A radical shake-up of public health services for children in Cumbria will ensure better support for families, despite reduced funding, according to nurses leading and delivering the new model.
The plans, agreed by Cumbria County Council last week, will mean increased caseloads for health visitors and spell the end of the traditional school nursing service and family nurse partnership scheme.
The redesign is expected to deliver savings of £900,000 this year and next, by bringing together key public health services for children and young people from birth to 19 with other early intervention work.
As previously reported by Nursing Times, the plans have been described as “devastating” by the School and Public Health Nurses Association (SAPHNA), which has expressed concern about potential loss of nursing expertise and face-to-face contact with children and families.
“They have gone for a cheaper version and are fitting the product to the budget, rather than the needs of children and young people,” said SAPHNA professional officer Sharon White.
However, Joanne Hiley, associate director of nursing, children and young people’s services at Cumbria Partnership NHS Foundation Trust was adamant nursing expertise would be retained and used to best effect, and maintained the revamped service was all about “putting families first”.
She told Nursing Times she did not expect nurses to be made redundant under a new county council contract with the trust, starting in April next year and there were no plans to downgrade nursing roles.
Cumbria plans radical shake-up of public health nurse roles
“We do not anticipate any redundancies among substantive health visitors or looked-after children, family nurse partnership and school nurses within the scope of the new 0-19 contract at this moment,” she said.
“There will be some change in function, but we’re confident redundancies won’t be needed,” she said. “We have absolutely amazing health visitors and school nurses in Cumbria, and I am passionate about doing everything I can to retain the clinical skills and the staff we have got.”
All five standard health visitor checks for young children would still take place, the county council have confirmed, with health visitors to be based children’s centres.
Ms Hiley, who is a qualified health visitor, said some of the savings were being made by cutting management and back office functions, and there were “economies of scale” from integrating services.
The trust and authority were also looking at pooling budgets, including money for safeguarding and children in care, she noted.
At the same time, she said “a significant amount of money” had been allocated to staff training.
“I am passionate about doing everything I can to retain the clinical skills and the staff we have got”
Under the new model, nurses currently delivering the family nurse partnership (FNP) will move into wider roles within multi-agency “strengthening families” teams that would aim to work with the 3,500 most vulnerable children in the county.
“If we had an infinite pot of money, would we continue with FNP? Probably yes,” said Ms Hiley. “But when you look at the results for Cumbria and the needs of families, I find it hard to justify.
“When you have practitioners with caseloads of 400 and some with caseloads of 20, is that an equitable service offer?” she asked.
“The strengthening families model means all families with child protection plans or children in need, and all looked-after children will have a named health practitioner who will used evidence-based tools and risk reduction plans and work with them in a really proactive way,” she said.
She added that improving safeguarding was one of the key priorities identified by staff, amid rising demand and increasing numbers of children entering the care system.
Charlotte Thompson, family nurse, Cumbria Partnership NHS Foundation Trust
“I see the Strengthening Families team as a positive step to address needs within families and wider communities that are targeted and specific.
“It will give us the opportunity to move outside the constraints of the family nurse model and be able to support families outside the under 19s age group.
“I believe having a bigger team across the skill mix will enable us to look at some wider issues, and target health needs to prevent further issues for the families we will work with and their communities.
“For example, looking at areas of high teen pregnancy and working towards reducing that with sexual health and relationships workshops, linking in with parenting programmes run by associate companies and targeted behaviour management with nursery nurses within the family home.”
Nevertheless, Ms White from SAPHNA described the plans as “flawed” and a “patchwork quilt”.
She said she understood the reasoning behind decommissioning the high-cost FNP but questioned Cumbria’s approach.
“What they are proposing doesn’t really emulate the intensiveness of this heavily-researched, well-evidenced model,” she said.
The changes will see the school nursing service currently staffed by 11 whole-time equivalent nurses disbanded in a favour of a new service staffed by six whole-time equivalent school nurses working as “clinical school-aged health co-ordinators”.
There will be less face-to-face contact between young people and nurses, and between schools and nurses, with more emphasis on email and text communication.
Cumbria plans radical shake-up of public health nurse roles
Cumbria Partnership has already launched the ChatHealth service that allows young people to text a school nurse for advice.
Ms White, who has been involved in the roll-out of ChatHealth in other areas, said it was a successful scheme, but should be used in combination with face-to-face interaction.
“You need a blended approach, as this is not a standalone service,” she said. “The flaw in Cumbria’s plan is that it is the only alternative and you cannot deliver services remotely. Children need face-to-face, parents need face-to-face and our partners need face-to-face.”
However, Ms Hiley said she was confident the new arrangements were the best way forward for Cumbria, given challenges including the geography and rural nature of the county.
“The starting place wasn’t a robust school nursing service,” she said. “The starting place was 11 whole-time equivalent nurses for over 300 schools. How can you reach 100,000 children with 11 nurses?”
“Children need face-to-face, parents need face-to-face and our partners need face-to-face”
She said the trust and the council’s public health team were working with school nurses to design the new health co-ordinator roles, which could involve running public health campaigns and other work with schools based on the needs of children.
She maintained the new service should mean school nurses spent “more dedicated time” on addressing children’s health needs, because they would no longer be responsible for child protection cases and other safeguarding issues.
“We have got to be bold,” she said. “There are some areas which have cut school nursing completely.
“We are going to build on things like Chat and look at ways we can connect. We need to work with the school nurses to look at the needs of the children and what that role needs to be,” she said.
Meanwhile, she told Nursing Times she was keen to look at ways schools could “buy back” school nursing time individually or across groups of schools.
“Arrangements for safeguarding vulnerable children will be enhanced”
She said there was a place for pushing for more funding for public health, but Cumbria’s plan was about using current resources to get “better value from the public pound”.
“At a government level – when you are trying to reduce spend – the sensible answer for me will always be to invest in public health and prevent problems from occurring earlier,” she said.
“We do need to be lobbying and doing other things to say: ‘I would love to have more money for health visitors and school nurses’, but we have got to be realistic,” she said.
“Certainly in Cumbria the public health staff are as passionate as me about trying to protect as much as we can,” added Ms Hiley.
“We have tried to be creative. There is always going to be a risk in something you do, but if I wasn’t confident that we could take on this challenge, we wouldn’t be doing it,” she told Nursing Times.
Cumbria County Council has also defended the plans, highlighting the impact of central government cuts on local authority budgets.
Cumbria nurses defend council shake-up of public health services
“These changes will result in a broader and better service for children and young people and follow detailed consultation with provider organisations, partners, staff, parents and young people about the type of service they want,” said Councillor Ian Stewart, cabinet member for public health and communities.
“In particular, arrangements for safeguarding vulnerable children will be enhanced because there will be one named person working with each family on all health matters, and a strong focus will remain on the key priorities of promoting breastfeeding, tackling obesity, and supporting mental and emotional health and wellbeing,” he said.
“While the government has cut the budget for public health, the council continues to try to protect the service from the full impact of that cut, and through better integration of health, education and social care we can achieve these improvements for less cost,” he added.