THIS DEED IS MADE ON
BETWEEN
(1) North Yorkshire County Councilof County Hall, Racecourse Lane, Northallerton, DL7 8AD (the "Council")
(2) Harrogate and District NHS Foundation Trust of Lancaster Park Road, Harrogate, North Yorkshire, HG2 7SX (the “Trust”).
WHEREAS
(A) The Council is a Local Authority established under the Local Government Act 1972 (as amended) and by virtue of Part 1 of the Care Act 2014 the Council is responsible for ensuring access to, commissioning and/or providing early year’s and health services on behalf of the population of North Yorkshire.
(B) The Trust is an NHS Foundation Trust established under Section 35 of the National Health Service Act 2006 (“2006 Act”).
(C) Section 75 of the National Health Service Act 2006 and the NHS Bodies and Local Authorities Partnership Arrangements Regulations 2000, S.I. 617 (“Regulations”) enable NHS bodies to exercise prescribed local authority health-related functions and for local authorities to exercise various prescribed NHS functions. The power to enter into section 75 agreements is conditional on the following:
§ The arrangements are likely to lead to an improvement in the way in which those functions are exercised.
§ The partners have jointly consulted people likely to be affected by such arrangements.
(D) The health-related functions that could be exercised by an NHS body on behalf of the Council under a Section 75 agreement include health visiting and school nursing.
(E) The Partners enter into this Agreement in exercise of the powers in Section 75 of the 2006 Act and the Regulations in order to establish a framework for the exercise of health related functions, and the integrated provision of the 0-19 healthy child service to eligible people within the Council’s administrative area in accordance with the terms of this Agreement. The delivery of the service is managed through joint governance mechanisms in which both the Trust and Council participate through a process of co-operation and joint working.
(F) The objective of this Agreement is to improve outcomes for children aged 0 to 19 and their families, through the provision of an integrated service. The service will be known as the 0-19 Healthy Child Service (“the Service”). This will be achieved through close working between the NHS and Local Government and which is pursuant to the obligations for the Partners to co-operate with each other in providing such services in accordance with Section 82 of the 2006 Act
(G) The Agreement promotes and implements the joint delivery and support of the Service by bringing together public health, children’s social care and NHS services to ensure that the Services is an integrated part of comprehensive, multi-agency services for children and young people. The Partnership Arrangements will allow for more coordinated approaches to the delivery of the Service, leading through shared outcomes, coordinated support and joined up oversight. This will enable improved efficiency within the system and better experience and outcomes for people accessing services. The aims and objectives of the Partners are set out in Clause 3.
(H) The Partners intend to develop their partnership over time and move towards further integration in respect of service provision. Key work streams including looking at further integration of working practices and pathways, co-location of services, integrated data and information systems and, potentially, service management. The ongoing aim is to ensure that needs and issues are identified early, and the right interventions and support by the right practitioner at the right time and place are implemented. During the Agreement the Partners will continually pursue opportunities for children’s services integration, wider partnership working, and integrated provider management approaches.
(I) This Agreement follows consultation jointly by the Partners with such persons as appear to the Partners to be affected by these arrangements and these arrangements contribute to the fulfilment of the objectives set out in the Health Improvement Plan as required under the Regulations.
(J) The Partners are satisfied that the arrangements contemplated by this Agreement are likely to lead to an improvement in the way that their funds and services for children and young people aged 0-19 and their families are managed and delivered.
(K) The Council and the Trust have approved the terms and conditions of this Agreement.
(L) The Partners are entering into this Agreement in exercise of powers referred to in Section 75 of the 2006 Act.
1 Defined Terms and Interpretation
1.1 In this Agreement, except where the context otherwise requires, the following expressions shall have the meanings respectively ascribed to them:-
"2000 Act" means the Freedom of Information Act, 2000;
"2006 Act" means the National Health Service Act, 2006;
“Additional Services” means any services that are not included in the Services on the Commencement Date but are subsequently included within the scope of this Agreement by agreement between the Partners in accordance with Clause 35;
"Agreement" means this Agreement, Schedules and Annexes and any variation of it from time to time agreed by the Partners;
"Aims and objectives" means as described in Clause 3 of this Agreement;
"Annual Review" means a review undertaken by the Partners to demonstrate the extent to which the Aims and Objectives have been delivered for each year of the Agreement;
"Authorised Officers" means the person notified by each of the Partners to the other from time to time as authorised to act on behalf of that Partner (which person shall until further notice be for the Council its Commissioning Manager Health and Inclusion and for the Trust its General Manager for North Yorkshire);
“Change in Law” means a change in Law that impacts on the Partnership Arrangements, which comes into force after the Commencement Date;
"Commencement Date" means 1 July 2021;
"Council" means North Yorkshire County Council (and any successor to its statutory function);
"Council Health Related Functions" means those of the health related functions of the Council, specified in Regulation 6 of the Regulations as relevant to the provision of the Services as further set out in Schedule 2 including in particular the functions under Section 2B and 6C (1) of the 2006 Act;
"Data Controller" has the meaning set out in the Data Protection Legislation;
"Data Protection Legislation" means, for the periods in which they are in force in the United Kingdom, the GDPR, the Data Protection Act 2018, the Electronic Communications Data Protection Directive 2002/58/EC, the Privacy and Electronic Communications (EC Directive) Regulations 2003 and all applicable laws and regulations relating to Processing of Personal Data and privacy, including where applicable the guidance and codes of practice issued by the Information Commissioner, in each case as amended or substituted from time to time;
“Exit Strategy” means an exit strategy agreed between the Partners within six (6) months of the Commencement Date of this Agreement;
"Expiry Date" means 31 March 2024;
“Financial Contributions” means the financial contributions of the Partners as set out in Schedule 3;
"Financial Year" means the financial year from 1st April in any year to 31st March in the following calendar year;
"GDPR" means (a) the General Data Protection Regulation (Regulation (EU) 2016/679); and (b) any equivalent legislation amending or replacing the General Data Protection Regulation;
“Health Improvement Plan” means the local NHS health improvement and modernisation plan which applies to the Trust and any other plan known to incorporate the Aims and Outcomes;
"Healthy Child Board" means the Healthy Child Board (previously named the Healthy Child Shadow Board) which shall be the joint officer group responsible for the review of performance and oversight of this Agreement as set out in the governance arrangements in Schedule 4;
“Healthy Child Mobilisation Group” means the Healthy Child Mobilisation Group (previously the Healthy Child Operational Working Group) which shall be the joint group responsible for overseeing the mobilisation and delivery of the Service as set out in the governance arrangements in Schedule 4;
"Information Commissioner" means the UK's supervisory authority in relation to information rights, based at Information Commissioner's Office, Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9 5AF;
"Law" means any applicable law (including but not limited to decisions of the European Court of Justice) provision of the EC Treaty, legislation of the European Union, statute, bye-law, regulation, order, regulatory policy, guidance or code of practice (to the extent that such policy, guidance or code is legally binding) rule of court or directions or requirements of any Regulatory Body, delegated or subordinate legislation or notice of any Regulatory Body;
"NHS Functions" means those of the NHS functions listed in Regulation 5 of the Regulations as are exercisable by the Trust as are relevant to the provision of the Services, including in particular those set out in Schedule 2;
"Partners" means the parties to this Agreement and the term “Partner” shall mean either one of them; the term “Partnership” shall be construed accordingly;
“Partnership Arrangements” means the arrangements made between the Partners under this Agreement;
"Personal Data" shall have the meaning set out in the Data Protection Legislation;
"Pooled Fund" means any pooled fund established and maintained by the Partners as a pooled fund in accordance with the Regulations;
“Public Health Grant” means the ring fenced grant amount determined and paid to the Council by or on behalf of the Secretary of State pursuant to Section 31 of the Local Government Act 2003 towards expenditure incurred or to be incurred by the Council in exercising its public health functions;
“Quarter” means one of the following periods in each Financial Year:
(a) 1 April to 30 June (quarter one);
(b) 1 July to 30 September (quarter two);
(c) 1 October to 31 December (quarter three); and
(d) 1 January to 31 March (quarter four);
"Regulations" means the NHS Bodies and Local Authorities Partnership Arrangements Regulations 2000, S.I. 617 as amended by the Care Act 2014 (Consequential Amendments) (Secondary Legislation) Order, 2015 and other amendments as may be made from time to time;
"Regulatory Body" means a government department and regulatory, statutory and other entities committees and bodies which whether under statute, rules and regulations, codes of practice or otherwise are entitled to regulate or investigate the matters dealt with in this Agreement or any other affairs of either of the Partners;
"Service" means the 0-19 Healthy Child Service as set out in in Schedule 1 (Service Specification);
“Service Improvement Plan” means the plan developed by the Trust in response to its internally commissioned independent review of the Service, which sets out how the Trust is going to address issues identified with the Service. For the avoidance of doubt, this plan is separate to the Service Transformation and Improvement Plan;
“Service Transformation and Development Plan” has the meaning set out in Clause 8;
"Service User" means any eligible person receiving or entitled to receive the benefit of the Service;
"Trust" means Harrogate and District NHS Foundation Trust (and any successor to its statutory functions);
"TUPE" means the Transfer of Undertakings (Protection of Employment Regulations) 2006;
“VAT Guidance” means the guidance published by the Department of Health entitled "VAT arrangements for Joint NHS and Local Authority Initiatives including Disability Equipment Stores and Welfare- Section 31 Health Act 1999" as amended or replaced from time to time;
“Working Day” means any day other than Saturday, Sunday, a public or bank holiday in England.
1.2 In this Agreement, all references to any statute or statutory provision shall be deemed to include references to any statute or statutory provision which amends, extends, consolidates or replaces the same and shall include any orders, regulations, codes of practice, instruments or other subordinate legislation made thereunder and any conditions attaching thereto. Where relevant, references to English statutes and statutory provisions shall be construed as references also to equivalent statutes, statutory provisions and rules of law in other jurisdictions.
1.3 Any headings to Clauses, together with the front cover and the index are for convenience only and shall not affect the meaning of this Agreement. Unless the contrary is stated, references to Clauses and Schedules shall mean the clauses and schedules of this Agreement.
1.4 Any reference to the Partners shall include their respective statutory successors, employees and agents.
1.5 In the event of a conflict, the conditions set out in the Clauses to this Agreement shall take priority over the Schedules.
1.6 Where a term of this Agreement provides for a list of items following the word "including" or "includes", then such list is not to be interpreted as being an exhaustive list.
1.7 In this Agreement, words importing any particular gender include all other genders, and the term "person" includes any individual, partnership, firm, trust, body corporate, government, governmental body, trust, agency, unincorporated body of persons or association and a reference to a person includes a reference to that person's successors and permitted assigns.
1.8 In this Agreement, words importing the singular only shall include the plural and vice versa.
1.9 In this Agreement, "staff" and "employees" shall have the same meaning and shall include reference to any full or part time employee or officer, director, manager and agent.
1.10 Subject to the contrary being stated expressly or implied from the context in these terms and conditions, all communication between the Partners shall be in writing.
1.11 Unless expressly stated otherwise, all monetary amounts are expressed in pounds sterling but in the event that pounds sterling is replaced as legal tender in the United Kingdom by a different currency then all monetary amounts shall be converted into such other currency at the rate prevailing on the date such other currency first became legal tender in the United Kingdom.
1.12 All references to the Agreement include (subject to all relevant approvals) a reference to the Agreement as amended, supplemented, substituted, novated or assigned from time to time.
2.1 This Agreement will come into force on the Commencement Date.
2.2 Unless terminated earlier in accordance with Clause 30 or other prior lawful termination and subject to Clauses 2.3, 2.4 and 2.5, the Agreement will terminate on the Expiry Date.
2.3 The Partners may extend this Agreement for a period of 3 years by agreement in writing, subject to approval of the Partners (“the First Extension”). The First Extension will commence on the day after the Expiry Date.
2.4 The Partners may extend this Agreement for a further period of 2 years beyond the First Extension, (“the Second Extension”) by agreement in writing, subject to the approval of the Partners. Extension will commence on the day after the expiry of the First Extension.
2.5 The Partners may extend this Agreement for a further period of 2 years beyond the Second Extension (“the Third Extension”) by agreement in writing, subject to the approval of the Partners. The Third Extension will commence on the day after the expiry of the Second Extension.
2.6 The Partners will aim to enter into discussions about whether to extend this Agreement 18 months prior to the Expiry Date. The Partners will aim to enter into discussions about whether to further extend the Agreement 18 months prior to the expiry of each subsequent period of extension i.e. 18 months prior to the expiry of the First Extension and 18 months prior to the expiry of the Second Extension. Any agreement to extend this Agreement will be formally confirmed in writing by the Partners 12 months prior to the Expiry Date or, as applicable, 12 months prior to the expiry of the First Extension or 12 months prior to the expiry of the Second Extension, unless otherwise agreed by the Partners.
3.1 The Partners have agreed to enter into partnership arrangements as described in this Agreement for the purpose of developing and providing the Service as set out in Schedule 1.
3.2 The overall strategic aim of the Service will be to ensure the delivery of high quality services for children and families through joint working across the health and social care system.
3.3 The strategic objectives of the Partnership are:
3.3.1 To ensure the effective and efficient management and delivery of the Service;
3.3.2 To ensure that the Service forms an integrated part of multi-agency children’s and young people’s services across North Yorkshire, with clear links and connectivity with early help and preventative services, children’s social care and paediatrics and other services;
3.3.3 Through sharing resources and working in collaboration, to improve service, performance, quality and outcomes for families and children and young people;
3.3.4 To ensure that services are children, young people and family focused, and responsive to identified needs;
3.3.5 To deliver seamless services through effective multi-agency and multi-disciplinary planning, communication and processes;
3.3.6 To ensure value for money and efficient use of resources, maximising income where at all possible and avoiding duplication;
3.3.7 To respond to gaps in service delivery through improved service design, and inform commissioning intentions;
3.3.8 To increase the range of skills, professional and organisational, available for the provision of services and provide a diverse range of learning and development opportunities for staff.
4.1 The Partners agree to adopt the following principles when carrying out this Section 75 agreement:
4.1.1 To be openly accountable for performance of the Partners’ respective roles and responsibilities set out in this Section 75;
4.1.2 To communicate openly and transparently about major concerns, issues or opportunities relating to the delivery of this Section 75;
4.1.3 To commit to learn, develop and seek to achieve full potential from the Service;
4.1.4 To share information, experience, materials and skills to learn from each other and develop effective working practices, work collaboratively to identify solutions, eliminate duplication of effort, mitigate risk and reduce cost;
4.1.5 To adopt a positive outlook and behave in a positive, proactive manner;
4.1.6 To act in the best interests of Service Users and their families and to ensure that they are always at the forefront of decision making;
4.1.7 To adhere to statutory requirements and evidence based best practice, complying with applicable laws and standards including EU procurement rules, data protection and freedom of information legislation;
4.1.8 To act in a timely manner, recognising the time-critical nature of the project and to respond accordingly to requests for support;
4.1.9 To act in good faith to support achievement of the key objectives and compliance with these principles; and
4.1.10 To provide coherent, timely and efficient decision-making.
5.1 The purpose of this Agreement is to establish a framework through which the Partners can secure the provision of the Services in accordance with the terms of this Agreement.
