Focus on under-fives for health programme gets public backing

This story was published 18 January 2021

A new model for providing a range of public health services for children and young people across North Yorkshire has received approval by people who responded to a consultation on the proposal.

Healthy child consultation

North Yorkshire County Council consulted the public, stakeholders and professional bodies over a 12 week period on a new way of working for the Healthy Child Programme.  The outcome of that consultation goes before the Council’s Executive next week.

The new model for the Healthy Child Programme will prioritise children under five, to support their early development and to ensure that they are ready to learn. It is designed to help local partners to be innovative in the way they co-ordinate the right level of support for children, young people and families. 

The Healthy Child Programme is a child and family health promotion system for children aged 0-19 years. Some of the services within it are for all children, such as health visiting, and some are targeted to those most in need, such as vulnerable families and children and young people with emotional health and drug and alcohol problems.

The Council currently commissions these services from Harrogate and District NHS Foundation Trust (HDFT) and is proposing a new, long-term agreement with the Trust to deliver these services across North Yorkshire.

The Executive will also decide on whether to go ahead with the proposals subject to a public consultation on the nature of the agreement with the Trust.

The proposals will continue the universal service for children under 5, but will focus on more tailored support for children and young people aged 5-19 and target support for families most in need.

Although three quarters of the 245 people who responded to the consultation agree that the under-fives should be the focus of the new health programme, along with five to 19 year olds most in need, there were some concerns about the future of services currently delivered under the programme such as hearing and vision screening.

The report before the Executive explains that the programme will also work closely with Public Health England, clinical commissioning groups, primary care, NHS hospital trusts, voluntary organisations and community groups to ensure that children and families are supported to access alternative support for those services which will now fall outside the programme.

Louise Wallace, North Yorkshire’s Director of Public Health explains: “The County Council, which leads on public health, has been funding the programme and working with the NHS Trust for a number of years to provide the service. 

“We are now looking to continue that relationship for a longer term of up to 10 years. This will provide the opportunity to transform the way we provide services to children and families, and help closely align the programme with the Early Help Service run by the County Council’s outstanding-rated Children and Young People’s Service, as well as other health services and community support.”

The County Council and partners have needed to find new ways of delivering the Healthy Child Programme in the face of a 15 per cent national reduction to public health funding and a requirement for a £4m saving in public health spending in North Yorkshire in the next few years.

“However, we will protect the Programme as much as possible”, said Louise Wallace, “and reductions to these services will be less than the overall cut to the Public Health Grant. We will have a universal and targeted service for children and it will continue to be our biggest single area of spend in public health.

“There is evidence that a focus on 0-5 years not only supports improving health outcomes, but improves wider societal and economic outcomes.  There is also evidence that increasing investment in children under five can impact on childhood obesity, emotional wellbeing and school readiness. Improvements in these areas will in turn support lifelong positive outcomes.

“We will continue to deliver mandatory health checks for children under five years old and will continue to support new parents with a focus on those children and families most in need.  There will also be a focus on emotional resilience for young people.

“We are committed to continue delivering a safe and effective service that protects children and young people and contributes to them growing up well.”

The proposals consulted on included:

  • Mandatory visits to families with children under five at key child development stages will be co-ordinated by a qualified health visitor.
  • At-risk under 5s and their families will continue to be prioritised, as they are now, with face to face visits where needed;
  • Learning from how services have operated under Covid-19 restrictions, introducing a blended approach of face to face and online contact for families, based on robust assessment of the child and family’s needs;
  • More integrated support from agencies across the health, education, social care and voluntary sector for children to be ready to learn and to address developmental concerns in children and young people;
  • More prevention and early intervention activities to reduce childhood obesity focused on infant feeding and family diet and nutrition including breastfeeding and healthy weaning;
  • A partnership approach to the prevention and management of risky adolescent behaviour including prioritising and improving emotional health and resilience
  • Effective identification and management of the safeguarding of children and vulnerable parents or family members.

“During the Covid-19 pandemic, we have had to make emergency changes to the way we delivered many of our face to face services for children, young people and families,” said Stuart Carlton, North Yorkshire’s Director of the Children and Young People’s Service.   “We now have really strong learning about how to provide a safe and effective personal service via digital platforms which can be taken forward for the Healthy Child programme. This is one part of a multi-agency partnership approach to ensure that the right services are provided at the right time and in the most effective way to meet diverse needs across the county.

“The proposals allow resources to be targeted at those most in need by employing some of these innovations.”

Suzanne Lamb, Head of Safeguarding (Lead Nurse for Public Health and Quality) from Harrogate and District NHS Foundation Trust, said: “Thank you to everyone who took the time to feed into the consultation. It’s been really important to hear from everyone who wanted to provide their views.

“We all want to ensure that effective services can continue to be delivered to children, young people and families in North Yorkshire. However, it’s clear that the future model will need to look very different to what’s being currently offered. We appreciate the opportunity to continue to work closely with North Yorkshire County Council in a longer term arrangement. This will further build on the established partnership with the Council and will be part of a wider ambition to further integrate children's services so families receive the best experience of the services they use.

“We know that this will result in significant changes to the current service model, and we will continue to work with our colleagues to identify how they would like to be supported through service transformation.”