Skip to content

Children’s nurses consultation help

imageWE URGE ALL OUR SUPPORTERS TO RESPOND TO THE CONSULTATION
Please follow this link to the Council consultation and read our point by point guidance – see below –  to help you.

We have drawn on the experience of a range of professionals and campaigners

THE CONSULTATION CLOSES ON SUN 21 AUGUST AT 11.59PM – IT HAS BEEN EXTENDED BY ONE WEEK. PLEASE COMPLETE BY THEN

 

GUIDANCE TO CONSULTATION IN BRIEF – CLICK HERE FOR WORD DOCUMENT

Council proposals in blue

Save Lewisham Hospital campaign says:

COUNCIL PROPOSALS FOR HEALTH VISITORS
PROPOSALS 1-6  – they are not numbered by the Council

Strongly disagree
Health visitors and health visiting services should not be reduced because they provide an essential service for children’s health and well being age 0-5.

COUNCIL PROPOSALS FOR CHILDREN’S CENTRES
We are looking at how we can continue to make better use of our
Children’s Centres in future, including what services they could provide, and where these are provided from. Please tell us how you feel about the following proposals:

Co-locate Children’s Centres with other health and education services

Neither agree nor disagree.
Without further detail this is not clear. Health facilities for children’s and families need properly purposely provided buildings with proper facilities.

 

Integrate the one-to-one family support service provided by Children’s Centres with our health visitor support for vulnerable families.

Neither agree nor disagree.
This is unclear.

COUNCIL PROPOSALS FOR SCHOOL NURSES

 

COUNCIL PROPOSAL 1, beginning…
School nurses currently offer a health assessment to children when they enter primary school. In future, school nurses might provide a combined assessment for reception …

 

Agree if properly resourced and NHS provided.

 

 

COUNCIL PROPOSAL 2, beginning…
MyTime Active currently deliver a weight management programme for children in Lewisham…

Agree if properly resourced and NHS provided.

COUNCIL PROPOSAL 3, beginning…
The school nursing service currently plays a key role in safeguarding and child protection. n future, we will continue to require school nurses to undertake health assessments…

Agree
We support this if there are adequate resources.

COUNCIL PROPOSAL 4,  beginning…

The school nursing service currently supports the health and emotional wellbeing of children and young people through school drop-ins, appointments and health promotion 
work…

Strongly disagree
It is known that the numbers of young people attending A&Es from schools in mental health crises has increased greatly. Early intervention services such as school nursing are vital in this context. 
The proposed cut of 22% as is planned, is dangerous.

 

COUNCIL PROPOSAL 5 beginning…
School nurses also provide support to children with long term conditions and disabilities. In future, a dedicated nursing team, supported by community children’s doctors, and disabilities in schools…

 

Strongly disagreee because this service already exists

COUNCIL PROPOSAL 6, beginning…
The school nursing service currently delivers immunisations to school age children. In future, immunisations will continue to be provided in schools but might be delivered by a different immunisation team.

 

Strongly disagree

There is no reason for this change as the school nurse team is already providing a good service. They know the schools and as well as providing the immunisation service can pick up on vital wider issues which young people may present in these contexts. 

 
FULL BACKGROUND TO COUNCIL CONSULTATION AND DETAILED GUIDANCE

The basis for the consultation is a £2m cut
Health visitor and school nurse funding has recently transferred from the NHS to Local Authorities- who are suffering massive government cuts in funding.

In Lewisham there will be an assumed financial cut of £2m from a budget of £9.1m (£7.35m for Health Visiting and £1.75m for school nursing).

This represents a cut in funding of 22%. It is just not possible to provide the same standard of care currently delivered.

The council has not conducted, or made public, a risk or needs assessment of these proposals. 
This is unfair on children, suggesting cuts without knowing the potential impact on their lives, and asking people to give feedback without advising them of the possible consequences.

