SBC Children, Families and Community Health Service

Updated 12 July 2017

Room 1.46 is the registered name of the community health services for children, young people and families provided by Swindon Borough Council. They provide a range of different services throughout the Swindon area, which is a unitary authority. Services are run from four main hubs in different parts of the town and from the main council offices. At the time of the inspection there were approximately 49,026 children under the age of 18, of which 14,000 were under 4.5 year olds, living in the Swindon area. Up until the third quarter of the year, at the point of our inspection, the service had recorded approximately 17,000 contacts with children and their families. There were 176 staff employed by the service.

The main services provided are health visiting, the family nurse partnership service, school nursing, physiotherapy, occupational therapy, speech and language therapy, a children’s complex health team and the Targeted Mental Health Service, known as TaMHS. The service also provided a health service to Looked After children, completing the statutory required health assessments. There was a named nurse for child protection and also a health decision maker who provided children's health representation on the the Multi-Agency Safeguarding Hub (MASH).There was also a substance misuse service.

The family nurse partnership is a national scheme designed to support first time parents under a certain age who are identified as benefiting from more intensive support from a health visiting service.

The complex health team could provide care packages and support to children, and their families, with complex needs living in the community, which could when required include end of life care and support.

The TaMHS service works with children and young people with emotional and mental health needs that cannot be met by staff within universal settings such as schools and children’s centres. They work with such concerns as, anxiety, attachment difficulties, low self-esteem, loss, trauma, emotional distress, low mood, self-harm and eating difficulties.  All referrals are assessed on an individual basis and they could then refer to other services or offer short term support (up to six interventions or appointments) on a one to one basis. The team could also offer consultations and advice to families, schools or other agencies.

Updated 12 July 2017

We found that services provided by the provider were safe.

• There was a positive and open culture around reporting of incidents and learning was shared throughout the various professional teams.
• There was a high standard of safeguarding supervision being completed and staff were aware of their roles and undertook regular training. Learning from serious case reviews had been widely shared and actions implemented to address any identified shortfalls.
• The service regularly reviewed and updated their policies to ensure they were in date and in line with the latest guidance. Relevant and current evidence-based guidance, standards, best practice and legislation was used to develop how services, care and treatment were delivered.
• There were various examples of outstanding multi-disciplinary working. This included co-located teams sharing practice and information and providing support to colleagues and other partners working in the community.
• Staff provided compassionate care and treated families and children with respect. Feedback from families about the various professionals was consistently positive about the caring and professional approach provided.
• In general services reflected local needs and were flexible in providing continuity of care and choice. The provider discussed the changing demand and needs of certain services with commissioners in order to review provision.
• Children and their families were generally able to access services in a timely way for assessment and treatment. Services were appropriate and were within national referral to treatment time targets for appointments.
• There was an effective governance framework to support the delivery of the strategy and good quality care. Monthly performance data for each service was reviewed and shared with staff and management and a quarterly report shared with the joint commissioning board and the performance and quality board.
• Leaders understood the challenges to good quality care and could identify the actions needed to address them. Managers said they were empowered through the leadership of the service which enabled them to use their initiative and see work through to completion.
• Staff felt valued and respected. All staff we spoke with felt they were appreciated for the role they performed. There was a strong emphasis on promoting the safety and well being of staff. Measures were taken to protect the safety of the staff when working alone within the community.

However;

• The out of hours on call system for the children's complex care team relied on just two senior staff to provide this seven days a week.
• The provider had completed a number of audits of different records and identified the recording of consent needed improving.
• Paediatric therapy, specifically occupational and speech and language therapy and the TaMHS service (Swindon Targeted Mental Health Service) had long waiting times for appointments and treatment. They were unable to currently meet the demand on their services within the target time for appointments.

Updated 12 July 2017

We found services to be safe because:

• There was a positive and open culture around reporting incidents and learning was shared throughout the various professional teams.
• There was a high standard of safeguarding supervision being completed and staff were aware of their roles and undertook regular training. Learning from serious case reviews had been widely shared and actions implemented to address any identified shortfalls.
• Safe and child friendly environments were maintained in the location hubs where services were delivered from.
• Records were written and managed in a way that kept people safe and protected confidentiality. Records were regularly audited and the provider had action plans in place to improve the consistency of record keeping.
• Risk assessments were completed as part of the assessment process for children receiving care or treatment. There were mechanisms in place to identify patients at risk.