5.2 The Council agrees that the Trust will exercise the Council’s Health Related Functions to the extent necessary for the purposes of performing its obligations under this Agreement in conjunction with the NHS Functions.
5.3 The Council Health Related Functions that are being exercised under the Agreement by the Trust are further set out in Schedule 2 of this Agreement. The NHS Functions which the Trust will exercise in conjunction with the Council Health Related Functions are described in Schedule 2 of this Agreement.
6.1 The Trust agrees to provide the Service in accordance with the Service specification in Schedule 1 and subject to the governance arrangements set out in Schedule 4. The Trust will be responsible for the management and the delivery of the Services under this Agreement.
6.2 The Trust shall ensure that all relevant legislation and statutory guidance in relation to delivery of the Service are complied with and shall manage its staff and the Service in accordance with all such legislation and statutory guidance.
6.3 From the Commencement Date and until such time as the process set out in Clause 6.4 is agreed by the Healthy Child Board and implemented, if the Trust wishes to make any significant or material change to the daily operational procedures and processes (e.g. safeguarding arrangements) adopted by the Trust to deliver the Service, the Trust will report the proposed change to the Healthy Child Board for agreement prior to implementation. For the avoidance of doubt “significant or material change” includes any issue that is reported to the Trust operational team or executive directors. If the Trust needs to make such a significant or material change urgently and there is no meeting of the Healthy Child Board scheduled within the required response time as indicated by the Trust, the Trust will report the changes to the Council’s Director of Children and Young People’s Services and its Director of Public Health explaining the need for urgent approval. The Council’s Director of Children and Young People’s Services and its Director of Public Health will liaise with the Trust and consider whether the changes can be agreed, with the aim of responding respond within the timeframe requested by the Trust.
6.4 The Trust will use reasonable endeavours to develop Operational Pressure Escalation Levels (“OPEL”) for the purpose of delivery of the Service by 31 December 2021. The OPEL will describe the different levels of pressure on the Service and an appropriate Service level response for each level. The proposed OPEL will be taken to the Healthy Child Board for agreement prior to implementation. Following agreement by the Healthy Child Board and implementation of the OPEL, the Trust will have authority to make the agreed response depending on the level of service pressure, in accordance with the OPEL. Should there be any other proposed changes in the daily operational procedures and processes outside of the changes described in the OPEL (e.g. safeguarding arrangements) that need to be adopted by the Trust to deliver the Service, the Trust will report the proposed change to the Healthy Child Board for agreement prior to implementation. When such a change is required to be made urgently, and the relevant timeframe means the matter cannot be considered by the Healthy Child Board by the next scheduled meeting, the changes will be reported urgently by the Trust to the Council’s Director of Children and Young People’s Services and Director of Public Health (or their agreed deputy), who will liaise with the Trust and consider whether the changes can be agreed. The Council will aim to respond within the timeframe requested by the Trust.
6.5 Other services may be included in the Agreement if they are intended to meet the needs of the Service Users, meet the agreed joint Aims and Objectives of the Partners as described in Clause 3, and the Healthy Child Board so determines, subject to the Agreement being formally varied in accordance with Clause 35.
7 staffing
7.1 The Trust shall ensure that adequate staff are allocated to the provision of the Service, and that those staff members are competent and able to carry out their duties, including but not limited to, having the appropriate and up-to-date qualifications where applicable to that role.
7.2 Staff remain subject to their respective employer’s terms and conditions and employment policies.
7.3 Each Partner will bear responsibility for all costs associated with their directly employed staff, including basic costs of employment and associated non- pay costs including professional indemnity, and costs associated with development and training.
7.4 The Trust will invite the Council to take part in the recruitment process for the recruitment of senior positions within the Service. For the purpose of this recruitment, senior posts refers to operational director, general manager and service manager (or any equivalent role) and if appropriate, clinical/professional leadership posts. Where such senior positions are mainly or wholly focused on North Yorkshire services, the Council will automatically be involved in the final decision making panel (unless otherwise agreed with the Council’s Director of Children and Young People’s Services and Director of Public Health). The Trust will include this information in its update to the Healthy Child Board on the workforce position, which will be provided in accordance with Clause 16.2.5 of this Agreement.
7.5 The Partners may wish to develop/create integrated service functions in the future.
8 service transformation and Development Plan
8.1.1 set out the agreed Aims and Outcomes for each specific Service and any Additional Services;
8.1.2 describe any changes or development required for the specific Service; and
8.1.3 provide information on how changes in funding or resources may impact the specific Service.
8.4 In the event that any agreed changes to the Service Transformation and Development Plan results in any increases or reductions in the level of services in the scope of the Agreement, the partners shall vary the Agreement in accordance with Clause 35. It is acknowledged that the Partners may be required to agree corresponding adjustments to the financial arrangements as set out in Schedule 3 of this Agreement.
8.5 If the Partners cannot agree the contents of the Service Transformation and Development Plan or any subsequent changes to the Service Transformation and Development Plan, the matter shall be dealt with in accordance with Clauses 29.1 and 29.2. Pending the outcome of the dispute resolution process (without for the avoidance of doubt does not include the mediation process set out in Clauses 29.3 to 29.27 or termination of the Agreement under Clause 30), the Partners shall continue to provide the Service on the same basis as the Services were provided as at the Commencement Date or in accordance with the latest agreed version of the Service Transformation and Development Plan, as applicable.
9.1 The Partners shall adhere to the performance management framework set out in Schedule 5.
9.2 Either Partner can request the Healthy Child Board to commission an:
9.2.1 independent review of the Service; or
9.2.2 a peer review in respect of the Service.
9.3 The Council’s Director of Children and Young People’s Services and Director of Public Health reserve the right to trigger an independent review or a peer review (as set out in Clause 9.2 above) in respect of the Service if for whatever reason, the Healthy Child Board does not agree to commission such a review.
9.4 If an independent review or peer review is commissioned under Clause 9.2 or 9.3, both Partners will co-operate fully with the review and agree to share any findings in a transparent and open way.
10.1 The financial arrangements in respect of the delivery of this Agreement shall be as described in Schedule 3, which may be amended from time to time in accordance with Clause 35.
10.2 Each Partner shall pay its own costs and expenses incurred from time to time in the negotiation and management of this Agreement, save as expressly otherwise provided in this Agreement.
10.3 For the avoidance of doubt, it is not the intention of the Partners through this Agreement to establish a Pooled Fund, although there is nothing in this Agreement that precludes the Partners from doing so if subsequently agreed in accordance with Clause 35. If the Partners do agree to establish a Pooled Fund, the Parties recognise that this Agreement will require amendments to ensure compliance with the Regulations.
10.4 To enable the Council to understand the joint financial and performance position for the Service, the Trust will work on an “open book” basis and report on the financial and performance position of the Service to the Healthy Child Board as required by Clause 16.2.2 of this Agreement.
10.5 The Council will report to the Trust on an “open book” basis in respect of the Public Health Grant. This includes details of the national allocations (as relevant to the Council) and any increases or changes to the Public Health Grant.
11 RISK SHARE, OVERSPENDS AND UNDERSPENDS
Risk Share
11.1 No risk share arrangements shall apply to this Agreement unless otherwise agreed in accordance with Clause 35. For the avoidance of doubt, each Partner shall manage their own risks in respect of their respective financial and resource contribution to the Service as set out in Schedule 3.
Overspends
11.3 Subject to Clauses 11.4 and 11.6, liability for any overspends shall sit with the Trust save where the Council and the Trust agree otherwise and the Council confirms the position in writing.
11.4 Notwithstanding the position as set out in Clause 11.1 and 11.3 above, where there is a financial pressure for either Partner, both Partners commit to working collaboratively to discuss how this might be addressed. Partners will work together and flexibly with respect to any overspends and underspends that arise. This could, for example, look at phasing any overspends where appropriate and also balancing off any underspends against non-funded pay costs.
11.5 The Trust shall make the Council aware of any potential overspend as soon as it becomes aware of this possibility. The Trust will confirm reasons for the overspend, both current and projected.
11.6 The Council, if notified by the Trust in accordance with Clause 11.5, shall use reasonable endeavours to agree recommendations with the Trust for action to bring the budget back into balance.
Underspends
11.9 Subject to Clause 31.4, the benefit of any not already committed underspend on termination or expiry of this Agreement (whichever is appropriate) shall be repaid in full to the Council.
13 SET UP COSTS
14 PREMISES/non-financial contributions
14.1 As at the Commencement Date the list of the premises owned by the Council from which parts of the Service may be delivered (the “Council Premises”) are:
14.1.1 Atmosphere, Pickering;
14.1.2 Bedale Children’s Centre, Bedale;
14.1.3 Bilton Children’s Centre, Harrogate;
14.1.4 Briercliffe Children’s Centre, Scarborough;
14.1.5 Colburn Children’s Centre, Colburn;
14.1.6 County Hall, Northallerton;
14.1.7 Eastfield Pinder Hub/Outspace, Scarborough;
14.1.8 Knaresborough Children’s Centre, Knaresborough;
14.1.9 Norton/Malton Ryedale Children’s Centre;
14.1.10 Oak Beck House, Harrogate;
14.1.11 Richmond Youth Centre, Richmond;
14.1.12 Ripon and Harrogate Prevention Hub;
14.1.13 Sandpiper, Selby;
14.1.14 Skipton Children’s Centre, Skipton; and
14.1.15 Thirsk and Sowerby Children’s Centre, Thirsk.
14.2 The Partners acknowledge that the Council Premises named in Clause 14.1 may change by agreement in writing between the Partners. The Healthy Child Board will review the Council Premises regularly with a view to promoting co-location between the Service and other children and young person teams, whilst noting that the Trust is subject to a statutory duty to involve services users in the development and consideration of proposals for service change.
14.3 The Council will make the Council Premises available to the Trust for the delivery of the Services and additional usage in relation to Service delivery including, but not limited to, meetings and training that relate to the Service. For the avoidance of doubt, any use of the Council Premises by the Trust must be directly linked to the Services.
14.4 The Council will grant a license for the Trust to enter the Council Premises on a non-exclusive basis for the delivery of the Service. Such license will terminate automatically on the termination of this Agreement for any reason. The costs associated with the license fall outside of this Agreement.
14.5 There are no other non-financial contributions by the Partners.
15.1 The governance arrangements in respect of this Agreement are set out in Schedule 4.
15.2 The Trust shall nominate its Authorised Officer, who shall be the main point of contact for the Council and shall be responsible for representing the Trust and liaising with the Council’s Authorised Officer in connection with the Partnership Arrangements.
15.4 The Authorised Officers shall be responsible for taking decisions concerning the Partnership Arrangements on behalf of their respective organisations, unless they indicate that the decision is one that must be referred to their respective boards or committees. All decisions in respect of this Agreement shall be made by each Partner in line with its own Standing Orders and Scheme of Delegation.
15.5 The Partners shall each nominate officers to the Healthy Child Board in accordance with Schedule 4 terms of reference for the Healthy Child Board. The terms of reference for the Healthy Child Board, as at the Commencement Date, are set out in Schedule 4. The terms of reference for the Healthy Child Board may be amended from time to time by agreement between the Partners in writing).
16 QUARTERLY REVIEW AND general REPORTING
16.1 The Partners shall carry out a joint quarterly review of the Partnership Arrangements within 30 days of the end of each reporting Quarter. The aim of the review is to identify and consider new issues as have arisen during the Quarter and to address/confirm progress in respect of previously agreed actions.
16.2 The Trust shall submit a quarterly report to the Healthy Child Board setting out:
16.2.1 Progress against the Service Improvement Plan;
16.2.2 Financial management information including programme budget, programme costs and narrative describing the financial position and performance against the Service Improvement Plan;
16.2.3 A summary of new issues/actions arising during the Quarter and a summary of progress against previously agreed actions;
16.2.4 the Service delivery against the agreed outcomes and performance as set out in Schedule 5; and
16.3 Ahead of every regular meeting of the Healthy Child Board, the Trust will prepare and submit a report addressing staff recruitment and retention, feedback and actions arising from staff surveys and any other issues impacting upon staff working within the Service.
16.4 By 30 June 2022, the Healthy Child Mobilisation Group will have produced a report addressing how the Service, including its management and practices, will become more integrated with other local services. The report will be submitted to the Healthy Child Board for consideration at the next scheduled meeting. The Healthy Child Board will consider the report and agree an action plan for implementation by the Partners.
17.1 The Partners agree to carry out a review of the Partnership Arrangements within three months of the end of each Financial Year (“Annual Review)” in line with the process set out in Clauses 17.3 and 17.4 of this Agreement.
17.2 The scope of the Annual Review will be agreed by the Healthy Child Board in advance and will include as a minimum:
17.2.3 plans to address any underperformance in the Services;
17.2.5 review of plans and performance levels for the following year; and
17.3 The Healthy Child Mobilisation Group will, as part of the Annual Review, review the Service and the Partnership Arrangements, having regard to the scope of the Annual Review agreed by the Healthy Child Board in accordance with Clause 17.2, and prepare a report for consideration by the Healthy Child Board. The Healthy Child Board will review the report, together with the Council’s Director of Public Health; the Director of Strategic Resources and/or the Assistant Director of Strategic Resources for the Council, and consider and agree any recommendations for the Service that are to be made to the Trust’s Board and the Council.
17.4 The Healthy Child Board will agree a final version of the report for submission to both the Trust’s board and to the Council for approval.
18 STANDARDS
18.1.1 the service standards set out in Schedule 1 and Schedule 5;
18.1.2 the prevailing standards of clinical governance;
18.2 The Trust shall ensure its operational guidance and procedures reflect compliance with this Clause 18. In particular the Trust shall comply with the North Yorkshire Safeguarding Policy.
21.1 The Partners acknowledge that for the purpose of this Agreement, they are each Data Controllers and agree to comply with their obligations under the Data Protection Legislation and abide by Schedule 6 (Information Sharing Agreement).
22 FREEDOM OF INFORMATION ACT AND ENVIRONMENTAL PROTECTION REGULATIONS
22.1 The Partners acknowledge that each of them is subject to obligations under the 2000 Act (“FOIA”) and the 2004 Regulations.