Further, the Council does not mention their recent consultation, which sought to de-register 13 of 17 Children’s Centres from Ofsted.  So while this consultation wants to increase the children’s centre workload, another consultation is cutting their budget and their ability to accept referrals for vulnerable children.

The Council itself acknowledges greatly increasing need:

  • Increase in local birthrate to over 5000 per year;
  • Increase in numbers of vulnerable families – where 400 children require child protection plans compared to 300 only a few years ago.
  • The Council states that the numbers of children on the targeted health visitor caseload for health visiting has increased to 2000.
  • Thresholds for social work intervention are rising, placing greater responsibility on health visitors and school nurses.

 ROYAL COLLEGE OF PAEDIATRICS AND CHILD HEALTH – 15 July 2016
‘Child wellbeing in the UK ranks a poor 16th out of 29 income rich countries… breastfeeding rates are deemed the worst in the world, it is highly concerning to learn that of the £50.5m [public health] spending reductions planned for 2016-17 by local authorities, the biggest single area affected was services directly aimed at improving the health of children and young people…’

‘It is vital that [public health] services provided by local authorities such as health visiting, school nurses and weight management programmes are protected. Without them, obesity rates will rise… health costs will spiral, breastfeeding rates will fail to get better and thousands of babies each year will miss out on the many benefits it provides. In addition, obesity prevention, school nurses and health visitors are all important in the prevention and early detection of mental health problems, so these services are vital for maintaining both the physical and mental health of our children.’
Letter from RCPCH to the Health Service Journal 15 July 2016

 

DETAILED POINT BY POINT CONSULTATION GUIDANCE

Council text is in blue Save Lewisham Hospital Campaign help text in black

 

HEALTH VISITORS 

The Save Lewisham Hospital Campaign says:

  • Health visitors are experienced nurses and midwives with a post graduate qualification in public health nursing.
  • Health visitors offer health care from early pregnancy until a child is 5, particularly supporting successful breast feeding, good parenting and child development. Health visitors provide a service that can be accessed easily without a waiting list for an appointment
  • The Council description (see below) does not mention ante natal care.
  • Health visitors do a lot of safeguarding work – early detection and intervention- and work very closely with social work colleagues. This work requires a high level of skill in communication, child development knowledge and knowledge about public health issues including domestic violence.
  • Health visitors give advice on a whole range of issues from caring for minor illnesses to caring for children with chronic illness and disability.
  • Their nursing and midwifery backgrounds and the extra course in public health nursing equip them for this role.

COUNCIL DESCRIPTION OF ROLE OF HEALTH VISITORS
Health visitors work with families to promote the health and wellbeing of children aged under 5 years. They provide advice and support in a number of areas, such as:

  • New birth visits
  • Health and development checks
  • Parenting support
  • Specific advice on subjects such as breastfeeding and postnatal depression

They also operate a targeted health visiting service for children and families who require extra support.

Lewisham has16 Children’s Centres located in different buildings across the borough, including schools. They offer a range of services, activities, information and guidance for families with children aged under 5 years. Some services supported by health visitors, such as breastfeeding groups, are delivered directly from Children’s Centres.

LEWISHAM COUNCIL PROPOSAL 1

Health visitors undertake five children’s developmental health checks and these are usually carried out in the family home. In future, two of these checks – the 7-11 month check and the 2-2.5 year check for families not identified as vulnerable – might be delivered in Children’s Centres and in groups. All other checks will continue to be done in the home.

The SLH campaign strongly disagrees, we say:

  • The early years are the most crucial time for children – the first 1000 days – conception to age 2 – is recognized by government as vital, so to cut ante-natal visits to just the ‘vulnerable’ is dangerous.

