Everyone wants the transfer of public health nursing to be successful but there is a real tension between the priority to be given to universal preventative work with long term objectives and targeted intervention with high need families, especially when resources are tight.
The importance of the early years is now accepted across the political spectrum, whether current policies are delivering against government objectives is another matter. As the annual Ofsted report on Early Years notes the gap in outcomes for young children by the end of the reception year is still too large and not shifting rapidly. Whilst most 3 and 4 year olds are now accessing their free entitlement to early education (childcare) only 58% of eligible 2 years olds were accessing this valuable input in 2014-15, that means 103,000 children are not.
At the recent National Children’s and Adults Services Conference, delegates heard that the transfer arrangements had gone smoothly as a result of good cooperation across the sectors at national and local level. The boundary issues created by the focus on people living on LA boundaries, rather than GP registration as under the NHS, had by a large been resolved and there was strong agreement that there was much potential for utilising this skilled and experienced workforce in creative ways.
So delegates were urged to think about one early years workforce with the health visitor as lead professional working with early years practitioners, midwives, therapists, teachers and family support workers etc. Although we talk about integrating social care and health a lot, in early years the central role of education must be recognised. Joining up this large workforce with local health visitors more coherently must make sense, including the opportunity for integrated reviews for at 2 year olds.
The very real contribution that health visitors can make to child protection work, particularly engaging with families as a trusted professional was recognised. Recent less enthusiastic evidence about family nurse partnerships was debated, acknowledging how hard it is to import models from other countries, in this case the U.S., and make them work. Finally the important role in identifying children with additional needs was acknowledged.
But all of this can happen at the moment. What will be different with LAs at the commissioning helm? Integration is not easy and also not an end in itself. Delegates were urged to have those hard debates about objectives so that investment can be utilised wisely, seek opportunities to reduce overlap and duplication and, above all, value the contribution of health visiting as both a profession which can connect with local communities and intervene in a skilled way when needed. Directors of public health and directors of children’s services and their respective cabinet members should have those hard discussions about vision, values and targeting resources.
The importance of early years is accepted but that doesn't mean current policies are delivering