North East Lincolnshire Council Children’s Health Provision provides health visiting and school nursing services to children, young people and families in the Grimsby, Cleethorpes and Immingham area. They also provide an early intervention and prevention specialist service for families with children who have attention and behaviour difficulties.
We found the following areas of good practice:
Staff we spoke with were confident about safeguarding and knew what to do if they had a concern or needed to raise an alert. Children’s Health Provision (CHP) worked closely with the Local Safeguarding Children Board (LSCB) and shared their safeguarding policies and protocols with other providers and partner agencies. Compliance with safeguarding children training and safeguarding supervision was good.
Vaccinations were safely stored with processes in place to maintain the cold chain during transportation and use. Health visitors were non-medical prescribers and we saw up to date Patient Group Directives (PGDs) for use by the school nursing service. Care records were completed accurately, in keeping with professional standards. We saw they were completed in a timely manner.
There were measures in place to protect staff who were lone working. Staff told us they followed lone worker guidelines and made local arrangements to ensure they were kept safe.
There were some good outcomes for Children’s Health Provision who achieved a high overall participation rate of 99.3% in the National Child Measurement Programme (NCMP) and consistently good results in the immunisation programme.
Policies and procedures were in line with the National Institute for Health and Care Excellence (NICE) and national guidance. There was a process in place to monitor new guidance from NICE and cascade those relevant to service leads for action.
The organisation had achieved level three accreditation with the UNICEF Baby Friendly Initiative. This is a global programme of the World Health Organisation and UNICEF, which encourages health services to improve the care provided to mothers and babies so they are able to start and continue breastfeeding for as long as they wish.
Staff were caring and offered emotional support to children, young people and families. Parents told us staff were very kind, understanding and helpful and we observed staff communicating with children, young people and their families in a respectful and considerate manner. Staff took time to explain things clearly and made time to answer questions. We received 92 comment cards from children, young people and families; 90 of these were positive and two had both negative and positive views. Comments about the Family Action Support Team (FAST) were exceptionally positive.
There was good access to services. The school nursing team had set up a duty phone line, which was staffed Monday to Friday from 12pm – 5pm. Staff were able to respond quickly to calls and escalate them to the appropriate school nurse if urgent. Clinics, support groups and drop in sessions were planned and provided at a variety of locations, across the geographical area to enable good access for families.
Interpreter services were available and staff could refer parents whose first language was not English for language lessons to support their integration into the local community. Staff were required to complete equality and diversity training. Information provided by the service showed compliance with this training was 100% for staff in the Family Action Support Team (FAST), 82% for school nurses and 76% for health visitors.
Health visitors told us they routinely undertook maternal mood assessments when they visited new mothers. School nurses used hospital passports for children with special needs.
Staff were aware of the vision and values of the service. They described the culture as open and they felt safe to own up if they made a mistake. Staff spoke positively about their line managers and service managers. They told us team leaders were visible, approachable and actively involved in the daily operation. However, some staff told us they did not feel confident about the leadership above this level.
The service was undergoing consultation on remodelling at the time of our visit. We found morale varied amongst staff groups and there was some anxiety about the outcome of the consultation and the new model of service delivery. Despite this anxiety, most staff were passionate about the services they delivered to children, young people and families.
We saw some good examples of innovation. For example, the school nurse text messaging service for young people and the parallel programme provided by the Family Action Support Team (FAST).
However, we also found the following issues that the service provider needs to improve:
Although managers informed us there was an incident reporting culture and staff were encouraged to report incidents, we found clinical incident reporting was low and not consistent between all staff. Some staff were unclear what they should report as an incident and were therefore not reporting all incidents. We were concerned that incident reporting was low and the opportunity for learning and sharing from incidents could be missed.
Team leaders and the senior management team did not have oversight of staff compliance with mandatory training. Staff were not clear on which mandatory training they had completed and told us the systems for recording mandatory and statutory training were confusing and not easy to use. From information provided to us by the service, we could not be assured that staff were compliant with all mandatory training.
There were no infection prevention and control or hand hygiene audits taking place at the time of our inspection. Managers and team leaders told us they had identified an audit tool and this was in the process of being adapted for use in the service.
The voluntary redundancy of five whole time equivalent health visitors at the end of 2016 had affected service delivery. Due to the reduction in staffing capacity, the health visiting service was not able to deliver the full Healthy Child Programme (HCP). The service was only able to provide three out of the five key visits to all families with the remaining two visits being targeted at the most vulnerable children and families. Staff were concerned that this was a risk to children and families as issues may be missed.
We found inconsistencies in staff receiving individual appraisals. Health visiting and school nursing staff we spoke with said they had not all received an appraisal in the last year. Staff in the Family Action Support Team (FAST) told us they received quarterly group supervision but had not had an individual appraisal for two years.
Although the service had processes in place to ensure risks were identified, monitored, managed and controlled through the corporate risk register; this did not fully align with risks we identified on inspection, for example, lack of oversight of mandatory training and staff appraisals.
We reviewed information during the inspection and could not find evidence the service had carried out necessary employment checks on directors of the service.
Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with two requirement notices. Details are at the end of the report.