 

  • The whole rationale behind health visiting is to provide a whole population service, which is how vulnerable families are identified and any health needs which need addressing. How can it be known who is vulnerable if health visitors are not routinely visiting parents? Every contact counts.
  • Vulnerability can occur at any time to anyone. For example, post-natal depression does not obey vulnerability criteria. Parents who need support will be missed if only a small number are offered home visits and this may have tragic consequences.
  • While groups may be good for socializing, mothers who are at most risk are least likely to attend or participate in a group- because of anxiety, confidence or language barriers. A group is never the best context for identifying and discussing sensitive issues, where people may fear being judged.
  • Post-natal depression – a significant part of a health visitor’s role – could be missed if women only have the option of attending a group.

LEWISHAM COUNCIL PROPOSAL 2
Health visitors currently run baby clinics in Children’s Centres and GP practices. Parents can take their babies to these clinics for weighing and advice. In future, we might:

  • Reduce the overall number of clinics delivered with the aim of them all being done in Children’s Centres
  • Introduce parental weighing of babies at clinics while continuing to provide access to a Health Visitor for advice

The SLH campaign strongly disagrees, we say:

  • If all child health clinics are done in children’s centres the important partnerships between GPs and practice staff, developed over years to help identify and safeguard at risk children will be broken up.
  • Children, at present, go to their GP practice for immunisations as part of the Healthy Child Programme. By going to a Children’s Centre clinic, they will once again meet yet another unfamiliar person – this increases the risk of missing concerns.
  • The Council is increasing the workload for Children’s Centres. But at the same time, it is planning to de-register 13 of 17 children’s centres from Ofsted, because of further budget cuts demanded by the government.  Once de-registered, these centres cannot support vulnerable families

LEWISHAM COUNCIL PROPOSAL 3

Health visitors currently provide five mandatory health checks for families (in pregnancy, new birth, 6-8 weeks, 7-11 months and 2-2.5 years). They also provide additional checks for some families at 3-4 months and 3.5 years. The government is consulting on changes to these mandatory health checks, which is likely to give Lewisham and other local authorities more flexibility to target additional checks at the most vulnerable families. In future:

  • Health visitors might only provide checks during pregnancy for women identified as vulnerable by maternity services. Other women will continue to have access to GPs and midwives for health checks during their pregnancy

Health visitors might only offer additional checks at 3-4 months and 3.5 years to families that are identified as vulnerable.

The SLH campaign strongly disagrees, we say:

  • The Council assumes the government will back the dropping two of the five mandatory health checks for under-fives. This proposal rests on an assumption which may not happen and which is financially driven in the first place.  At present, there are 5 mandatory checks, children in Lewisham should be entitled to them.

  • All children should have access to evidence based health care. It is not always evident which children are vulnerable as they can become vulnerable at any time, so ongoing assessment is essential. The NHS was founded on universal health care ‘from the cradle to the grave’ so why should many children miss out on their check?
  • As a society we should class all children as vulnerable – to air pollution/accidents etc. as well as poverty/domestic abuse/substance misuse. There is no one assessment tool that can identify all vulnerable children. Classifying some children as non-vulnerable is a subjective decision denying most of them access to an important check.

LEWISHAM COUNCIL PROPOSAL 4

Health visitors currently support 3 out of the 6 ‘breast feeding groups’ in Lewisham, by giving advice on feeding, weaning, mother and baby’s health and nutrition. These groups, and the provision of the volunteer breastfeeding peer supporters, are coordinated by the Breast Feeding Network. In future, we might transfer management of these groups to the health visiting service, supported by maternity services.

The SLH campaign strongly disagrees, we say:

  • The breastfeeding network do an excellent job with the help of almost 30 unpaid volunteers who are committed to promoting breastfeeding.
  • Health visitors and midwives already have huge workloads and will not be able to take on the management of this large group of volunteers.
  • Breastfeeding saves the public purse a huge amount of money in reducing the need for health care as breastfed babies have less gastrointestinal infections etc.

