Family Nurse Partnership & Health Visiting

Updated 30 August 2022

The Family Nurse Partnership (FNP) and Health Visiting services are part of an integrated 0 – 19 service which also includes the School Health service. The Healthy Weight Healthy Nutrition and Baby Friendly Initiative team provides a pathway based within the 0 - 19 services. The 0 -19 services are commissioned by the London Borough of Tower Hamlets Public Health Division and are provided by the Tower Hamlets GP Care Group. This is a Community Interest Company (CIC) owned by a federation of GP practices in Tower Hamlets.

The School Health service, which provides care to children between the ages of five and 19, is registered with CQC under a separate location. We inspected School Health separately the week prior to this inspection.

The Health Visiting team’s delivery model is based on the nationally mandated Healthy Child Programme (HCP). The HCP requires them to complete five mandatory checks; antenatal 28-week contacts, new birth visits within 14 days, six to eight-week reviews, one-year development reviews, and two to two-and-a-half-year development reviews.

The FNP part of the service is a voluntary programme for first-time mothers that aims to support young mothers aged 21 and under from the early stages of pregnancy until the child is between one and two years old. Mothers are partnered with specially trained family nurses who regularly visit them at home or in community venues and use a psycho-educational approach, focusing on positive behaviour change. As well as focusing on health, the FNP aims to help mothers in other areas of their lives, such as housing, employment and finances, and independent living skills, as these impact on family health and well-being. The FNP also helps deliver the HCP as part of their intensive visiting programme.

The FNP and health visiting services have links to Children’s Centres, GPs and other professionals from the health and social care sector.

The regulated activities attached to this service are diagnostic and screening procedures, maternity and midwifery services, and treatment of disease, disorder or injury. There is a registered manager in post.

There had been no previous inspections completed at this location. Therefore, no compliance actions / requirement notices or enforcement needed to be checked.

What people who use the service say

Parents we spoke with were very satisfied with the care they received from the Family Nurse Partnership (FNP) and health visiting services. We spoke with 10 parents. They said staff were kind, knowledgeable, and discussed their wellbeing as well as their child’s development.

Updated 30 August 2022

We had not previously inspected this location. We rated it as good because:

• Leaders had a clear vision for the service and were making changes to ensure the sustainability of it given national staff shortages. The service was in the process of implementing a new staffing model to meet the local population needs. They had started to introduce a skill mix so non-health visitor staff could help improve their delivery of the Healthy Child Programme (HCP) mandated milestone checks. They adopted a ‘grow our own’ approach by training and employing student health visitors who passed their courses.
• Staff were supported to do their jobs well. Staff mostly kept up to date with their mandatory training, and there were opportunities for them to complete additional training and develop in their roles. Staff were competent for their roles and received training, supervision and appraisals. New staff introduced through the skill mix review were required to complete competency frameworks.
• Staff received regular safeguarding supervision. Staff understood how to protect adults and children from abuse and the services attended multidisciplinary meetings with other agencies to do so.
• The service controlled infection risk well. The environments and equipment used by staff and children were kept clean.
• Staff provided parents with relevant and helpful written and verbal information. They monitored children’s development and provided advice on things such as feeding, safe sleeping and safety in the home.
• The services mostly worked well with other healthcare professionals and partner agencies. They attended multidisciplinary meetings, provided training and guidance, and shared relevant information where appropriate, although staff sometimes did not respond to all information from other professionals, for example GPs, in a timely manner.
• Parents we spoke to were very positive about the service. They said staff were kind, knowledgeable, and discussed their wellbeing as well as their child’s development.
• The service had access to interpreters and British Sign Language services where required. Patient records contained alerts if these were required.
• The new senior leadership team were aware of most of the risks to the services and had plans in place to mitigate them. Managers had good oversight of data relevant to the services. They used this data to make decisions and improvements.
• Managers encouraged staff engagement and an open organisational culture. Senior leaders were accessible to staff at all levels. There was well-being support in place which was valued by staff.
• Senior leaders had oversight of incidents and complaints. Managers investigated incidents and complaints and shared the lessons with staff to minimise the risk of them happening again.

However:

• The health visiting teams did not have robust systems in place to ensure oversight of all children and families. Each team held a list of the vulnerable children, but health visitors did not always update this list fully. Managers were aware this was an issue and planned to introduce a new system to ensure better oversight.
• Staff did not always update their electronic diaries with their appointments, which meant managers did not always have oversight of their commitments if staff went off sick or on leave, and caseloads were not always reallocated promptly when staff were on long-term leave or had left the service. The service planned to implement caseload weighting and caseload management processes.
• The service did not complete all checks required by the Healthy Child Programme (HCP). Performance was improving and managers had plans to ensure more checks were completed.
• The service did not have a robust process in place to protect staff working alone. The service relied on staff updating their electronic diaries with their whereabouts, but this did not always happen.
• The provider’s Safeguarding Children policy did not accurately reflect current national guidance. Safeguarding supervision action plans did not usually contain timescales for completion. Furthermore, we did not see evidence these actions were reviewed so it was unclear how the service assured itself they had been completed.
• An audit of patient care records had not been completed since 2020. We saw a range of quality in the care records we looked at.
• Staff did not have access to health information in local community languages, such as leaflets on common health issues.
• Staff did not always record that they had apologised or given children and families information or support when things went wrong.

Updated 30 August 2022

See summary above.