However:

• Not all managers responsible for undertaking root cause analysis had received training
• Whilst there was an increased demand for many services, staffing levels were maintained with the minimal use of agency staff, however vacancy levels combined with staff sickness in certain services were having an impact on delivery.
• The out of hours on call system for the children's complex care team relied on just two senior staff to provide this seven days a week.

We found the services to be effective because:

• The service regularly reviewed and updated their policies to ensure they were in date and line with the latest guidance. Relevant and current evidence-based guidance, standards, best practice and legislation was used to develop how services, care and treatment were delivered.
• The service monitored patient outcomes and undertook a range of audits to promote best practice.
• Staff were being regularly supervised and appraised and were fully engaged in the process. Supervision was used to improve and support staff and share good practice. There was high completion of supervision sessions and staff were very positive about this aspect of their employment.
• There were various examples of outstanding multi-disciplinary working. This included co-located teams sharing practice and information and providing support to colleagues and other partners working in the community.
• Staff worked together to assess and plan on-going care and treatment when families or children moved between teams or services. There was clarity about the referral process and how staff could advise families to access the different services available.
• Staff were aware of the need to ask for consent and for this to be appropriately recorded. We saw care plans where consent was clearly recorded.

However:

• Some staff had concerns about the new electronic care record system as we saw that data entry was time consuming and some information had to be duplicated.
• The provider had completed numerous audits of different records and identified the recording of consent needed improving.
• At the time of our inspection, the service was not using any telemedicine equipment in the delivery of care and support.

We found services to be caring because:

• Staff provided compassionate care and treated families and children with respect. Feedback from families about the various professionals was consistently positive about the caring and professional approach provided.
• We were told and observed that people's privacy and dignity was respected at all times.
• Staff communicated with children and young people so that they understood their care, treatment and condition. We observed staff explaining to children why they were attending and what treatment was taking place.

We found services to be responsive because:

• In general services reflected local needs and were flexible in providing continuity of care and choice. The provider discussed with commissioners the changing demand and needs of certain services in order to review provision.
• Services were planned to take account of the needs of different people. The provider collected and monitored data on the involvement of services with different ethnic groups. Staff undertook training in equality and diversity and were clear about their responsibility to be culturally sensitive and responsive to different needs.
• There were arrangements to enable access to services by children, young people and families in vulnerable circumstances and data was collected in respect of this, which ensured the provision was monitored.
• The FNP (Family Nurse Partnership) was commissioned to provide universal provision to all young mothers who were under 18 years at the time of conception. Of those offered the service the take up was measured at 95% over the previous twelve months, with very low attrition rates recorded.
• Children and their families were generally able to access services in a timely way for assessment and treatment. Services were appropriate and were within national referral to treatment time targets for appointments.

However:

• Paediatric therapy, specifically occupational and speech and language therapy and the TaMHS service (Swindon Targeted Mental Health Service) had long waiting times for appointments and treatment. They were unable to currently meet the demand on their services within the target time for appointments.

We found services to be well led because:

• The service reflected the values and objectives of the council to provide continually improving services for the local community. There was evidence from talking to staff of a strong connection with the local communities they worked with.
• There was an effective governance framework to support the delivery of the strategy and good quality care. Monthly performance data for each service was reviewed and shared with staff and management and a quarterly report shared with the joint commissioning board and the performance and quality board.
• Leaders understood the challenges to good quality care and could identify the actions needed to address them. Managers said they were empowered through the leadership of the service which enabled them to use their initiative and see work through to completion.
• Staff felt valued and respected. All staff we spoke to felt they were appreciated for the role they performed. There was a strong emphasis on promoting the safety and wellbeing of staff. Measures were taken to protect the safety of the staff when working alone and within the community.
• Patients and their families or carers views and experiences were gathered and acted on to shape and improve the services and culture. The provider had “a children in care council”, on which youth MPs were involved.