LEWISHAM COUNCIL PROPOSAL 5
A significant amount of the current health visiting budget is spent on a range of administrative activities. In future, we will develop new ways of delivering this support (such as better use of technology) which would mean we could reduce the budget for administration

The SLH campaign strongly disagrees, we say

  • Admin staff do a lot of important work, supporting health visitors. Cutting their jobs will mean in effect that health visitors will be doing their own admin work, adding to a work burden that is already too great.
  • IT systems need huge investment to improve. Improved IT in the community has been promised for over a decade yet still hasn’t happened.  It seems unlikely to improve while the government is committed to austerity cuts.  Removing the staff before the systems exist is putting the cart before the horse.

 

LEWISHAM COUNCIL PROPOSAL 6

The health visiting service currently provides community clinics to deliver BCG vaccinations to babies that have not received this after birth. In future, we might develop a local dedicated immunisation team that will be able to deliver these clinics

The Save Lewisham Hospital strongly disagree

  • Having a dedicated BCG immunisation team is not a good idea. It is likely to mean lower paid nurses doing a task-orientated role and not knowing the babies that they are immunising.
  • The services is also a prime target for privatisation. Immunisation includes assessing a baby and observing parent child interaction and is best done by community nurses who are part of the health visitor team. Every contact really counts as part of an early help pathway.
  • This proposal suggests a complete lack of understanding of how vital team work is for children’s health.

PROPOSALS FOR THE HEALTH VISITOR SERVICE – BLANK BOX FOR YOU TO FILL IN

The SLH campaign proposes:

  • To continue to offer ALL children evidence based health interventions by experienced and properly trained health visitors, nurses and midwives.
  • The government’s 5 year expansion programme for health visitors ‘a call to action’ was completed in 2015 and yet a year later local authorities, including Lewisham are proposing to cut the service that has so recently expanded.
  • This is a waste of public money and not fair to families and children.

 

CHILDREN’S CENTRES 

COUNCIL PROPOSALS FOR CHILDREN’S CENTRES
We are looking at how we can continue to make better use of our Children’s Centres in future, including what services they could provide, and where these are provided from. Please tell us how you feel about the following proposals:

Co-locate Children’s Centres with other health and education services

The SLH campaign says:
This implies closing either children’s centres or health centres.  It is not clear and has not been stated in the consultation.

Integrate the one-to-one family support service provided by Children’s Centres with our health visitor support for vulnerable families.

The SLH Campaign says:
There is already good partnership working between health visitors and family support workers in Children’s Centres. The change is financially driven and would impact greatly on the health visitor workload.


SCHOOL NURSES

The SLH campaign says:

  • The council consultation document grossly underestimates the role of school nurses.
  • School nurses are registered nurses who have undertaken additional specialist public health children’s nursing training. They are professionally qualified to work specifically with adolescents in school and youth settings
  • School nurses are responsible for mandatory weight monitoring of the entire school aged population 5-11.
  • There is a serious issue about what the school nurses are expected to do but cannot because of already insufficient resources.
  • The workforce is skilled in the delivery of child health promotion but currently does not have capacity to provide this at a sufficient level for all young people in Lewisham.
  • School nurses have many important public health duties including the above and also national immunisation programmes without the resources.
  • The cuts in social care funding have led to massive increase in school nurses’ child protection workload (‘safeguarding children’). Their workload has more than doubled in the last three years.
  • School nurses also play role in working with secondary school children, picking up emotional health and well-being issues in weekly “drop ins” in schools and youth settings, and liaising with mental health services.
  • School nurses liaise with doctors and teachers on children with medical conditions ensuring that children and young people’s access to education is not marginalised.
  • They work with the disability services for children in mainstream who have disabilities.
  • There is never enough resource or skill level to meet all the demands. 

COUNCIL SAYS
The school nursing service works with school-aged children, young people and their families to address health needs and promote health and wellbeing. They provide advice, support and information on a range of issues, including:

  • Healthy eating
  • Immunisations
  • Emotional health
  • Risk taking behaviours (such as drugs and alcohol)
  • Sexual health education (appropriate to the child’s age)

The service also offers extra support to young people who have more complex needs and to young people who are at risk of harm.

