Agenda item

Joint Report of the Chief Officer for Communities, Public Health, Environment and Prosperity and the Chief Officer for Children’s Services, on the outcome of the options appraisal and proposed recommendations for the provision of the 0-19 Public Health Nursing, attached.

An Impact Assessment is attached for the consideration of Members at the meeting.

Report of the Children’s Scrutiny Committee and Health and Adult Care Scrutiny Committee Public Health Nursing Spotlight Review (CSO/18/9), to be read in conjunction with the Joint Report above, attached.

(Councillors Atkinson, Connett, Dewhirst, Hannaford and Sellis attended in accordance with Standing Order 25(2) and spoke to this item).

The Cabinet considered the Joint Report of the Chief Officer for Communities, Public Health, Environment and Prosperity and the Chief Officer for Children’s Services, on the outcome of the options appraisal and proposed recommendations for the provision of the 0-19 Public Health Nursing, circulated prior to the meeting in accordance with regulation 7(4) of the Local Authorities (Executive Arrangements) (Meetings and Access to Information) (England) Regulations 2012.

The Council’s Director of Public Health (DPH) had statutory responsibility for the nationally mandated 0-5 Public Health Nursing Service, which could not be delegated.  The Council was one of five partners in a commissioning partnership for the provision of Integrated Children’s Services (ICS) provided by Virgin Care Ltd.  The 0-19 Public Health Nursing Service (PHNS) was one of the services, overseen by the DPH, the contract for which came to an end on 31^st March 2019. The Cabinet, on 11th October 2017, approved the undertaking of an options appraisal for the provision of the 0-19 Public Health Nursing, Portage and ROVICs services from April 2019 onwards as well as the undertaking of a public consultation.

In considering the future service delivery model for the 0-19 PHNS from April 2019 onwards, the following options had been considered and fell into two broad categories, the first being the procurement of the PHNS and second the Councils direct delivery of the PHNS.

Within each of the categories two options were considered:

Procurement of the Public Health Nursing Service

1a: Open procedure with one contract

1b: Procure a joint venture delivery vehicle

Devon County Council direct delivery of the PHNS

2a: ‘In-house’ as a department of Devon County Council

2b: Placing all activity relating to the PHNS into a wholly owned subsidiary of Devon County Council.

The service delivery models had been assessed against a set of strategic objectives for the delivery of the 0-19 PHNS, as outlined in the Report. However, irrespective of the delivery model a number of assumptions for the service remained, which included the specification for the 0-19 PHNS being based upon the national template 0-19 Healthy Child Programme, the budget of £10million per annum for the service which did not alter and that assumptions had necessarily been made on the staffing requirements.

The public consultation had been undertaken through the Have Your Say website from 6^th December 2017 – 15^th January 2018.  A total of 135 online responses were received with additional written representations from various medical committees, the CCG and Virgin Care Ltd. A number of key these emerged around workforce, System Alignment, Service Offer and Clinical Governance.

The Chief Officer’s Report referred to the Impact Assessment undertaken in relation to the proposals outlined in the report.  The Service would continue to work to the localised National Specification from April 2019, which had a positive impact on tackling health inequalities as the fundamental principle of what it sought to address. The service model would enable the continued provision of a more effective and efficient delivery of the Universal and Targeted elements of the service, with improved timeliness, accessibility and responsiveness to families’ needs where possible. The service specification included clear equality and access requirements, and the impact on children, young people and their families with protected characteristics and/or other vulnerabilities which would continue to be monitored and evaluated as the revised model developed.

No unmanageable consequences for current and future service users had been identified as a result of the service delivery options. Regardless of the commissioning and procurement arrangements, the protected characteristics would be considered across all elements of the service to ensure that the service reduced harm for those in greatest need.

The Cabinet also had before them the Report of the Children’s Scrutiny Committee and Health and Adult Care Scrutiny Committee Public Health Nursing Spotlight Review, (CSO/18/9) which was considered in conjunction with the Joint Report of the Chief Officers above. The Spotlight Review had met on the 24th January 2018 to review progress in developing options for Cabinet. This had built upon the work undertaken by the former ‘People’s’ Scrutiny Committee’ in March 2017 when the public health nursing contract was reviewed. The focus of the revisit was to contribute to the current decision on the future delivery model for the service.

The Report outlined a number of principles that service delivery should uphold which were around improved outcomes and life chances for children, strong governance and leadership, support for frontline staff, working collaboratively across the whole system, enabling IT systems and to champion Devon as an exemplar.

The matter having been debated and the options and/or alternatives and other relevant factors (e.g. financial, sustainability, carbon impact, risk management, equality and legal considerations and Public Health impact) set out in the Head of Service’s Report and/or referred to above having been considered:

It was MOVED by Councillor Croad, SECONDED by Councillor Hart and

RESOLVED

(a) that from April 2019, the Council’s Children’s Services be the provider of the 0-19 Public Health Nursing Service;

(b) that when the Council is satisfied that the 0-19 Public Health Nursing Service is achieving the objectives that the Council has set, in conjunction with national requirements, the Council explore alternative delivery models; and

(c) that the Children’s Scrutiny Committee and Health and Adult Care Scrutiny Committee be thanked for their Public Health Nursing Spotlight Review, the recommendations of which are accepted and endorsed, have been taken into account during the above deliberations and Cabinet welcomes the commitment of the spotlight review group to undertake follow up work in this area to ensure the principles of the report recommendations are upheld.

[NB: The Impact Assessment referred to above may be viewed alongside Minutes of this meeting and may also be available at:  http://new.devon.gov.uk/impact/].