22.2 The Partners agree that they will each cooperate with each other to enable any Partner receiving a request in relation to this Agreement under the 2000 Act or the 2004 Regulations to respond to a request promptly and within the statutory timescales. This cooperation shall include (but not be limited to) finding, retrieving and supplying information held, directing requests to other Partners as appropriate and responding to any reasonable requests by the Partner receiving a request for comments or other assistance.
22.3 Any and all agreements between the Partners as to confidentiality shall be subject to duties under the 2000 Act and 2004 Regulations. No Partner shall be in breach of Clause 23 if it makes disclosures in accordance with the 2000 Act and/or the 2004 Regulations.
23.1 The Partners shall ensure that confidentiality is maintained at all times in all matters relating to the services provided under this Agreement.
23.2 In this Agreement “Confidential Information” shall mean any information or data (of whatever nature and however recorded or preserved) of a confidential nature relating to either Partner or its activities or the activities and affairs of its employees, agents, Service Users or relatives, under this Agreement. Save that Confidential Information shall not include information or data that is or becomes:-
23.2.1 generally available to the public otherwise than by reason of breach of the provisions of this Clause;
23.2.2 known to the other Partner and is at its free disposal (having been generated independently by the other Partner or a third party) and not derived directly or indirectly from the Partner’s Confidential Information prior to its receipt from the Partner;
23.2.3 subsequently disclosed to the other Partner without obligations of confidence by a third party owing no such obligations to the Partner in respect of that Confidential Information;
23.2.4 required by law to be disclosed;
23.2.5 required by the Local Government Commissioner for England.
23.3 The Partners agree at all times during the continuance of this Agreement to keep confidential all the other Partner’s Confidential Information, and only to share such information to the extent permitted by Law. For avoidance of doubt, this Clause shall not affect the rights of any workers under Section 43 A-L of the Employment Rights Act 1996.
23.4 The Partners hereby warrant that in respect of the Confidential Information of the other Partner (including any person employed or engaged by them in connection with this Agreement) they shall:
23.4.1 only use the other Partner’s Confidential Information for the performance of their obligations under this Agreement;
23.4.2 not disclose any of the other Partner’s Confidential Information to any third party without the prior written consent of the other Partner;
23.4.3 take all necessary precautions to ensure that all the other Partner’s Confidential Information is treated as confidential and not disclosed (save as aforesaid) or used other than for the performance of their obligations under this Agreement by their employees, servants, agents or sub-contractors;
23.5 Nothing in this Clause 23 shall be deemed or construed to prevent either Partner from disclosing any Confidential Information obtained from the other to any employee, consultant, contractor or other person engaged by them in connection herewith, provided that they shall have obtained from the employee, consultant, contractor or other person a signed confidentiality undertaking on substantially the same terms as are contained in this Clause.
23.6 Upon termination or expiry of this Agreement, howsoever occurring, the Partners shall return or destroy at the direction and request of the other Partner all Confidential Information and all notes and memoranda prepared in relation to the Confidential Information, of the other Partner.
23.7 The Partners must ensure that all matters relating to the individual Service User’s circumstances are treated as confidential. When information is to be shared with other agencies a Service User consent form will be signed, the form of which shall be agreed between the Partners.
23.8 The provisions of this Clause 23 shall continue to apply notwithstanding termination of this Agreement.
24 OMBUDSMEN AND INVESTIGATIONS BY REGULATORY BODIES
24.1 The Partners shall co-operate with any investigation undertaken by the Health Service Commissioner for England or the Local Government Commissioner for England (or both of them) or any other Regulatory Body in connection with this Agreement.
25 AUDIT
25.1 The Trust shall provide to the Council any reports reasonably required concerning the Health-Related Functions for the purposes of their audit on reasonable notice. The Partners shall agree an annual audit schedule pertaining to elements of the Health Related Functions to determine compliance and quality.
26.1 Each Partner shall ensure that they maintain policies of insurance (or equivalent arrangements through schemes operated by National Health Service Resolution) in respect of all potential liabilities arising from this Agreement. Both Partners will seek to recover any losses incurred as a result of the arrangements set out in this Agreement through the insurance arrangements set out in this Clause 26.1. Each Partner shall at all times take all reasonable steps to minimise and mitigate any loss for which one party is entitled to bring a claim against the other pursuant to this Agreement.
26.2 Each Partner shall provide to the other upon request such evidence as may reasonably be required to confirm that the insurance arrangements are satisfactory and are in force at all times.
26.3 Subject to Clause 26.3A, the Trust (the “Indemnifying Partner”) shall indemnify the Council, its officers, employees and agents against any damage, cost, liability, loss, claim or proceedings whatsoever arising in respect of:
26.3.1 any damage to property real or personal, including any infringement of third party patents, copyrights and registered designs;
26.3.2 any personal injury including injury resulting in death;
26.3.3 any award or recommendation of compensation payable to a Service User following complaint or investigation by the Health Service Commissioner or Local Government Commissioner for England or any similar entity;
arising following the commencement date of this Agreement out of or in connection with the Service, to the extent such damage, cost, liability, loss, claim or proceedings shall be due directly to any negligent act or omission, fraud or a breach of contract in relation to this Agreement, by the Indemnifying Partner, its officers or employees, any fraudulent or dishonest act of any of its officers, employees or contractors or any breach of statutory or common law duty.
26.3A The Trust shall not be required to indemnify the Council for any damage, cost, liability, loss, claim or proceedings under Clause 26.3 to the extent that such damage, cost, liability, loss, claim or proceedings has been caused by any act or omission by or on the part of, or in accordance with the instructions of, the Council, its employees or agents or the Healthy Child Board.
26.4 Under this Agreement neither Party shall be liable to the other for any indirect loss of profit, loss of use, loss of production, loss of business, loss of business opportunity, loss of business revenue, loss of goodwill or any claim for consequential loss or for indirect loss of any nature.
26.5 The indemnity shall not apply to any such claim or proceeding:
26.5.1 unless as soon as reasonably practicable following receipt of notice of such claim or proceeding, the Council shall have notified the Trust in writing of it and shall, upon the Trust’s request and at the Trust’s cost, have permitted the Trust to have full care and control of the claim or proceeding, using legal representation approved by the Council, such approval not to be unreasonably withheld or delayed; or
26.5.2 if the Council, its employees or agents shall have made any admission in respect of such claim or proceeding or taken any action related to such claim or proceeding prejudicial to the defence of it without the written consent of the Trust (such consent not to be unreasonably withheld or delayed), provided that this condition shall not be treated as breached by any statement properly made by the Council, its employees or agents in connection with the operation of its internal complaints procedures, accident reporting procedures or disciplinary procedures or where such statement is required by Law.
26.6 Each Partner shall keep the other Partner and its legal advisers fully informed of the progress of any such claim or proceeding, will consult fully with the other Partner on the nature of any defence to be advanced and will not settle any such claim or proceeding without the prior written approval of the other Partner (such approval not to be unreasonably withheld).
26.7 The Partners shall use their reasonable endeavours to inform each other promptly of any circumstances reasonably thought likely to give rise to any such claim or proceedings of which they are directly aware and shall keep each other reasonably informed of developments in relation to any such claim or proceeding even where they decide not to make a claim under this Clause 26.
26.8 The Partners shall each give to the other such help as may reasonably be required for the efficient conduct and prompt handling of any claim or proceeding.
26.9 No Council staff will be transferring to the Trust under the terms of this Agreement. The Council therefore warrants that there are no individuals presently employed by the Council (including, for the avoidance of doubt, the Council’s Staff) whose contracts of employment will, by virtue of TUPE, would or could be deemed as employees of the Trust after the Commencement Date.
26.10 No Trust staff will be transferring to the Council under the terms of this Agreement. The Trust therefore warrants that there are no individuals presently employed by the Trust (including, for the avoidance of doubt, the Trust’s staff) whose contract of employment will, by virtue to TUPE, would or could be deemed as employees of the Council after the Commencement Date.
26.11 Nothing in this Agreement shall absolve the Council or the Trust of their statutory duties to Service Users or others.
27 LIABILITIES
27.2 As the Trust is currently providing the Service under separate service agreements (which will terminate prior to the commencement of this Agreement), all rights and liabilities under these existing agreements are preserved.
28 COMPLAINTS
28.1 Complaints, incidents and serious incidents related to the Service will be managed by the organisation from which they originate. If there is a complaint in relation to the provision of the Services, the Trust will investigate and respond to the complaint. If there is a perceived benefit in shared accountability the Partners will together take a decision on which Partner is best placed to lead the appropriate process to investigate and respond.
28.2 Where a complaint cannot be handled in the way described above or relates to the operation of the arrangements made pursuant to this Agreement or the content of this Agreement, then the Authorised Officers, or their nominated deputies will set up a complaints subgroup to examine the complaint and recommend remedies.
28.3 Any dispute or uncertainty about which procedure to follow should be resolved jointly by the Patient Experience Team (Trust) and the Complaints Manager (Council).
28.4 Where the complaint is being brought against both the Trust and the Council, it will be managed within the shortest timeframe of whichever Partner.
28.5 Both parties shall co-operate in the investigation of all complaints and will participate in the complaints resolution process as required.
28.6 Both parties shall co-operate in the investigation of enquiries from elected members of the Council.
28.7 The Trust shall ensure that all Services provided and arrangements for complaints are in accordance with its policy and that of the Equality and Human Rights Commission and all or any policies and procedures approved by the Trust as available through its web site under the 2000 Act.
28.8 During the term of the Agreement, the Partners shall work together to develop closer integration on a range of issues including complaints management.
28.9 Each Partner shall use their reasonable endeavours to inform the other Partner of any circumstance reasonably thought likely to give rise to a complaint or in which a complaint has been made.
29.2 In the event of a dispute over the application or interpretation of this Agreement, the dispute may be referred by the Partners in writing as follows:
29.2.1 in the first instance to the Authorised Officers or their nominated deputy to resolve through ordinary negotiations within ten (10) days;
29.2.2 in the second instance (if resolution by the Authorised Officers cannot be reached in line with Clause 29.2.1) to, the Healthy Child Board. The members of the Healthy Child Board shall use their best endeavours to resolve such disputes through ordinary negotiations within sixty (60) days;
29.2.3 in the third instance (if resolution by the Healthy Child Board cannot be reached in line with Clause 29.2.2) to, the Chief Executives or relevant Director within each organisation who shall co-operate in good faith to resolve the dispute as amicably as possible within 30 days of service of the notice.
29.3 If the Dispute is not resolved within thirty (30) days following a referral under clause 29.2.3, the Partners shall attempt in good faith to resolve the dispute through the model mediation procedure of the Centre for Effective Dispute Resolution (CEDR).
29.4 If the Partners are unable to agree on the joint appointment of a mediator within five (5) days, they shall make a joint application to CEDR to nominate the mediator.
29.5 The mediator, after consultation with the Partners where appropriate, will:
29.5.1 attend any meetings with either or both of the Partners preceding the mediation, if requested or if the mediator decides this is appropriate and the Partners agree;
29.5.2 read before the mediation each case summary and all the documents sent to him;
29.5.3 chair, and determine the procedure for the mediation;
29.5.4 assist the Partners in drawing up any written settlement agreement; and
29.5.5 abide by the terms of CEDR's model mediation procedure and CEDR’s code of conduct for mediators.
29.6 The mediator (and any member of the mediator’s firm or company) will not act for either of the Partners individually in connection with the dispute in any capacity during the Term. The Partners accept that in relation to the dispute neither the mediator nor CEDR is an agent of, or acting in any capacity for, either of the Partners. Furthermore, the Partners and the mediator accept that the mediator (unless an employee of CEDR) is acting as an independent contractor and not as an agent or employee of CEDR.
29.7 CEDR, in conjunction with the mediator, will make the necessary arrangements for the mediation including, as necessary:
29.7.1 nominating, and obtaining the agreement of the Partners to, the mediator;
29.7.2 organising a suitable venue and dates;
29.7.3 organising exchange of the case summaries and documents;
29.7.4 meeting with either or both of the Partners (and the mediator if appointed), either together or separately, to discuss any matters or concerns relating to the mediation; and
29.7.5 general administration in relation to the mediation.
29.8 If there is any issue about the conduct of the mediation upon which the Partners cannot agree within a reasonable time, CEDR will, at the request of either Partner, decide the issue for the Partners, having consulted with them.
29.9 The Partners agree to notify the mediator of any of the relevant timescales which they wish to observe.
29.10 Each Partner will state the names of:
29.10.1 the person(s) who will be the lead negotiator(s) for that Partner, who must have full authority to settle the dispute; and
29.10.2 any other person(s) (such as professional advisers, colleagues or sub-contractors) who will also be present at, and/or participating in, the mediation on that Partner’s behalf.
29.11 Each Partner will send to CEDR at least 2 (two) weeks before the mediation, or such other date as may be agreed between the Partners and CEDR, sufficient copies of:
29.11.1 its case summary; and
29.11.2 all the documents to which the case summary refers and any others to which it may want to refer in the mediation.
29.12 In addition, each Partner may send to the mediator (through CEDR) and/or bring to the mediation further documentation which it wishes to disclose in confidence to the mediator but not to the other Partner, clearly stating in writing that such documentation is confidential to the mediator and CEDR.
29.13 The mediator will be responsible for sending a copy of each Partner's case summary and supporting documents (pursuant to clause 23.10) to the other simultaneously.
29.14 The Partners should try to agree:
29.14.1 the maximum number of pages of each case summary; and
29.14.2 a joint set of supporting documents or the maximum length of each set of supporting documents.
29.15 The mediation will take place at the time and place arranged by CEDR.
29.16 The mediator will chair, and determine the procedure at, the mediation.
29.17 No recording or transcript of the mediation will be made.
29.18 If the Partners are unable to reach a settlement in the negotiations at the mediation, and only if both the Partners so request and the mediator agrees, the mediator will produce for the Partners a non-binding recommendation on terms of settlement. This will not attempt to anticipate what a court might order but will set out what the mediator suggest are appropriate settlement terms in all of the circumstances.
29.19 Any settlement reached in the mediation will not be legally binding until it has been reduced to writing and signed by, or on behalf of, the Partners. The mediator will assist the Partners in recording the outcome of the mediation.
29.20 The mediation will terminate when:
29.20.1 a Partner withdraws from the mediation;
29.20.2 a written settlement agreement is concluded;
29.20.3 the mediator decides that continuing the mediation is unlikely to result in a settlement; or
29.20.4 the mediator decides he should retire for any of the reasons in CEDR's code of conduct.
29.21 Every person involved in the mediation will keep confidential and not use for any collateral or ulterior purpose:
29.21.1 information that the mediation is to take place or has taken place, other than to inform a court dealing with any litigation relating to the dispute of that information; and
29.21.2 all information (whether given orally, in writing or otherwise) arising out of, or in connection with, the mediation including the fact of any settlement and its terms.
