often driving these initiatives. I think being in local government has given public health a much wider perspective when it comes to services to tap into.
“We also have a number of contracts for family hubs and there are a lot of attempts to integrate the support available in those with the healthy child programme and really focus on tackling health inequalities. One advantage of working with the voluntary and community sector is we are trusted by the public in a way statutory services are not. It’s not just Barnardo’s either. We are seeing other voluntary sector organisations working in this sphere too.”
Why there’s more to come
But Ms Kapasi believes there is much more to come. “We have just seen an uplift in the public health grant, which is really welcome given the cuts we’ve seen over the past decade.
“I hope it provides us with an opportunity to go further. Certainly, I think there is much more joined up work local government and the NHS can do. There is still a bit of a dissonance - the gap between the two is too big. Integrated care systems should hopefully address some of that – but we need to put our minds to it.
“Is there more that could be provided from GP surgeries, for example? Or how is the NHS working with local government on the wider determinants? We’re working with the Institute of Health Equity in a number of areas to look at just this.
“That includes a school readiness project in Cheshire and Merseyside that is targeting young mums using reading groups to link them in with a whole host of different services across local government and the NHS.
“Meanwhile, in Birmingham and Solihull there is a system-change approach which involves a corporate social responsibilities dimension which will funnel money from ICB contracts to invest in prevention.
“There are some good ad-hoc projects too. Dental health pop-ups have been run at family centres in the area where I sit on the community NHS trust board. And Barnardo’s is involved in a pilot project in seven areas where A&E family support workers are helping families with non-clinical needs, such as on-the-spot advice on accident prevention, emotional health and wellbeing, breast-feeding and doing follow up home assessments for frequent attenders where, for example, housing advice and support may be needed.
“You do not automatically think that primary prevention work can be done in A&E, but it absolutely can. One of the reasons why so many people go to A&E is that they just don’t know where to go.
“I think more could be made of the voluntary sector estate too. At Barnardo’s we have more than 600 shops across the country. We could be running more services from them by working alongside the NHS and local government. Work
