CHILDREN’S AND YOUNG PEOPLE’S SERVICES EALING – Early Intervention

There’s a national crisis in mental health – and any failure to address children’s needs is especially dreadful.  Rates of depression and suicides are rising.  NHS Child and Adolescent Mental Health Services (CAMHS) have been targeted for austerity cuts since 2010. Even the NHS Confederation says the system is at “tipping point”.  (See the Lowdown on Mental Health Services)

What’s happening in Ealing?  Our campaign research puts a spotlight on the situation. 

Healthy Child Programme – Public Health England

First point of contact NHS services Midwifery & Health Visiting & GP services

Pathways 0-5 year element – health visiting service preventive & universal services; Identifying health needs which include physical, social and emotional for child and family  

5 -19 Service led by school nursing service preventive universal services, and referral to GP for medical need and onward to other services as necessary including voluntary sector.

CAMHS Mental Health Tiers 

Health visiting and school nursing services link into the Ealing Tier 1 Universal services – early 

intervention. CAMHS will have children of all ages referred to their services but less likely to be under-fives but some developmental and behaviour problem can be identified in those early years.  

School children may be referred into Tier 2 services, counselling, YOTs etc

Tier 3 Specialist services will have children and adolescents with moderate to severe mental health problems.

Community Nursing Staff  

Specialist Public health Nurse qualification (Nursing & Midwifery Council Register)

In 2015 the health visitor and school nurse budgets were transferred to LA Public Health Department from the NHS. Both services are now managed by Central London Community Healthcare NHS Trust from 2018 

London Borough of Ealing

Staff Whole Time Equivalent (Agenda for Change Pay Banding )

Health Visitors

Grade 2018 2019 2020 

Band 6 33.21 30.2 22.93 

Band 7 4.88 3.80 5.0  Team Leaders and Practice Teachers

Totals 38.09 34.00 27.93

Band 5 6.22 3.63 5.63 Skill mix registered support nurses 

School Nurses

2018 2019 2020

Band 6 2.00 3.88 5.68

Band 7 1.80 1.00 1.00 Team leaders

Totals 3.80 4.88 6.6

There is DFE has also funded for Ealing pilot project (SWIS) for social workers in 8 secondary schools

Potential Workload

Total Population 2020 352,000

2020 – 5,250  births in Ealing Low birth weight 138 

0-19 Population  2020 – 67,000

0-4 population 2020 – 23,615

Ealing has 91 state-funded schools and nurseries

16 Secondary Schools

69 Primary Schools

8 Special & alternative schools 

25 children’s centres 

Special Educational Needs Primary 764

Secondary 389

Special School 824

Total Workforce  England

It would appear that since the transfer of funding to Local Authority in 2015  the England workforce numbers appear to have declined. 

Health visitors

2015 12,094 Increase in HV workforce – government investment. 

2017 8497

2020 6672

School Nurses

2017 2400

2020 925

There was an increase in skill mix with registered staff nurses and nursery nurses for the school nurse service. 

Access to services 

There is no maternity unit in Ealing Hospital, so mothers can choose to go to the hospital of their choice. As soon as baby is born then a notification will be sent to Ealing for mothers with Ealing addresses 

Access to services for Children and Families in Ealing is via Central London Community Health Trust website but parents should have contact information at the new birth assessment visit which include all the child health checks, health advice information and immunisation schedule.

Concerns

Workforce deployment during Covid-19 lockdowns 

Large workloads if following the mandated Healthy Child Programme – recommended caseload per health visitor is 250 families, but caseloads now can be 500-1000 families (iHV 2020)

Reducing numbers of staff over time since 2015 – council grants reduced

Staff leaving from stress of job – unmanageable workloads

Devastating toll of the pandemic. Are we abandoning children and young people?

Not enough nurses going into training for Specialist Qualification in Public Health Nursing – having to take out education loans

COVID-19 has made it very difficult for community nurses to carry the normal programme of visiting and child health clinics due to lockdown. Many of the contacts are now telephone or on line. These might exclude those families who don’t have access to IT. In some areas, health visitors can visit if they have adequate PPE. Almost 20% of heath visitors reported that 50% or more of their team were redeployed during the first year of pandemic.

Redeployment significantly reduced the workforce in some areas, leaving the remaining health visitors to manage increased caseloads, reducing the amount of time available to support individual families.  (Institute of Health Visiting  2020)

Review of Mandation of Health Visiting Services Gov. UK 2017 states that they have started to decline due to uncertainty during that year and reduced investment to LAs and possible delays in recruitment and training 

 Local authorities are responsible for commissioning public health services for children aged 0-19. Regulation requires all families with babies to receive five health visitor checks before their child reaches 2 and a half years old as described in the Healthy Child Programme 0-5 years. 

Public health services for children aged 0-19 are predominantly led and delivered by health visitors and school nursing teams with input from other partners as appropriate. 

Local commissioners should also consider the links and interface with screening programmes, mental health, sexual health, smoking, substance misuse and dental health. The core public health offer for all children includes: 

  • This guidance is based on a public health pathway for children and young child health surveillance (including infant physical examination) and development reviews 
  • child health protection and screening 
  • information, advice and support for children, young people and families 
  • early intervention and targeted support for families with additional needs 
  • health promotion and prevention by the multi-disciplinary team 
  • defined support in early years and education settings for children with additional and complex health needs 
  • additional or targeted public health nursing support as identified in the Joint Strategic Needs Assessment, for example, support for looked after children, young carers, or children of military families 

Best start in life and beyond: Improving public health outcomes for children, young people and families Public Health England 2020