29.22 All information (whether oral or documentary and on any media) arising out of, or in connection with, the mediation will be without prejudice, privileged and not admissible as evidence or disclosed in any current or subsequent litigation or other proceedings whatsoever. This does not apply to any information, which would in any event have been admissible or disclosed in any such proceedings.
29.23 Clauses 29.21 and 29.22 shall not apply insofar as any such information is necessary to implement and enforce any settlement agreement arising out of the mediation.
29.24 None of the Partners will call the mediator or CEDR (or any employee, consultant, officer or representative of CEDR) as a witness, consultant, arbitrator or expert in any litigation or other proceedings whatsoever. The mediator and CEDR will not voluntarily act in any such capacity without the written agreement of both the Partners.
29.25 CEDR’s fees (which include the mediator’s fees) and the other expenses of the mediation will be borne equally by the Partners. Payment of these fees and expenses will be made to CEDR in accordance with its fee schedule and terms and conditions of business.
29.26 Each Partner will bear its own costs and expenses of its participation in the mediation.
29.27 Neither the mediator nor CEDR shall be liable to the Partners for any act or omission in connection with the services provided by them in, or in relation to, the mediation, unless the act or omission is shown to have been in bad faith.
30 TERMINATION
30.2 The Partners may, without prejudice to any other provision of this Agreement, agree in writing to terminate the Agreement, and if the Partners so agree, they must agree the date upon which termination takes effect.
30.3.1 if the Second Partner is in breach of any material obligation under this Agreement, provided that, if the breach is capable of remedy, the First Partner may only terminate this Agreement under clause 30.3, if the Second Partner has failed to remedy the breach within 28 days of receipt of notice from the First Partner (Remediation Notice) to do so.
30.4 Either Partner may terminate this Agreement in whole or part upon a minimum of 12 months’ written notice following a failure to resolve a dispute under Clause 29.
30.5 If there is a Change in Law that:
30.5.1 prevents either Partner from complying with its obligations under this Agreement; or
30.5.2 makes provision of the Service significantly more or less onerous for the Trust,
the Partners will discuss the impact on the Services (including any financial impact) and agree a way forward, including whether termination under Clause 30.2 is required.
30.6 The provisions of clause 31 shall apply on termination of this Agreement.
31 CONSEQUENCES OF TERMINATION
31.1 On the termination or expiry of this Agreement, howsoever occurring:
31.1.2 the Partners will comply with the Exit Strategy;
31.1.4 any assets purchased in connection with this Agreement/the Services shall be returned to the Partner from whose Financial Contribution the purchase was made;
31.1.5 The Trust shall, at the request of the Council, assign any contracts or parts thereof, which relate to services it performs on behalf of the Council under this Agreement; and
31.2 Overspends on termination of the Agreement shall be dealt with in accordance with Clause 11.3.
31.4 The Trust shall be entitled to direct any underspends to the following purposes:
31.4.1 to meet obligations under existing contracts;
31.4.2 to defray the costs of making any alternative arrangements for Service Users; and
31.5 The provisions of the following clauses shall survive termination or expiry of this Agreement:
31.5.3 Clause 23;
31.5.4 Clause 26;
31.5.5 Clause 27;
31.5.6 Clause 28;
31.5.7 Clause 34; and
31.5.8 Clause 40.
31.6 In addition to the Clauses listed in Clause 31.5 above, any other provision of this Agreement that expressly or by implication is intended to continue in force on or after termination of this Agreement, howsoever caused, shall remain in full force and effect.
32 PUBLICITY
32.1 No Partner shall issue any press release or any statement containing information relating to or connected with or arising out of this Agreement or the matters contained in it, including information relating to the business or affairs of any other Partner, without obtaining the previous approval of the other Partner such approval to be in relation to its contents and the manner of its presentation and publication or disclosure (such approval not to be unreasonably withheld or delayed).
33 EXCLUSION OF PARTNERSHIP, JOINT VENTURE OR AGENCY
33.1 Nothing in this Agreement shall create a legal partnership as defined under the Partnership Act, 1890 or joint venture between the partners or the relationship of employer and employee between the Partners or render either Partner directly liable to any third party for the debts, liabilities or obligations of the other.
33.2 Neither Partner nor any of its employees or agents will in any circumstances hold itself out to be the servant or agent of the other Partner, except where expressly permitted by this Agreement.
33.3 Save as expressly provided otherwise in the Agreement or where the context or any statutory provision otherwise necessarily requires, neither Partner shall in any way whatsoever have authority to, or hold itself out as having authority to:
33.3.1 act as an agent of the other;
33.3.2 make any representations or give any warranties to third parties on behalf of or in respect of the other;
33.3.3 bind the other in any way; or
33.3.4 vary, amend revoke or create any byelaw.
34 PROTECTING CHILDREN AT RISK
34.1 The Partners shall at all times act to safeguard and promote the wellbeing of the Service Users. The protection of children at risk and safeguarding is a priority. A new service safeguarding model, agreed with the North Yorkshire Children Safeguarding Partnership, is in place which describes clearly the role of the Service/ programme within the system in North Yorkshire. There is a dedicated safeguarding team to work across the system, but the Partners recognise that all practitioners have a role to play in protecting children and keeping them safe.
34.2 The Partners shall maintain comprehensive procedures that:
34.2.1 promote the safety and welfare of children and adults at risk; and,
34.2.2 comply with any statutory requirements.
34.3 The Trust shall provide training on safeguarding matters to all Service staff, and they shall require all staff to undertake such training, ensuring they have an understanding of their safeguarding roles and responsibilities to a level that is commensurate with their duties to safeguard adults and children and to meet the competencies outlined in any national framework for safeguarding in accordance with the statutory requirements and government guidance relating to safeguarding adults and children.
34.4 The Trust shall maintain and keep training records of all such training undertaken by Service staff so as to evidence the staff’s attendance and the level of training undertaken. This training should include active encouragement to staff in respect of whistle blowing if they become aware of suspected abuse.
34.5 The Trust shall ensure that the issue of safeguarding of adults and children is included in its induction procedures for all service staff.
34.6 The Trust must ensure that professional boundaries are maintained between service staff and Service Users so that Service Users are safeguarded from any form of abuse or exploitation including physical, financial, psychological and sexual abuse, neglect, discriminatory abuse or self-harm or inhuman or degrading treatment through deliberate intent, negligent acts or omissions or ignorance by the Service staff in accordance with written policies and procedures.
35.1 The Partners anticipate that over the lifetime of this Agreement the provisions may need to change in order to support the delivery of the Aims and Objectives and the Service Specification in Schedule 1, which may themselves change from time to time (as agreed between the Partners) to reflect national and local priorities. This Agreement shall not be varied or amended unless such variation or amendment has been agreed in writing and signed by the Partners.
36 ASSIGNMENT AND SUB-contract
36.1 Subject to Clause 36.2 and other than as required by Law, neither Partner shall:
36.1.1 assign or transfer the whole or any part of this Agreement, without the prior written consent of the other Partner, which shall not be unreasonably withheld or delayed.
36.1.2 create any interest, charge or security over or deal in any other manner with this Agreement or part of it without the prior written consent of the other and for the avoidance of doubt, a partner shall be absolutely entitled to withhold such consent;
36.1.3 only sub-contract the performance of this Agreement or any part thereof with the prior written consent of the other partner, which consent the other partner shall be absolutely entitled to withhold;
36.1.4 cease to sub-contract if the other Partner in writing withdraws such consent, save that in such event the partner who has so sub-contracted shall be allowed a reasonable period in which to rearrange its affairs of not less than three months; and
36.1.5 consent to sub-contract (if given) shall not relieve the sub-contracting partner from any liability or obligation under this Agreement.
36.2 The Council may assign, novate, or otherwise dispose of its rights and obligations under this Agreement without the consent of the Trust, provided that such assignment, novation or disposal shall not increase the burden of the Trust’s obligations under this Agreement and such assignment, novation or disposal is limited to any legal entity with which the Council merges or which is a successor body of the Council by reason of statutory reorganisation.
36.3 Notwithstanding the Council’s right to assign, novate or otherwise dispose of its rights and obligations under this Agreement in accordance with Clause 36.2 above, in recognition of the nature of this Agreement and in keeping with the principles of partnership working set out in Clause 4, the Council agrees to communicate openly and transparently with the Trust (subject to any requirement imposed which prevents the Council from doing so) about the potential for any merger or statutory reorganisation of the Council and any anticipated transfer of this Agreement as permitted by Clause 36.2 above. For the avoidance of doubt, the Council may not be entitled to share information that is not already in the public domain ahead of any formal announcements made in respect of reorganisation.
37.1 In this Clause 37 “Intellectual Property” shall mean all copyright, patents trademarks, service marks, database rights, design rights (whether registered or unregistered) and all other similar proprietary rights as may exist anywhere in the world.
37.2 The Partners hereby grant each other a royalty free licence with the right to sub-license to use any of existing Intellectual Property of either Partner required for the performance of the other’s obligations under this Agreement in accordance with the provisions of this Agreement. Such license and any sub-licence to expire when this Agreement is terminated or expires howsoever occurring. Upon termination of the licence each Partner shall return or destroy and procure the return or destruction by any sub-licensee at the direction and request of the other Partner all the other Partner’s Intellectual Property.
37.3 Any Intellectual Property that arises solely as a result of this Agreement shall be assigned as follows:
37.3.1 If the Intellectual Property relates to the NHS Functions the rights shall be vested in the Trust;
37.3.2 If the Intellectual Property relates to the Council’s Health Related Functions the rights shall be vested in the Trust;
37.3.3 Where any Intellectual Property cannot be so determined as being created either in the exercise of NHS Functions or Health Related Functions (“Joint Intellectual Property”) then the Joint Intellectual Property shall vest in the Partner in the best position to exploit the Intellectual Property as determined by the Healthy Child Board. The other Partner shall be entitled to be paid royalties at a reasonable rate to be determined by the Healthy Child Board on any commercial exploitation of the Joint Intellectual Property.
37.4 Each Partner hereby grants to the other Partner an irrevocable royalty free license of all Intellectual Property arising in the course of this Agreement, with the right to sub license, to use such Intellectual Property for any purposes the other Partner sees fit, save that where a Partner is receiving royalties from the exploitation of Joint Intellectual Property from the other Partner it shall be entitled to sub-license such Joint Intellectual Property on a commercial basis with the prior consent of the other Partner, such consent not to be unreasonably withheld or delayed.
38 EVIDENCE IN LEGAL PROCEEDINGS
38.1 Each Partner shall if required to do so by the other provide any relevant information in connection with any legal proceedings, internal disciplinary hearing or other hearing arising in connection with this Agreement, save in connection with any proceedings or potential proceedings between the Partners.
38.2 Each Partner shall immediately on becoming aware of any accident, damage or breach of any statutory provision relating to or connected in any way with the Partnership arrangements under this Agreement, notify the other of the said accident, damage or breach.
38.3 Any information or assistance provided by either Partner to the other in accordance with this Clause 38 shall be provided free of charge unless the subject of the proceedings or hearing arose prior to the Commencement Date of this Agreement.
39.1 The terms herein contained together with the contents of the Schedules and Annexes constitute the complete agreement and understanding between the Partners and supersede all previous communications representations understandings and agreements with respect to the subject matter hereof, and any representation promise or condition not incorporated herein shall not be binding on either Partner.
39.2 Each of the Partners acknowledges and agrees that in entering into this Agreement, and the documents referred to in it, it does not rely on, and shall have no remedy in respect of, any statement, representation, warranty or understanding (whether negligently or innocently made) of any person (whether party to this Agreement or not) other than as expressly set out in this Agreement, excluding fraudulent misrepresentation.
40.1 In this Agreement, “Force Majeure” shall mean any cause preventing either Partner from performing any or all of its obligations which arises from or are attributable to either acts, events, omissions or accidents beyond the reasonable control of the Partner so prevented including act of God, war, riot, civil commotion, malicious damage, compliance with any law or governmental order, rule, regulation or direction, accident, breakdown of plant or machinery, fire, flood or storm or war, civil war, armed conflict or terrorist attack, nuclear, chemical or biological contamination or sonic boom.
40.2 If either Partner is prevented or delayed in the performance of any of its obligations under this Agreement by Force Majeure, that Partner shall forthwith serve notice in writing on the other Partner specifying the nature and extent of the circumstances giving rise to Force Majeure, and shall, subject to service of such notice and having taken all reasonable steps to avoid such prevention or delay (including exploring the possibility of sub-contracting the Service, subject to the Council’s consent), have no liability in respect of the performance of such of its obligations as are prevented by the Force Majeure events during the continuation of such events, and for such time after they cease as is necessary for that Partner, using all reasonable endeavours, to recommence its affected operations in order for it to perform its obligations.
40.3 If either Partner is prevented from performance of its obligations, by reason of Force Majeure, for a continuous period in excess of six months, the other Partner may terminate this Agreement forthwith on service of written notice upon the Partner so prevented, in which case neither Partner shall have any liability to the other except that rights and liabilities which accrued prior to such termination shall continue to subsist.
41 OBSERVANCE OF STATUTORY REQUIREMENTS
41.1 The Partners shall comply and ensure that their employees, agents and sub-contractors shall comply with all the relevant legal provisions, whether in the form of orders, regulations, statutes, statutory instruments, codes of practice, bye laws, directions or governmental guidance or the like, to be performed in connection with this Partnership arrangements under this Agreement.
42 THE CONTRACTS (RIGHTS OF THIRD PARTIES) ACT, 1999
42.1 The Contracts (Rights of Third Parties) Act, 1999 shall not apply to this Agreement.
43.1 The failure or delay of either Partner to exercise a right or remedy provided by this Agreement or by law shall not be construed to be a waiver of the right or remedy. A waiver of a breach of any provision of this Agreement or of a default under this Agreement shall not be construed to be a waiver of any other breach or default and shall not affect the terms of this Agreement.
43.2 A waiver of a breach of any terms of this Agreement or a default under this Agreement will not prevent a Partner from subsequently requiring compliance with the waived obligation. The rights and remedies provided by this Agreement are cumulative and (subject as otherwise provided in this Agreement) are not exclusive of any rights or remedies provided by law.
44.1 Any notice to be given under this Agreement shall either be delivered personally or sent by first class post or electronic mail. The address for service of each Partner shall be as set out in Clause 44.3 or such other address as each Partner may previously have notified to the other Partner in writing. A notice shall be deemed to have been served if:
44.1.1 personally delivered, at the time of delivery;
44.1.2 posted, at the expiration of forty eight (48) hours after the envelope containing the same was delivered into the custody of the postal authorities; and
44.1.3 if sent by electronic mail, at the time of transmission and a telephone call must be made to the recipient warning the recipient that an electronic mail message has been sent to him (as evidenced by a contemporaneous note of the Partner sending the notice) and a hard copy of such notice is also sent by first class recorded delivery post (airmail if overseas) on the same day as that on which the electronic mail is sent.