COUNCIL PROPOSAL 1
School nurses currently offer a health assessment to children when they enter primary school. In future, school nurses might provide a combined assessment for reception children consisting of a:

  • School entry health assessment
  • National Child Measurement Programme (weight checks for reception and also for year 6 children)
  • Hearing and vision screening

The SLH campaign says agree:
This proposal is what used to happen routinely, and would be beneficial if properly
resourced and NHS provided.

COUNCIL PROPOSAL 2
MyTime Active currently deliver a weight management programme for children in
Lewisham. In future, we will develop closer links between our weight management
programme and our school nursing service so that children who are overweight have access
to better support.

The SLH campaign says agree:
This proposal could be beneficial as long as it is resourced and remains within the NHS.

COUNCIL PROPOSAL 3
The school nursing service currently plays a key role in safeguarding and child protection.
In future, we will continue to require school nurses to undertake health assessments
for all children and young people aged 5-19 years when they become looked after or
under the protection of the local authority. Protecting vulnerable children will continue
to be a priority and school nurses will still attend statutory meetings to support children
and families when this is needed.

The SLH campaign says agree:
We support this if there are adequate resources. If resources are reduced, the ability to meet the statutory duty to attend safeguarding children meetings is threatened.

COUNCIL PROPOSAL 4

The school nursing service currently supports the health and emotional wellbeing of
children and young people through school drop-ins, appointments and health promotion
work. However, school nurses have limited capacity to do this work. In future,
we might redesign this element of the service to create a dedicated ‘teenage health service’
which will:

  • Be accessible from a number of venues in the borough as well as from schools
  • Offer online advice and face to face support about health and emotional
    wellbeing, alcohol and drugs misuse, and sexual health.
  • Signpost and refer young people to other local services

The SLH campaign says Strongly disagree:

  • It is known that the numbers of young people attending A&Es from schools in
    mental health crises has increased greatly. For example, in one local A&E
    the numbers have increased from approximately 1 a day to 3-5 a day.

  • Early intervention services such as school nursing are vital in this context.
    The proposed cut of 22% as is planned, is dangerous.
  • It is safer that one NHS agency support the emotional health of young people –
    the involvement of too many agencies fragments the service, leading to arguments between services about who is responsible for a child with multiple diagnoses.
  • We are concerned at the vagueness of the Council proposals- which say that a
    reduced service ‘might’ be redesigned. It is impossible to comment on
    such vague plans without a public health needs assessment.
  • This is indicative of spreading a lower funding resource further.

COUNCIL PROPOSAL 5

School nurses also provide support to children with long term conditions and disabilities.
 In future, a dedicated nursing team, supported by community children’s doctors,
might provide this support. They might also train school staff on how to look after
children with long term conditions and disabilities in schools.

The SLH campaign says:

  • A dedicated nurse team – the special needs nurse team – already exists in this role for over 10 years, providing support and clinical children’s nursing expertise to the school nursing team.
  • The proposed cuts reduce, not improve, what already exists.

COUNCIL PROPOSAL 6

The school nursing service currently delivers immunisations to school age children. In future, immunisations will continue to be provided in schools but might be delivered by a different immunisation team.

The SLH campaign strongly disagrees
There is no reason for this change as the school nurse team is already providing a good service. They know the schools and as well as providing the immunisation service can pick up on vital wider issues which young people may present in these contexts. 

Are there any other proposals we should consider for the school nursing service?Continue to support this service, without cuts, as school nurses are already overloaded and play a vital role in many aspects of child health.

The SLH campaign strongly says
Continue to support this service, without cuts, as school nurses are already overloaded and play a vital role in many aspects of child health.

Save Lewisham Hospital Campaign 4 August 2016