To approve the commissioning intentions for public health nursing and early help services.

These will be part of Herefordshire’s approach to supporting families and providing early help for children and young people aged 0 to 19 and up to 25 for young people with a disability and/or additional health needs. This includes public health nursing (encompassing health visiting and school nursing) and an approach which supports greater integration with children’s centre services, early years and early help services together with wider family befriending, mentoring and third sector services from April 2018.

The committee considered a report from the cabinet member health and wellbeing and the cabinet member young people and children’s wellbeing concerning procurement of universal and early help services for children, young people and families. The report was introduced by Lindsay MacHardy, public health specialist, who advised the committee that the proposal contained in the report placed the family and child at the heart of the commissioning exercise. The commissioning exercise would enable further integration of the approach for early help and public health nursing services.

Hazel Braund, Director of Operations at Wye Valley Clinical Commissioning Group (CCG) spoke on behalf of the CCG and raised concerns regarding the procurement exercise. It was not felt that the proposal took account of safeguarding issues and no discussion with the safeguarding board had taken place. The principles of the commissioning exercise were supported but there was disappointment that the CCG had only been made aware of the proposals at a late stage and without sufficient detail on which to base a proper assessment. It was a significant paper that the committee was being asked to consider, proposing a very different model of operation to existing arrangements. There was concern that without an understanding of existing models it would be a challenge to scrutinise effectively the new arrangements proposed in the report.

Chris Baird, interim director for children’s wellbeing, said that the early help strategy had been to the Herefordshire Safeguarding Board (HSCB) and the board had considered the approach in Herefordshire. Commissioners and providers of children’s services had to ensure that the service had appropriate safeguarding in place and followed the HSCB’s procedures.

The committee made the comments below during the debate:

·         Concern regarding a lack of consideration of safeguarding issues in the proposals and the reported lack of engagement with the safeguarding board.

·         Concern regarding the reported lack of consultation with the CCG.

·         The redesign survey report attached to the draft cabinet report demonstrated that there was a lack of awareness of WISH in the local community. Very few respondents accessed the site for guidance and advice. Further work was required to raise the profile of the service and ensure that it was accessed more readily by the community.

·         There was not felt to be a sufficient level of evidence in the report to provide assurance that the contracts currently in place were providing value for money and effective service. However the committee was content to support the extension of the family befriending services, proposed in the draft cabinet report contracts up to March 2018 with Vennture and Homestart to ensure a consistency of service during the current year.

·         The committee required further detail of the services that would be procured in order to undertake effective scrutiny of the proposal. The draft cabinet report was not clear about tangible outcomes and quantifiable results sought through the procurement. The committee was unable to assess the terms of the proposed commissioning exercise to determine if it could realistically achieve its stated aims. The report in its current state did not contain enough detail to enable effective scrutiny The outcomes sought through the commissioning exercise needed to be defined clearly and any targets which providers would be required to meet.  The committee requested sight of the contract specification informing the commissioning exercise and to be circulated to potential bidders.

·         There was concern regarding the provision of services within rural areas of the county. It was recognised that the report referred to the issue of rurality but more detail was required to show how services would be delivered across rural areas. The use of internet based services to deliver services across rural areas was noted but it was felt that in areas where broadband provision was limited this was not an effective solution. The notion that access to services would be facilitated through text messaging was also undermined by the paucity of mobile telephone signals in certain areas of the county.

·         Access to services in market towns would be compromised by the limitation of public transportation from rural areas.

·         The use of local facilities to support provision of services such as church halls was supported but there was doubt regarding the ability of local communities to sustain such services.

·         It was felt that the commissioning intentions needed to include greater detail on proposals for the provision of services from rural areas and how the resilience of those services would be ensured. 

·         The committee supported the principles of early intervention contained in the proposal and the contribution this made to a general focus on prevention.

·         The committee felt that the cabinet members responsible for presenting the decision to cabinet should be informed of the significant concerns raised.

·         The committee queried what action would follow the submission of its concerns to the cabinet members; it was requested that the contract specification be circulated to members of the committee for assurance, ahead of the proposed decision by cabinet. 

The motion outlined below was proposed by Councillor Lloyd-Hayes and seconded by Councillor Summers. The motion was carried unanimously.

Resolved - That the committee:

1)    supports the extension of the family befriending services contracts with the existing providers to the end of March 2018;

2)    has significant concerns about the commissioning exercise proposed. The cabinet members for health and wellbeing and young people and children’s wellbeing are asked to have regard to the committee’s concerns, particularly:

-          The reported lack of consultation concerning safeguarding arrangements and engagement with the Herefordshire Safeguarding Children’s Board;

-          The provision of services in rural areas;

-          The requirement for additional detail in the report, in particular the contract specification ; and

-          A reported lack of communication with the CCG.

3)    requests that, before a decision is taken on the proposal, the cabinet members share additional information with the committee, including the contract specification.

There was a brief adjournment from 11.25 a.m. – 11.34 a.m.