44.2 In proving such service, it shall be sufficient to prove that personal delivery was made, or that the envelope containing such notice was properly addressed and delivered into the custody of the postal authority as prepaid first class or airmail letter (as appropriate), or that the electronic mail was properly addressed and no message was received informing the sender that it had not been received by the recipient (as the case may be).
44.3 The address for service of notices as referred to in Clause 44.1 shall be as follows unless otherwise notified to the other Partner in writing:
44.3.1 if to the Council, addressed to the Authorised Officer; and
44.3.2 if to the Trust, addressed to the General Manager for North Yorkshire 0-19 Services.
45.1 If any provision of this Agreement shall be found by any court or administrative body of competent jurisdiction to be invalid or unenforceable, such invalidity or unenforceability shall not affect the other provisions of this Agreement, which shall remain in full force and effect.
45.2 If any provision of this Agreement is so found to be invalid or unenforceable but would be valid or enforceable if some part of the provision were deleted, the provision in question shall apply with such modifications as may be necessary to make it valid or enforceable.
46.1 This Agreement shall be governed by and construed in all respects in accordance with the laws of England and the Partners submit to the exclusive jurisdiction of the Courts of England.
47.1 This Agreement may be executed in one or more counterparts. Any single counterpart or a set of counterparts executed, in either case, by all Parties shall constitute a full original Agreement for all purposes.
IN WITNESS whereof the Partners Authorised Officers have signed and executed as a Deed and delivered this Agreement on the day and year first before written.
EXECUTION OF AGREEMENT BY THE TRUST
THE COMMON SEAL of Harrogate and District NHS Foundation Trust
Was hereunto affixed in the presence of:
Authorised Signature…………………………..
Name (print)……………………….
Position…………………………….
Date……………………………….
Authorised Signature…………………………..
Name (print)……………………….
Position…………………………….
Date……………………………….
EXECUTION OF AGREEMENT BY THE COUNCIL
THE COMMON SEAL of North Yorkshire County Council
Was hereunto affixed in the presence of:
Authorised Signature…………………………..
Name (print)……………………….
Position…………………………….
Date……………………………….
Schedule 1– SERVICE SPECIFICATION
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EXECUTIVE SUMMARY
OUR SYSTEM FOR IMPROVING THE HEALTH AND WELLBEING OF CHILDREN, YOUNG PEOPLE AND FAMILIES
1. Priorities
2. Principles
3. Vision for Services
4. A Focus on Outcomes
NATIONAL CONTEXT
LOCAL CONTEXT
5. Local Data and Intelligence
6. Supporting Strategies
INTEGRATED 0-19 HEALTHY CHILD PROGRAMME
7. Scope of Service
8. High Impact Areas
9. Service Model
10. Service Transformation Programme
11. Digital Delivery
12. Enhanced Community Approach
0-5 HEALTH AND WELLBEING REVIEWS
13. Developmental Visits and Assessments from Antenatal to 4/5 Years
14. Levels of Delivery
15. High Impact Areas
16. Transition to parenthood, early weeks and beyond
17. Maternal mental health (perinatal depression)
18. Breastfeeding (initiation and duration)
19. Healthy weight, healthy nutrition andphysical activity
20. Managing minor illness and reducing hospital attendance and admission
21. Health, wellbeing and development of the child age 2 –2.5 year old
review (integrated review) and support tobe ‘ready for school’.
22. Health Protection
23. Antenatal and Newborn Screening
SERVICES FOR SCHOOL AGED CHILDREN
24. National Child Measurement Programme (NCMP)
25. Emotional Health and Wellbeing
26. Support for Children who are Elected Home Educated (EHE)
27. Supporting Children, Young People and Families at Risk of Poor Outcomes
28. Comprehensive Assessment – Vulnerable Children, Young People and Families
29. Children with Special Educational Needs and/or Disabilities (SEND)
30. Multi-Agency Child Exploitation (MACE)
31. Support for Children and Young People Attending Pupil Referral Units (PRU)
LOOKED AFTER CHILDREN/CARE LEAVERS
32. Looked After Children/Care Leavers
33. Transition into Adulthood/Services
SERVICE ACCESS AND DELIVERY ENVIRONMENT
34. Service Delivery Location
35. Co-Location
36. Operating Hours
37. Service Environment
38. Inclusion Criteria
39. Exclusion Criteria
40. Access and Referrals
41. Interdependencies with Other Services
42. Moving Out of Area
CHILD PROTECTION AND SAFEGUARDING
43. Child Protection and Safeguarding
COMPLIANCE AND GOVERNANCE
44. Clinical Governance
45. Data Requirements
46. Information Technology System
47. Information Governance
48. Confidentiality
49. Data Information, Systems and Confidentiality
50. Technical Security Requirements
51. Future Proofing
A TRANSFORMED WORKFORCE
52. Strategic and Operational Leadership
53. Workforce Competency and Development
MOBILISATION
54. Mobilisation Plan
PERFORMANCE AND SERVICE MANAGEMENT
55. Quarterly Service Reviews
56. Service Users Feedback and Engagement
57. Staff Performance
58. Organisational Performance
59. Auditing Impact and Outcomes
APPENDICES
REFERENCES
Executive Summary
One of the four North Yorkshire County Council Plan key ambitions for 2023 is that every child and young person has the best possible start in life[1]. Our measure of success in delivering this ambition is that North Yorkshire will be ‘A place of opportunity where all children and young people are happy, healthy and achieving’ (Children and Young People’s Plan).
In order to achieve this ambition local partners are working together to transform the way we plan, design and deliver services and support children, young people and families; with a focus on the things that underpin our outcomes. These include strong attachments to parents and carers and ensuring that parents and carers have the relationships, networks and support they need to raise children and young people. We have started to focus on prevention and early intervention by promoting resilience, and focusing our resources upstream to improve outcomes for children and young people and protect them from harm. The aim is to create positive changes that are widespread, high impact and long lasting.
The North Yorkshire Children and Young People’s Plan, Young and Yorkshire 2 sets out our system approach to meeting the health and wellbeing needs of children and young people (Figure 4). The Plan sets out the ambitious and aspirational approach embraced by partners within the County.
The Plan was informed by the voice of children and young people and their families/carers and sets not only the step-by-step improvements, but also some of the more difficult challenges that sometimes limit children’s life chances – whether it be the family they are born into, school they go to or the community they grow up in. The plan acknowledges that these differences are unacceptable and we have set out our commitment to tackle them.
To help achieve our vision, we are working to bring together work programmes under a progressive transformation programme – The Childhood Futures Programme. These include the Healthy Child Programme, key delivery elements of North Yorkshire Children and Young People Services and Healthy School Programme. Three areas form the initial focus of the transformation of approaches of partners to improve children and young people outcomes in North Yorkshire:
· School Readiness
· Emotional Health and Resilience in children and young people
· Vulnerability
This Healthy Child Programme Service Specification will contribute to delivering this agenda.
The offer is a disaggregated model:
· 0-6 mandated services - universal and targeted health visiting health and wellbeing reviews and the National Child Measurement Programme (NCMP)
· 6-19 model for school aged children which provides the following services:
o Emotional health and resilience Tier 1
o Safeguarding as per criteria
o Children who are Looked After
· There will be no generic school nursing service
For the purposes of this document, this will be referred to as the disaggregated model. The Trust will work collaboratively with service commissioners and other service providers to innovate and find more efficient and outcome focused ways of improving the health and wellbeing of children and young people and families in North Yorkshire.
Our System for Improving the Health and Wellbeing of Children, Young People and Families
1. Priorities
The nine priorities within the North Yorkshire Children and Young People’s Plan, Priorities and the Measures of Success are listed in Figure 1 below.
Figure 1: North Yorkshire Priorities for Children and Young People
As a system, we know that a significant proportion of children and young people do not achieve these outcomes. However, we interact with children, young people and families from before birth through to staged review points and with teenagers. We know that often we do not meet the needs identified because our responses are disjointed and uncoordinated, and are missing the opportunities to enable families to use and widen their own networks of support.
This is why we are embarking on an ambitious programme of service transformation with the aim of achieving ‘full integration’, optimising integrated working practices of preventative services and other appropriate services and support for the 0-19 age group within North Yorkshire. This requires developing a shared understanding of what an integrated 0-19 services means and involves amongst all partners.
2. Principles
Since 2013 and the transfer of Public Health responsibilities to the Council, there has been considerable joint work between the County Council and health services, and more recently promoting integrated working practices across the system. Most notable is the partnership working between the Healthy Child Programme (provided by Harrogate and District NHS Foundation Trust) and Prevention Service (now Early Help Service) within the County Council.
These developments have laid the foundations for a better integrated system for planning, commissioning and delivering preventative and early intervention services for children, young people and families. We are building on these successes to deliver an integrated 0-19 service and this Service specification is central to this process.
We recognise that service integration means different things to different people. Thus, part of the transformation journey will involve defining and developing the different ways we will work effectively and efficiently together to achieve a fully integrated 0-19 service in North Yorkshire[2]. We have made a good start at describing the levels of collaboration[3]. Our ambition is to work towards the optimum level of collaboration with opportunities for children’s service integration, wider partnership working and integrated Trust management approaches.
To facilitate collaborative working, the Healthy Child Programme Service will operate under a partnership arrangement, in which the North Yorkshire County Council Children and Young People Service (CYPS) partners with an NHS Foundation Trust (NHSFT), integrated partnership working and Trust management approaches, using Section 75 (s75) of National Health Services Act 2006[4]. This includes establishing a Programme Collaboration Board and Mobilisation Group to ensure the right leadership and governance that will enable service transformation.
This new way of working will work to the following partnership principles:
· Transformational and innovative – innovation, continuous improvement and appropriate use of digital technologies to deliver services and support.
· Improving outcomes, through delivery of strong evidence based practice that promotes consistent messages and support. A strong focus given to prevention, health promotion and early identification of needs.
· Commitment to listening to children and young people and their families and the wider communities, and to involving them directly in understanding problems, designing and testing solutions and co-producing outcomes.
· Addressing inequalities and easy access -open access for all but intensive targeted work with priority population groups that is timely and consistent.
· Delivering excellent quality through strong leadership, professional and skilled workforce, effective system working and value for money.
· Collaborating in information sharing system to help record, communicate and exchange data accurately, effectively, and consistently, and facilitate the use of information that has been exchanged.
· Collaborating with local partners, valuing each other’s contributions, and working effectively together to solve problems.
3. Our Vision for an Integrated 0-19 Service
The purpose of the Service is to provide a comprehensive range of preventative and early interventions to expectant parents/carers, children, young people and families in North Yorkshire. This includes a range of universal interventions delivered to the whole population, as well as targeted interventions and support to those with identified need and the most vulnerable.
The vision for the Service is to deliver high quality, evidence based interventions which support children, young people and families, and identify and respond appropriately to needs across North Yorkshire to improve health and wellbeing outcomes.
The Service will have the following characteristics.
· An integrated service offering assessment, advice and support to expectant parents/carers, children, young people and families, working in collaboration with the Early Help and Early Years Services within the County.
· A high quality approach to ensuring the effective delivery of the Healthy Child Programme including all mandatory functions (5 mandated health visiting contacts and the National Child Measurement Programme).
· Support the delivery of an enhanced integrated service to improve school readiness.
· Support the delivery of an enhanced integrated service to improve social, emotional and mental wellbeing children and young people.
· Support the delivery of an enhanced integrated service to reduce risk taking behaviour in adolescents.
· Effective management of the safeguarding of children and their families.
· Provision of an appropriately trained and supervised workforce.
· Harness technology and the digital opportunity in service delivery and needs assessment, with robust safeguarding in place.
· Demonstrable commitment to improving outcomes for children, young people and families in North Yorkshire.
· Accessible service working into service users’ homes, children’s centres and appropriate community venues
· Work with Stronger Communities and voluntary and community organisations to maximise the use of community assets and networks for prevention and early intervention.
· High levels of communication and engagement with children, young people and their families including use of innovative methods of communicating, for example social media, apps, texting and websites.
· Productive relationships with other professionals supporting children, young people and their families.
· A distinctly branded and visible service which is understood by service users and stakeholders.
4. A Focus on Outcomes
We need a clear focus on prevention and early intervention ways of working across the system and the Service will be required to deliver the Healthy Child Programme and contribute to the delivery of an integrated 0-19 services, in partnership with other local services with measurable and indicative outcomes.
The Service will deliver on and contribute to reducing inequalities and improving the key outcomes as identified in the Public Health Outcomes Framework, the Guide to Early Years Profile, the NHS Outcomes Framework and other relevant frameworks:
· Increased breast feeding at 6-8 weeks
· Reduced number of low birth weight babies
· Reduced smoking for pregnant women at delivery and hence more smoke free homes
· Improved child development at 2-2.5 years
· Improved school readiness for children in Reception Class
· Increased social and emotional development ASQ-3/ASQ-SE
· Fewer children are obese or overweight in reception aged 5-6 years and at age 10-11 years
· Contribute to increased population vaccination coverage
· Contribute to the improvement in oral health and a reduction in oral health inequalities for ages 0-6 years, with a greater percentage reduction in dental disease in the most deprived areas according to the Index of Multiple Deprivation (IMD).
· Contribute to more children being emotionally resilient and wellbeing and making good lifestyle choices including
· Contribute to less children being admitted to hospital due to illness or accidents, including a reduction in the rates of admissions to hospital for children 0-4 years and older children (5-14 year olds and 15-24 year olds)
· Contribute to reducing the number of children in care.
· Contribute to improving outcomes for children in care and care leavers
· Contribute to reducing the number of children living in poverty.
NATIONAL CONTEXT
Getting a good start in life and throughout childhood, building resilience and getting maximum benefit from education are important markers for good health and wellbeing throughout life.
Professor Sir Michael Marmot[5] and the Chief Medical Officer[6] have highlighted the importance of giving every child the best start in life and reducing health inequalities throughout life. Both recognise the importance of building on the support in the early years and sustaining this across the life course for school-aged children and young people to improve outcomes and reduce inequalities through universal provision and targeted support.
More recently, The Early Years Healthy Development Review Report, The Best Start for Life: A Vision for the 1,001 Critical Days (2021), has highlighted the importance of the early years and the difference this period can make in achieving better physical and emotional health outcomes The best start for life: a vision for the 1,001 critical days - GOV.UK (www.gov.uk).
Delivering this vision is dependent upon a wide range of organisations and key stakeholders working together and embracing change.
