There’s a national crisis in mental health – and any failure to address children’s needs is especially dreadful. Rates of depression and suicides are rising. NHS Child and Adolescent Mental Health Services (CAMHS) have been targeted for austerity cuts since 2010. Even the NHS Confederation says the system is at “tipping point”. (See the Lowdown on Mental Health Services)
What’s happening in Ealing? Our campaign research puts a spotlight on the situation.
Healthy Child Programme – Public Health England
First point of contact NHS services Midwifery & Health Visiting & GP services
Pathways 0-5 year element – health visiting service preventive & universal services; Identifying health needs which include physical, social and emotional for child and family
5 -19 Service led by school nursing service preventive universal services, and referral to GP for medical need and onward to other services as necessary including voluntary sector.
CAMHS Mental Health Tiers
Health visiting and school nursing services link into the Ealing Tier 1 Universal services – early
intervention. CAMHS will have children of all ages referred to their services but less likely to be under-fives but some developmental and behaviour problem can be identified in those early years.
School children may be referred into Tier 2 services, counselling, YOTs etc
Tier 3 Specialist services will have children and adolescents with moderate to severe mental health problems.
Community Nursing Staff
Specialist Public health Nurse qualification (Nursing & Midwifery Council Register)
In 2015 the health visitor and school nurse budgets were transferred to LA Public Health Department from the NHS. Both services are now managed by Central London Community Healthcare NHS Trust from 2018
London Borough of Ealing
Staff Whole Time Equivalent (Agenda for Change Pay Banding )
Health Visitors
Grade 2018 2019 2020
Band 6 33.21 30.2 22.93
Band 7 4.88 3.80 5.0 Team Leaders and Practice Teachers
Totals 38.09 34.00 27.93
Band 5 6.22 3.63 5.63 Skill mix registered support nurses
School Nurses
2018 2019 2020
Band 6 2.00 3.88 5.68
Band 7 1.80 1.00 1.00 Team leaders
Totals 3.80 4.88 6.6
There is DFE has also funded for Ealing pilot project (SWIS) for social workers in 8 secondary schools
Potential Workload
Total Population 2020 352,000
2020 – 5,250 births in Ealing Low birth weight 138
0-19 Population 2020 – 67,000
0-4 population 2020 – 23,615
Ealing has 91 state-funded schools and nurseries.
16 Secondary Schools
69 Primary Schools
8 Special & alternative schools
25 children’s centres
Special Educational Needs Primary 764
Secondary 389
Special School 824
Total Workforce England
It would appear that since the transfer of funding to Local Authority in 2015 the England workforce numbers appear to have declined.
Health visitors
2015 12,094 Increase in HV workforce – government investment.
2017 8497
2020 6672
School Nurses
2017 2400
2020 925
There was an increase in skill mix with registered staff nurses and nursery nurses for the school nurse service.
Access to services
There is no maternity unit in Ealing Hospital, so mothers can choose to go to the hospital of their choice. As soon as baby is born then a notification will be sent to Ealing for mothers with Ealing addresses
Access to services for Children and Families in Ealing is via Central London Community Health Trust website but parents should have contact information at the new birth assessment visit which include all the child health checks, health advice information and immunisation schedule.
Concerns
Workforce deployment during Covid-19 lockdowns
Large workloads if following the mandated Healthy Child Programme – recommended caseload per health visitor is 250 families, but caseloads now can be 500-1000 families (iHV 2020)
Reducing numbers of staff over time since 2015 – council grants reduced
Staff leaving from stress of job – unmanageable workloads
Devastating toll of the pandemic. Are we abandoning children and young people?
Not enough nurses going into training for Specialist Qualification in Public Health Nursing – having to take out education loans
COVID-19 has made it very difficult for community nurses to carry the normal programme of visiting and child health clinics due to lockdown. Many of the contacts are now telephone or on line. These might exclude those families who don’t have access to IT. In some areas, health visitors can visit if they have adequate PPE. Almost 20% of heath visitors reported that 50% or more of their team were redeployed during the first year of pandemic.
Redeployment significantly reduced the workforce in some areas, leaving the remaining health visitors to manage increased caseloads, reducing the amount of time available to support individual families. (Institute of Health Visiting 2020)
Review of Mandation of Health Visiting Services Gov. UK 2017 states that they have started to decline due to uncertainty during that year and reduced investment to LAs and possible delays in recruitment and training
Local authorities are responsible for commissioning public health services for children aged 0-19. Regulation requires all families with babies to receive five health visitor checks before their child reaches 2 and a half years old as described in the Healthy Child Programme 0-5 years.
Public health services for children aged 0-19 are predominantly led and delivered by health visitors and school nursing teams with input from other partners as appropriate.
Local commissioners should also consider the links and interface with screening programmes, mental health, sexual health, smoking, substance misuse and dental health. The core public health offer for all children includes:
- This guidance is based on a public health pathway for children and young child health surveillance (including infant physical examination) and development reviews
- €child health protection and screening
- €information, advice and support for children, young people and families
- early intervention and targeted support for families with additional needs
- €health promotion and prevention by the multi-disciplinary team
- defined support in early years and education settings for children with additional and complex health needs
- additional or targeted public health nursing support as identified in the Joint Strategic Needs Assessment, for example, support for looked after children, young carers, or children of military families
Best start in life and beyond: Improving public health outcomes for children, young people and families Public Health England 2020