A number of national policies are enabling actions in shaping local services to plan the design and delivering for the identified health and wellbeing needs of children and young people including (but not limited to):
· Healthy child programme 0 to 19: health visitor and school nurse commissioning - GOV.UK (www.gov.uk) March 2021.
· No child left behind (PHE 2020) and Childhood Vulnerability in England (Children’s Commissioner 2019)
· NHS Long Term Plan – Chapter 3: Further Progress in Quality and Outcomes, A strong start for children and young people. https://www.longtermplan.nhs.uk
· Maternity Transformation Programme – Drive improvement and ensure women and babies receive excellent care wherever they live, to make care more personal and family friendly. https://www.england.nhs.uk/mat-transformation
· The Healthy Child Programme – A universal and targeted public health services available to all children and aims to ensure that every child gets the good start they need to lay the foundations of a healthy life. https://www.gov.uk/government/publications/healthy-child-programme-0-to-19-health-visitor-and-school-nurse-commissioning
· Working Together to Safeguard Children 2018 – A guide to inter-agency working to safeguard and promote the welfare of children. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/779401/Working_Together_to_Safeguard-Children.pdf
· Social Mobility Action Plan for Education – Includes a plan for the early years with a focus on improving early language acquisition. https://www.gov.uk/government/news/plan-to-boost-social-mobility-through-education
· Statutory guidance on planning, commissioning and delivery of health services for looked-after children - https://www.gov.uk/government/publications/promoting-the-health-and-wellbeing-of-looked-after-children--2
This Service Specification is based on these national guidance policies, and data derived from local learning and engagement with stakeholders and children and young people and their families. The aim is to work closely with all key partners to make the best use of collective resources, using a whole systems based approach as identified in Figure 3.
Figure 3: Whole systems based approach to delivery of Public Health 0-19 children’s services (PHE Guidance 2018)
LOCAL CONTEXT
5. Local Data and Intelligence
North Yorkshire covers over 3,000 square miles, ranging from isolated rural settlements and farms to market towns such as Thirsk and Pickering, and larger urban conurbations such as Harrogate and Scarborough. Whilst North Yorkshire is, in overall terms, more affluent than a typical local authority in England, there are areas of profound deprivation, including some parts of the County that are ranked within the 10% most deprived areas in England. The County is also home to a significant military presence, including the UK Army’s largest Garrison at Catterick in the north of the County.
We have carried out a Children and Young People Joint Strategic Needs Assessment (JSNA)[7] to inform the development of an integrated 0-19 service. The following provides an overview of some of the key issues and concerns impacting on the health and wellbeing of children and young people in North Yorkshire.
5.1 Demographic Profile
· There are 128,820 children and young people aged 0-19 in North Yorkshire in 2019, projected to decrease by 0.1% to 120,286 by 2035.
· There is a slightly higher proportion of males to females and more children aged 5-9 than those aged 0-4.
· About 7% of school children are from ethnic groups.
· 660 Children who are Looked After residing in North Yorkshire as of May 2021. 402 of this group are NYCC and 258 are out of area children places in North Yorkshire.
· There are 325 of children on a child protection plan in North Yorkshire.
· There are also children on a child protection plan in North Yorkshire open to neighbouring local authorities, to whom we provide a service.
5.2 Armed Forces
· In 2017, there were over 9,000 serving personnel in North Yorkshire of which about 6,700 are resident in Richmondshire and 1,900 Harrogate.
· It is estimated that by 2031 there will be an increase in the adult personnel population in Catterick by around 3,000 individuals[8]. When children are added the population will be about 9,000. This will create additional demand for services which needs to be taken into account in planning future services.
5.3 Wider determinants of health
· The 2019 Index of Multiple Deprivation (IMD) identifies 24 Lower Super Output Areas (LSOAs) of the 373 LSOAs in North Yorkshire which are amongst the 20% most deprived in England, with a population of 36,000 people. Twenty of these LSOAs are in Scarborough district with a combined population of 30,000.
· A higher proportion of children claim free school meals (FSM) in primary compared with secondary schools. The proportion of FSM claimants increased slightly in North Yorkshire primary schools from 2017 to 2018, compared with a decrease nationally.
· Scarborough district has the most children eligible for FSM (25.7%) in comparison to Craven district (8.0%) with the least. This highlights a clear correlation between FSM eligibility and children in poverty, as Scarborough district has a high level of children in poverty and therefore receive FSM compared to Craven district.
· The average Attainment 8 score[9] for North Yorkshire (48.1) was higher than England (46.9) in 2018/19. Scarborough district had the lowest Attainment 8 score in 2018 (40.6) and Harrogate had the highest score (52.7).
· In 2019, the proportion of those aged 16 to 17 Not in Education Employment or Training (NEET) in North Yorkshire was 8.8%, significantly higher than England (5.5%).
5.4 Health Improvement
· In 2018, the proportion of all live births with a low birth weight in North Yorkshire was 6.7%; this is significantly lower than England (7.4%).
· In 2019/20 in North Yorkshire, 23.4% of the proportion of children aged 4-5 aged were identified as overweight or obese, similar to England (23%). There were 32.5% of children in Year 6 (aged 10-11) identified as overweight or obese, significantly lower than England (35.2%). The Scarborough district has the highest and the Craven district the lowest.
· In reception (aged 4-5 years), Scarborough district has a significantly higher rate of children who are identified as overweight or obese, in contrast to Harrogate district which has a significantly lower rate compared to England in 2019/20
· The under 18 conception rate for North Yorkshire in 2018 was 12.8 per 1,000, significantly better than England average of 16.7 per 1,000.
5.5 Health Protection
· In 2019/20, slightly less than 95% (the minimum recommended coverage level) of children have received their first dose of immunisation by the age of two in North Yorkshire (93.6%). By the age of five, only 87.9% of children have received their second dose of MMR immunisation.
· The proportion of eligible children aged 5 who have received two doses of MMR vaccine in North Yorkshire (87.9%) is higher than England (86.8%).
5.6 Prevention of Diseases and Ill-health
· In 2018/19, North Yorkshire (48.5%) has a significantly higher rate of mother’s breastfeeding at 6 to 8 weeks after birth than England (42.7%).
· In 2019/20, North Yorkshire has a similar proportion of females smoking at the time of delivery (10.8%) compared to the England average (10.4%). Ryedale (14.2%) and Scarborough (14.9) districts have a significantly higher rate than the England average.
· The rate of children and young people being admitted to hospital due to alcohol specific conditions in North Yorkshire in 2016/17-2018/19 is 44 admissions per 100,000 people aged under 18, compared to 31.6 per 100,000 in England; the rate in North Yorkshire is significantly higher than England.
· Harrogate (65.8 per 100,000) and Scarborough (68.2 per 100,000) districts have a significantly higher rate of hospital admissions due to alcohol specific conditions for those aged 18 and under compared to England (31.6 per 100,000) in 2019/17 – 20187/19.
· In 2018/19, North Yorkshire (108.6 per 100,000) has a significantly higher rate of hospital admissions caused by unintentional and deliberate injuries in children aged 0 to 14 years compared to England (96.1 per 100,000). Harrogate (82.4 per 100,000) is the only district that has a significantly lower rate than England.
· In 2018/19 North Yorkshire (158.4 per 10,000) has a significantly higher rate of hospital admissions caused by unintentional and deliberate injuries in young people aged 15 to 24 years compared to England (136.9 per 10,000). With the exception of Selby and Ryedale districts, the remaining five districts in North Yorkshire have a rate which is significantly higher than England.
5.7 Growing up in North Yorkshire survey (GuNY) 2018[10]
The Growing up in North Yorkshire survey (GuNY) is a two-yearly survey of local pupils that is undertaken on behalf of the Council by the Schools Health Education Unit (SHEU) based at Exeter University.
Since 2006, pupils in schools within the County North Yorkshire have been surveyed to collect information on their learning and well-being, the most recent of which was conducted in 2018. Over 19,000 children participated in GuNY in 2018. This survey provides a rich dataset on the experiences and perceptions of children and young people in the County, and helps inform the provision of Children and Young People’s Services in North Yorkshire.
Some of the key priorities identified in the summary report produced by the Schools Health Education Unit on behalf of North Yorkshire County Council include:
· Developing resilience and emotional wellbeing
· Promoting positive ethos and culture of the school
· Pupil voice influencing decisions
· Reducing risky behaviours
· Reducing inequalities caused by deprivation
· Promoting the adoption of healthy lifestyles
· Preventing and reducing bullying
There are sections in the JSNA which focus specifically on some of the key questions asked of secondary school students and which are linked to the stated priorities across the districts in North Yorkshire. This is an extensive survey and not all questions are presented in this report.
5.8 North Yorkshire Healthy Child Programme Engagement Report 2019
North Yorkshire County Council initiated an engagement activity during August 2018 to inform the re-commissioning of the Healthy Child Programme in April 2021. The aim of engagement was to obtain the views of a variety of stakeholders in order to review the services currently offered and inform development of a new service model. The key findings are:
· Support for a 0-19 approach to service planning and delivery and regular health and wellbeing reviews as touchpoints of early identification of needs
· Vulnerable families are a priority
· School readiness, Emotional wellbeing and Adolescent risk taking as priority areas
· Autism Spectrum Disorder (ASD)/Attention Deficit Hyperactivity Disorder (ADHD) Concern – service offer and workforce skills to respond
· Diverting activity from GP’s to Early Help interventions would support ‘right place right time’ approach to care and support
· Information sharing systems should be improved
· A clear offer required for children with complex health needs
· Healthy Child Safeguarding role as a valued element of the service
5.9 Priority Areas for Action
Detailed analysis of the three areas (School Readiness, and Emotional and Mental Wellbeing) which form the focus of transformation of approaches of local partners to improve children and young people’s outcomes are found in the JSNA report. This includes a review of existing service pathways and developing new ones that will help to integrate 0-19 services across the health and social care system, and to identify, predict and manage demand for services and support.
6. Supporting Local Strategies
The scope of the 0-19 Service has been informed by a number of local plans and strategies in North Yorkshire. These are summarised below. The strategies are regularly updated and the Trust will work with local partners to ensure that service delivery remains consistent with the strategies for the duration of the contract. Any new or alternative strategies emerging during the life of the contract must also be considered.
6.1 North Yorkshire County Council Plan
The North Yorkshire Plan identifies four key ambitions for 2023:
· Every child and young person has the best possible start in life;
· Every adult has a longer, healthier and independent life;
· North Yorkshire is a place with a strong economy and a commitment to sustainable growth that enables our citizens to fulfil their ambitions and aspirations; and
· We are a modern council which puts our customers at the heart of what we do.
6.2 Health and Wellbeing Strategy
The North Yorkshire Health and Wellbeing Strategy sets out its priorities and outcomes which informs the basis of commissioning plans in the area[11]. “Start Well” is one of the five themes, and has been further developed in the Children and Young People’s Plan.
The Service Model has been developed in the context of the principles from the Health and Wellbeing Strategy:
· Recognise where things are different
· Tackle issues early
· Joining things up to make life simpler
· Make a positive contribution
· Keep people safe
· Spend money wisely
6.3 Children and Young People’s Plan, Young and Yorkshire 2
The Service will work to support the delivery of the Children and Young People’s plan in North Yorkshire, Young and Yorkshire (see section 1 above)and the NYCC Looked After Children and Care Leaver’s Strategy 2018-2021.
This vision is “A place of opportunity where all children and young people are happy, healthy and achieving”. The principles, priorities and outcomes are summarised on the pages above.
The Director of Public Health Annual Report 2018, “Back to the Future”, which reviewed progress in the health and wellbeing of children and young people in the past five years identified obesity, a healthy start in life and mental health as the top priority areas for stakeholders.
The Service Model has been developed in the context of these principles and priorities and will support the delivery of the outcomes.
6.4 Early Help Strategy
The Early Help Strategy aims to create a shared approach to meeting enhanced need across the health and social care system. It sets out a new direction of travel for the provision of Early Help services across North Yorkshire, a move to one agreed assessment tool and shared plan (“Continuum of Need”).
The Service will support the delivery of the seven strategic objectives of the Early Help Strategy:
· Improve early identification and response to children in need of enhanced support, across the partnership.
· To increase community capacity to support effective early help delivery in localities.
· Implement ‘Signs of Safety’ methods across the partnership using strength based support.
· Foster a strong culture of collaboration, integration and ownership for solution focussed
· Interventions.
· Build on the No Wrong Door methodology and contextual safeguarding – to implement a partnership approach to the management of risky adolescent behaviour.
· Improve attendance and inclusion and reduce the number of exclusions
· Explore the use of shared data to capture early help activity and outcomes
6.5 Supporting Children and Young People with Social, Emotional and Mental Health (SEMH) Difficulties in School – Future in Mind Local Transformation Plan for North Yorkshire
Children and young people face many challenges in their lives, ranging from difficult home environments and trauma to stress and anxiety about exams and their future, complex long-term physical and mental health conditions.
Local policies and delivery plans have been developed based on national strategies {Future in Mind Report (2015), Five Year Forward for Mental Health (2016), the Green Paper ‘Transforming Children and Young People’s Mental Health Provision (2018)}. They include a Whole Pathway Commissioning Group to enhance integration, build a skilled workforce, improve communications and increase prevention and early intervention. Key services include an enhanced eating disorder service, universal and targeted wellbeing service in schools, an online counselling service and mental health support teams in schools and colleges (in certain areas of the county)
6.6 Strategic Plan for Special Education Needs (SEND) Provision
The North Yorkshire Strategic Plan SEND Education Provision 0-25 is for all children and young people who have special education needs and disabilities, their families and all those working with them. It builds on both the Council Plan and The Young and Yorkshire 2 Children and Young People’s Plan.
The strategic priorities are for all children and young people with SEND to:
· Have the best educational opportunities so that they achieve the best outcomes
· Be able to attend a school or provision locally, as close to their home as possible, where they can make friends and be part of their community
· Make progress with learning, have good social and emotional health and to prepare them for a fulfilling adult life.
INTEGRATED 0-19 (up to age 25 SEND) HEALTHY CHILD PROGRAMME SERVICE
7. Scope of Service
This Service will contribute to delivering an integrated 0-19 service in North Yorkshire for expectant parents/carers, children, young people and families in the area that offers interventions from the antenatal stage to the age of 19 (up to 25 for SEND).
0-6 years
· Mandated health reviews through a risk assessed and blended approach of physical and virtual support rather than the current model of all visits being face to face
· Safeguarding support
· Targeted support for children and families most in need and where required
· A focus on best start in life in particular on infant feeding and family nutrition and diet
School aged children (6-19):
· Safeguarding support
· Support for emotional wellbeing and resilience young people
The above is a minimum offer for all young people and will apply to those aged 18-25 years who have Special Education Needs/Disabilities (SEND) or are leaving care.
The Service will deliver the Mandated National Child Measurement Programme (NCMP) and contribute in delivering measures to reduce childhood obesity.
The Service will work with other agencies to maximise resources to innovate and provide coordinated effective support through mandated touchpoints for children, young people and their families who are at risk of not achieving desired outcomes. This includes being responsive to the needs and opportunities identified, promoting access to evidenced based support around attachment, early learning, healthy development, parental/carer capacity, social inclusion and good maternal emotional wellbeing and mental health.
8. High Impact areas
While 0-19 services contribute to the delivery of 0-19 Healthy Child Programme, there are areas of health and wellbeing that Health Visitor and services for school-age children within the parameters of the disaggregated 6 -19 model and are evidenced to have a significant impact on.
Health visitors lead the Healthy Child Programme 0 to 5 and the 6 early years high impact areas:
· supporting the transition to parenthood
· supporting maternal and family mental health
· supporting breastfeeding
· supporting healthy weight, healthy nutrition
· improving health literacy; reducing accidents and minor illnesses
· supporting health, wellbeing and development: Ready to learn, narrowing the ‘word gap’
School nurses lead the Healthy Child Programme 5 to 19 and the 6 school age years high impact areas
· supporting resilience and wellbeing
· improving health behaviours and reducing risk taking
· supporting healthy lifestyles
· supporting vulnerable young people and improving health inequalities
· supporting complex and additional health and wellbeing needs
· promoting self-care and improving health literacy
The Service will ensure that early intervention, prevention and a family-centred focus are embedded within daily practice that contributes to good outcomes across these 12 High Impact Areas.
9. Service Model
The Service model prioritises the delivery of services for children aged under 6 and their families as well as those children and young people aged 6-19 in the safeguarding and Children who are in the Looked After arena (using the 6-19 agreed criteria). The Service will improve service delivery and outcomes, using both universal and targeted approaches with a focus on:
· The quality and consistency of health and wellbeing reviews in families with children under 6 using a blended approach of face to face and virtual visits using both a robust risk assess framework and Demand and Capacity tool.
· Safeguarding/ Children who are Looked After using the 6-19 agreed criteria
· Emotional Health and Resilience 0-19 including perinatal mental health and Specialist Team 6 -19
· Infant Feeding, Family Diet and Nutrition to reduce the level of childhood obesity
· Skill Mix Teams with new roles in to support Emotional Health and Resilience, Breast Feeding and Family Diet and Nutrition, and also in working with local partners such as early years and early practitioners in the 2-2.5 year reviews.
· Service Innovation and Transformation - Development of the Digital Offer, Integrated Pathways with partners, Building Community Capacity, Service User engagement
· Aligning with the NYCC Children and Young People’s Service 3 teams – East, West and Central (Selby is in the West Team for the purposes of Service Delivery within HDFT)
10. Service Transformation
Our ambition is that the new 0-19 Model of Service in North Yorkshire will help to integrate the working practices of prevention and early intervention services and community support for children, young people and families - under the banner of the Childhood Futures Programme. This includes integrated working practices across the:
· Key contacts in the Healthy Child Programme
· Early Help
· Early Years
· School Readiness/ Speech and Language Service Pathway - This is not currently part of the HDFT offer and is being piloted
· Key services to Improve the Physical, Social and Emotional Health and Wellbeing of parents/carers, children and young people
A number of workstreams have been established and these are aligned with the further development of the model set out in section 9 above:
· Emotional Health and Resilience
· Infant Feeding, Family Diet and Nutrition
· Developing Different Ways of Working
The Service will contribute to this transformation programme and work has started to articulate how this might be achieved for children aged 0-6 years (Figure 5 below). For example, the Health Child Programme mandated five contacts are central to ensuring that children are school ready, through the effective early identification and addressing of early developmental and learning needs.
Figure 5:
Over the life of the contract, the Service will be expected to work in partnership with service commissioners and other service providers to further develop these opportunities and transform them into a new service model. In a similar vein, the Service will work in partnership with the whole system to transform services for school-aged children, where the need is identified.
11. Digital Delivery
One of the strategic priorities of the North Yorkshire Health and Wellbeing Board is to implement an enhanced and appropriate use of digital technologies, to help deliver more efficient and responsive services. Harnessing technology and the digital opportunities are also important in achieving a safe, convenient and personalised health and wellbeing services and support.
This approach will underpin the transformation of 0-19 services, and the Service will actively embrace the innovative use of technology to improve service delivery and outcomes. Innovation in this area must take account of the latest research which requires appropriate safeguarding needs to be in place to stop the known harmful effects of some social media platforms. The Council will work with the Trust around real and perceived risks.
As a minimum the Service will:
· Provide and operate, within a year of operation, an information sharing agreement that will exchange data accurately, effectively, and consistently, and facilitate the use of information that has been exchanged.
· Ensure that all staff are digitally enabled to work in settings or remotely.
· Provide a digital offer to children, young people and families (particularly for some universal provision). Professionals will need to be skilled and empowered to tailor their engagement to the needs of the child, young person and family, making more or less visits depending on needs, using different ways of engaging (phone, text, social media, website) based on what works for that child, young person and parent(s)/carer(s).
12. Enhanced Community Approaches
The Service will:
· Ensure the workforce delivering the service has a wide knowledge of the needs in North Yorkshire through the use of available data (e.g. Joint Strategic Needs Assessment, Child Health Profile and Public Health Outcomes Framework), as well as information gathered by the service and other services in day-to-day work.
· Ensure the workforce has a high level of knowledge of community resources and assets (Children’s Centres, General Practice, community groups, peer support groups etc.).
· Ensure the service is clearly visible and provides written and online advice and information to service user and the wider community, in relation to the services offered and how these can be accessed.
· Engage in relevant early help and early years, education and community support networks.
· Utilise community provision, for example, health centres or children’s centres to provide additional opportunities for services users to access advice and information in relation to a range of topics.
0-6 HEALTH AND WELLBEING REVIEWS
An area-based geographical Healthy Child Service delivered and structured in line with local children’s services alongside the Early Help teams, working together todeliver integrated, evidence-based services for children andtheir families, with a focus on prevention, promotion and early intervention.
The service will deliver services and interventions in line with the transformed model of Health Visiting.
Figure 6: Universal health
and wellbeing reviews and suggested contacts as part of overall
support 0 to 5 years
The Service will deliver the following mandated health and wellbeing reviews.
13. Developmental Visits and Assessments from Antenatal to 2 ½ Years
The Service will deliver a series of visits from the antenatal period until children reach primary school age. These will form a core part of the activity of the Service and enable it to make a universal offer to all expectant parents/carers and families with children below the age of 6.
Visits will be designed to address specific areas at each stage of development and promote good parent/carer-child attachment. The Service will comply with all national requirements for current mandated checks and reviews, including adherence to timescales and the competency and professional background of those carrying out mandated interactions.
All contacts in children under 1 years old will be carried out by qualified Health Visitors and the 2-2.5 year integrated review will be carried out by a skill mixed team led by a qualified Health Visitor.
· Antenatal
· New Baby
· 6-8 weeks
· 9-12 months
· 2-2.5 years
The Service will deliver additional contacts in response to the family health needs assessment.
14. Levels of Delivery
Figure 7 below describes the core elements of the ‘Universal in Reach – Personalised in Response’ model, which is based on four levels of service depending on individual and family needs: community, universal, targeted and specialist levels of support.
The availability and utilisation of community-based assets is central to the universal offer, while health visitors and school nurses are well placed to identify needs, provide evidence-based public health interventions and signpost to community-centred and asset based approaches (PHE 2018).
Figures 8 & 9: Core elements of a universal reach, personalised response model; A high level overview of health visitor and school nurse contributions
Health visiting and school nursing service delivery model - GOV.UK (www.gov.uk) March 2021
14.1 Community level
The Service will have a broad knowledge of community health needs and resources available e.g. health profiles, Children’s Centres and self-help groups to work in partnership to develop these where there is identified need and make sure families know about them. These will include:
· Empower families within the local community, through maximising family resilience.
· Develop community resources and capacity with involvement of local agencies and community groups as appropriate.
· Collate and co-ordinate information, data and intelligence in order to ensure that the best interests of the child are met.
· Use information and intelligence about communities’ assets in partnership with communities to support the health and wellbeing of 0-6 year olds, to inform the Joint Strategic Needs Assessment (JSNA).
· Use intelligence to develop a service offer to respond to local need.
· Raise awareness and promote the services offered to professionals, children and young people and their families.
· Work in partnership with Children’s Services in the local authority and community and voluntary sector to ensure that local innovation can flourish and appropriate developments grown.
· Work with the Council’s Stronger Communities to identify and develop peer support groups and where appropriate support existing groups.
· Use networks to improve public health; signposting families to other services already existing locally, particularly early years’ services and professionals but also adult education and training.
· Utilise local media opportunities for health promotion.
14.2 Universal Delivery
The Service will lead delivery of the 0-6 HCP. The Service will ensure that every parent/carer, and child have access to a Health Visitor and the child will receive development checks (as listed below and detailed in Appendix 2) and receive consistent good evidence-based information about healthy start issues such as parenting and immunisation.
At this level the Service will be expected to:
· Offer core health reviews to all families – (as set out within the current national mandate and any nationally recommended change will be negotiated between the Council and HDFT and delivered in a variety of formats depending on cumulative risk assessment, except primary visit and 2-2.5 year review, which will always be face to face.
· Promote attachment.
· Help families understand the short, medium and longer term consequences of their health related behaviour forthemselves and others.
· Plan behaviour change in terms of easy steps over time; this will support families to plan and implement change in a realistic and manageable way.
· Plan with families ‘if/then’ coping strategies to improve resilience.
· Recognise in conjunction with families how their social context and relationships may affect their behaviour, and identify and plan for situations that might undermine changes they are trying to make.
14.3 Targeted Delivery (Universal Plus)
Families can
access timely, expert advice from the team when they need it on
specific issues such as postnatal depression, weaning or
sleepless children sleep problems
At this level the Service will be expected, in addition to the Universal Delivery:
· Provide additional services to families that are identified as needing more support than is universally offered by the Healthy Child Team
· Provide early intervention to promote the Best Start in Life
·
Include in the offer care packages forbut not restricted to maternal mental health, parenting/carersupport, toilet training, complex
needs, weaning and
baby/toddler sleep problems, working in partnership
with Council early Help as required.
14.4 Specialist Delivery (Universal Partnership Plus)
Health Visitors to provide ongoing support, playing a key role in bringing together relevant local services to help families with continuing complex needs, for example where a child has a long-term condition.
At this level the Service will be expected to deliver, in addition to the Universal Plus:
· Provide additional on-going support to vulnerable families; this could be additional visits, co-working with other agencies including joint visits and delivery of integrated, multi-agency care packages.
· In partnership with Early Help work within the local common assessment framework and local Council processes to ensure early intervention.
·
Provide ongoing support to children
in the safeguarding and looked after arena. Following national and
local polices to ensure children at risk of or suffering
significant harm receive the right support and care.
· Work with other agencies in the assessments of Looked After babies and children aged 0-6 years, with timescales in line with national requirements and contribute to ensuring any action plans are implemented.
· Work with other agencies to ensure provision of the 0-6 HCP and additional services to meet identified health and wellbeing needs.
· Work with agencies to deliver more intensive support – this could include, but is not restricted to, a range of special needs, for example families at social disadvantage,safeguarding, families with a child with a disability, young parents/carers, adult mental health problems or substance misuse.
14.5 Key principles of reviews
The following will be common to each review and the Service will need to demonstrate they have been considered and covered all areas:
Continuous assessment – Assessment of family strengths, needs and risks; providing parents/carers with the opportunity to discuss their concerns and aspirations; assess child growth and development, communication and language, social and emotional development; and detect abnormalities. Health Visitors should use evidence-based assessment tools and must use ASQ 3 for the 2 -2.5 year review.
Promote Immunisations – the Service should promote immunisations and signpost to GP if informed that the child is unvaccinated. This could be via self-reporting from families.
Carry out health promotion – Make every contact with the family a health promoting one. Supporting parents/carers to know what to do when their child is ill, and promoting appropriate use of primary and urgent care services with the view to reducing hospital attendance and admissions.
Identifying and supporting children with additional needs – The Children and Families Act – SEND Code of Practice 2015 states ‘Where a health body is of the opinion that a young child under compulsory school age has, or probably has, SEN, they must inform the child’s parents/carers and bring the child to the attention of the appropriate local authority. The health body must also give the parents/carers the opportunity to discuss their opinion and let them know about any voluntary organisations that are likely to be able to provide advice or assistance’.
The service will be expected to:
· Have a process in place to bring the child to the attention of the local authority.
· Work in partnership with other services in supporting the assessment of and developing the education health and care plans for children aged 0-6. This will be through sharing information about the child’s and family’s needs and reviewing in collaboration with other services what they can do to support the delivery of these plans.
· Provide assessment, care planning and on-going support for babies and children up to school entry with disabilities, long term conditions, sleep or behavioural concerns, other health or developmental issue in the context of the HCP.
· Actively contribute to the Local Offer.
Information sharing and active consent – The Service will be expected to gain consent to share live birth data and agree a process with the Council to regularly transfer this information. The Service will be expected to seek to gain written or electronic consent to share information with other agencies but in particular with Early Help as agreed in Schedule 6 (Information Sharing Agreement) of Section 75 of Partnership Agreement.
15. High Impact Areas in Early Years
Figure 10 lists the six high impact areas for early years and how they relate to the 4 overarching aims for early years:
· focusing on preconceptual care and continuity of carer
· reducing vulnerability and inequalities
· improving resilience and promoting health literacy
· ensuring children are ready to learn at 2 and ready for school at 5
Figure
11. High impact areas for early years
16. Transition to parenthood, early weeks and beyond
This will be delivered at the antenatal and postnatal contacts and where possible in group based activities:
· Deliver in partnership with other agencies, of evidence based antenatal and postnatal groups to promote attachment, for example, parenting classes/groups e.g. Preparing for Pregnancy and Beyond, parent quality marked parenting classes, and evidence-based groups for parents.
· Support for parenting – one of the core functions of the HCP is to support parenting using evidence-based programmes and practitioners who can work across different agencies and who are trained and supervised. Work with parents, using well evidenced, strengths-based approaches e.g. motivational interviewing, Solihull approach to promote positive lifestyle choices and support positive parenting practices to ensure the best start in life for the child.
· Deliver, in partnership with other agencies, of evidence-based parenting programmes for toddlers and pre-school children e.g. Incredible Years Pre-school basic programme and other evidence based programmes
· Promotion of social and emotional development – The HCP include opportunities for parents and practitioners to review a child’s social and emotional development using evidence-based tools such as ASQ 3 Promote parent and infant mental health and secure attachment.
17. Maternal Mental Health (Perinatal Depression)
· Active enquiry and support for those identified at risk
· Direct support to women with mild to moderate emotional health difficulties in line with the Trust’s perinatal mental health standard operating procedure
· Identifying and assessing emotional health is an integral part of the antenatal, new birth contact, the 6-8 week review and the 6-12 months assessment. Health Visitors will ask the depression identification questions and the Generalised Anxiety Scale 2 (GAD-2) screening tool for anxiety (if indicated) as part of a general discussion about a woman's mental health, wellbeing and medical history.
· If low mood is identified the 0-19 service will work in line with the Trust’s Perinatal Mental Health Standard Operating Procedure.
· The Health Visitor may offer 6 short term guided therapeutic interventions (listening visits) using evidence based approaches such as Motivational Interviewing, Solihull approach or CBT (where trained), including a discussion about how symptoms will be monitored and intervention evaluated (for example, by using validated self‑report questionnaires, such as the Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire (PHQ‑9) or the 7‑item Generalized Anxiety Disorder scale (GAD‑7).
18. Breastfeeding (initiation and duration)
· On-going breastfeeding support across North Yorkshire for all families. This includes the provision of specialist support for mothers experiencing difficulties in breastfeeding.
· Achieve and maintain full accreditation of UNICEF Baby Friendly community initiative. Compliance with UNICEF BFI standards and works jointly with the Council’s children’s centres to provide training and support to the wider workforce.
· Delivery of breastfeeding support is co-ordinated across the different sectors, with the Service as the interface with key partners including maternity, primary care and early year’s settings and as partners in a multi-agency approach to this important and shared public health outcome.
· The Service will lead work around breastfeeding in the community, including building community capacity to support breastfeeding by working with communities groups and children’s centres to set up services where there is a need.
· Training and resources are provided for the workforce to support work around breastfeeding.
· The promotion of the availability of healthy start vitamins to all families via Children’s Centres
19. Healthy weight, healthy nutrition andphysical activity
The focus should be on the prevention and early identification of unhealthy weight in children, through an emphasis on, and promotion of:
· breastfeeding
· delaying the introduction of solid food to babies until at, or around, 6 months of age
· healthy eating – healthy foods, portion size, limiting snacking, etc.
· an active lifestyle
· good oral health
The Service will support early identification of weight concerns through the mandated contacts. The service will provide care planning and weight management interventions that are quality assured and evidence based in their approach to health promotion and childhood obesity prevention.
Advice and support around interventions such as promotion of healthy eating and increasing physical activity, as appropriate based on guidelines. Where appropriate strengths based, solution focussed intervention that improves parenting/carer efficacy to help children and their families achieve and maintain a healthier weight will be offered.
Implement NICE guidance through a partnership approach with parents and carers. This encourages responsive parenting and a holistic family focused method of addressing excess weight in childhood should be actively employed to help the whole family change habits and achieve new goals. Supporting children, parents and carers to achieve or maintain a healthy weight through advice and help with accessing locally available services.
Where weight management issues are identified at 2-2.5 year review, families will be encouraged and supported to access appropriate evidence based interventions.
20. Managing minor illness and reducing hospital attendance and admission
· All health reviews should include age appropriate accident prevention messages including the use of the Home Environment Assessment Tool (HEAT) to assess risk of harm in the home.
· Follow up A&E attendances as per the Trust’s policy.
· Prescribe medication as an independent/supplementary prescriber in accordance with current legislation as per decision based on need. Where Health Visitors have not undertaken this module in training, it is a requirement of CPD for completion within the first 2 years of practice. For more information visit http://www.nmc-uk.org/Nurses-and-midwives/Regulation-in-practice/Medicines-management-and-prescribing/ this needs clarity in terms of capacity and also additional costs of prescribing and expectation of staff.
· Contribute through the mandated contacts the early identification of developmental and health needs and signpost and/or refer for investigation, diagnosis, treatment, care and support as appropriate.
21. Health, wellbeing and development of the child age 2 –2.5 year old review (integrated review) and support tobe ‘ready to learn’
It is anticipated that integrated reviews will take place within the child’s childcare/education setting within the geographical area of North Yorkshire. Where this is not possible, alternative means of undertaking such review will be discussed and agreed with the child’s parent/carer. Information sharing will take place between education and health services to allow the transfer of the child’s assessment information.
Where the child’s childcare/education setting is outside of this geographical area, partnership working with the childcare/education setting will take place to ensure that there is an integrated review and the transfer of the child’s assessment information.
To be addressed throughout all reviews but particularly at the 9-12 month and 2-2.5 year reviews.
· Topics should include;
o Health promotion,
o Healthy weight and active lifestyle,
o Raising awareness and signposting families to ensure that all children are accessing routine preventive careand advice (primary dental care services, hearing and vision assessments, incontinence advice, etc).
o Promote injury prevention and age appropriate behaviour and boundary management messages.
Promotion of good language development and supporting parents/carers to understand important milestones is essential whilst also identifying early any speech, language and communication difficulties.
The Service will support active identification of those families eligible for the 2 year offer and sign post appropriately.
Model for 2-2.5 year integrated review
|
Universal |
Universal plus |
Universal Partnership Plus |
|
A separate EYFS Progress Check and HCP review will be maintained, integration will be achieved via information sharing and joined-up responses to needs |
At a universal plus level it is expected that a joint review will be offered to all families |
All UPP families should receive one joint review meeting |
The Service will ensure a family focused and safe transition into school aged (6-19) services, through close partnership working with services meeting the needs of children and young people aged up to 19.
22. Health Protection
The Service will:
· In partnership with the Trust, Council and Public Health England, the Service will provide whatever support or assistance is reasonably required in response to a national, regional or local Public Health emergency or incidents.
· Respond to childhood communicable disease outbreaks and health protection incidents as directed by the Health Protection Team (PHE) in a timely manner.
· Contribute to reducing barriers to high coverage for childhood immunisations in order to prevent serious communicable disease, particularly targeted at vulnerable groups.
23. Antenatal and Newborn Screening
The Service will ensure:
· Delivery of the health visiting aspects of the new-born screening programmes in line with UK National Screening Committee Programme Standards.
· That when a child under the age of 12 months transfers into an area that the Health Visitor must check new-born blood spot status and arrange for urgent screening if necessary.
· That it develops its own local area new-born blood spot policies and pathways in partnership with local midwifery, Child Health Information Systems (CHIS) and GP colleagues
· That Health Visitor check the status of all screening results including hearing, New-born Infant Physical Examination (NIPE) and Hep B schedule, immunisation status and refer appropriately, if required.
SERVICES FOR SCHOOL AGED CHILDREN (6-19)
The Safeguarding/ Children who are Looked After Teams and the Emotional Health and Resilience team will:
Provide support to children aged 6-19 in North Yorkshire as part of the disaggregated model in the commissioned areas of:
· Safeguarding
· Children who are Looked After
· Low level Tier 1 emotional wellbeing and resilience support
24. National Child Measurement Programme (NCMP)
The 0-6 Service will deliver the mandated NCMP programme The Service will:
· Deliver the NCMP in line with national operating guidance and standards, including recording of accurate data and submitted using the online tool on time.
· Provide effective communication and feedback of the results of height and weight measurements to parents/carers in a sensitive manner, promoting healthy weight and physical activity.
· Support and signpost to parents/carers of children who have been identified as overweight or obese with a BMI over the 91st centile, or children who are under the 5th centile in both reception and year 6 and encourage them to join community programmes in accordance with appropriate local pathways.
· Support the reduction in childhood obesity by pro-actively working to promote healthy eating, increase physical activity and working with children within the infant feeding and family diet and nutrition pillar . The Service will work in partnership to contribute to the Integrated Healthy Weight Pathway.
· Refer children who present as obese, overweight or underweight to the relevant service.
25. Emotional Health and Wellbeing
The Emotional Health and Resilience Team will:
· Provide communication and interventions which raise confidence and self-esteem for children and young people, including those aimed at prevention of poor emotional and social well-being and personal coping mechanisms to protect against psychological ill health. This includes building resilience in and supporting those who may be experiencing emotional and mental health difficulties.
· Following an accepted referral, ensure children and young people with emotional health concerns are offered preventative support and have access to a named Emotional Resilience Nurse.
· Refer to the CAMHS and other services as appropriate.
· Ensure all children and young people who are referral into the service and have been identified as having a non-urgent mental health concerns are communicated with within 2 weeks of referral and should ensure an initial contact is arranged within 8 weeks
26. Support for Children who are Elected Home Educated (EHE)
The Service will establish agreed procedures with colleagues within the Quality & Improvement Service in the Children and Young People’s Service for identifying and communicating with the parent/carer of EHE children, as per the disaggregated model.
All EHE children can be offered the services within this specification and the partnership will ensure that they have access to information to enable them to self-refer into the service.
27. Supporting Children, Young People and Families at Risk of Poor Health Outcomes
The Service will work directly with those children and young people who are known to be at risk of poor health outcomes where they are being actively support by the service through safeguarding or looked after children.
28. Comprehensive Assessment – Vulnerable Children, Young People and Families
The 0-6 Service and 6-19 disaggregated service model will:
· Ensure that where children, young people and families are actively being supported by the Service evidence-based preventive programmes will be utilised in an effort to reduce the risk of poor future health and wellbeing.
· Undertake child and family focussed assessments using professional knowledge, skills and tools such as Signs of Safety and NYSCP Threshold Guide, and follow relevant multi-agency policies and protocols to identify vulnerability or child maltreatment. North Yorkshire Safeguarding Children Partnership procedures should be used if a child is identified to be at risk of significant harm.
· Deliver Family Health Needs assessments and Home Environment Assessment Tool (HEAT) contribute to multi-agency assessments, planning and interventions, relating to babies, children, young people and families who are at risk and need additional support
· Contribute to targeted services in the child protection and/or LAC arena so that the outcomes of disadvantaged or most “at risk” children and families are not compromised by poor early experiences and environment, including vulnerable groups at risk of being marginalised from the service, including those not in schools, for example, but not limited to:
o Children missing education
o Children educated at home
o Young people not in education, employment and training (NEET)
o Children educated on site – for example children’s homes
o Children missing from home and/or at risk of sexual exploitation
o Contextualised safeguarding
· Contribute to a multi-agency approach to ensure the welfare of children and young people, for example keeping children safe from violent extremism and child sexual exploitation.
29. Children with Special Educational Needs and/or Disabilities (SEND)
The Service will work in their statutory obligations to:
· Deliver the NCMP to all children and young people with SEND attending schools in North Yorkshire.
· Focus on early identification and assessment of health and developmental needs in children aged 0-6 and signpost and / or refer for investigation, diagnosis, treatment, care and support.
· Develop care pathways that take into account the full range of needs and thresholds ensuring support and signposting for Education, Health, Care Plan (EHCP) for those children with SEND.
· Contribute and support local CCGs and/or ICS’s and the Council to develop and implement pathways for children with SEND. This includes active involvement of parents/carers and children, to ensure their individual needs are considered at all stages and are brought to the attention of the relevant support services.
· Work in partnership with key stakeholders and commissioners to review SEND provision within the County as and when required. Future offer in relation to SEND to be delivered in line with the agreed outcomes of any review and in line with current and future SEND pathways.
30. Multi-Agency Child Exploitation (MACE)
Children and young people who are at risk of, and exploited are the victims of child abuse and their needs require careful assessment.
The Service will contribute to a multi-agency approach to ensure the welfare of children and young people, for example keeping children safe from violent extremism and child exploitation.
· Contribute to the Multi-Agency Child Exploitation (MACE) meetings on contextual safeguarding.
· Contribute to intelligence gathering on children and young people, based on issues and problems the see in their interactions with them.
· Contribute in a wider context of safeguarding children and young people who are at risk of and exploited.
· Promote awareness of child exploitation services (e.g. Children’s Society Hand in Hand Project, Partners Against Child Sexual Exploitation – PACE and Trusted Relationships Project) and make referral to these services where appropriate.
31. Support for Children and Young People Attending Pupil Referral Units (PRU)
The Service will be offered the 0-19 (25) service in line with the offer to mainstream schools.
LOOKED AFTER CHILDREN/CARE LEAVERS
32. Looked After Children/Care Leavers
The Service will undertake Review Health Assessments (RHA) for Looked After Children aged between 0-18 as requested by the Specialist LAC nurse team. At the final RHA the Service will help provide the care leaver with a completed health summary/passport (as devised by the Multi-Agency Looked After Partnership) and liaise with the Leaving Care pathway team as appropriate.
The Service will implement the Named Public Nurse model and follow-up health needs between health assessments conduct the reviews in accordance with the quality standards required by (but not limited to) North Yorkshire Children’s Social Care, Statutory Guidance, British Association for Adoption and Fostering and the local CCG and/or ICS’s and will ensure that the outcome of reviews are recorded accurately and communicated to the Specialist LAC nurse team in a timely way. The Specialist LAC team will provide training and continuing professional development to the HCP workforce to ensure staff have the required skills and knowledge to complete high quality health assessments and completion of health passports for care leavers.
Attending multi-agency Looked After review meetings. The service will offer support and advice to all children and young people for up to 1 year post leaving care at any age.
Where the young person is a care leaver, the Service should liaise with the Leaving Care team to provide relevant information to secure smooth transition to adult health provision where required.
Contribute to multi-agency decision-making, assessments, planning and interventions, relating to Looked After Children (LAC). This includes providing Review LAC Child health assessments (in accordance with Promoting the Health and Wellbeing of Looked After Children Statutory Guidance 2015) and reports in accordance with the local Safeguarding Children Board policies and procedures and national guidance such as Working Together to Safeguard Children (HM Government, 2015).
33. Transition into Adulthood/Services
For those young people identified as Looked After and are reaching the age where their service needs will transfer to adult provision they will be encouraged to familiarise themselves with adult services. Where the young person has specific barriers to engaging with adult provision the Service should provide additional reassurance and support to assist them with transition. The Service will work in partnership with Leaving Care Teams to ensure a smooth transition.
SERVICE ACCESS AND DELIVERY ENVIRONMENT
34. Service Delivery Location(s)
The Service will:
· Be delivered within the County boundaries ensuring ease of access for children, young people and families and maximising opportunities for them to access the service.
· Have the option to be delivered and co-located in accordance with the area based footprint. The Service will ensure that community settings provide equity of access.
· Offer a choice of locations and times for visits (including virtual ones) which best meet service user needs. Locations must be easily accessible for all children, young people and families who live in the local vicinity (including access by public transport and at times appropriate to the service user), child and young family friendly, suitable for multi-disciplinary delivery of services in both individual andgroup sessions and be conducive to flexible availability (e.g. early mornings, lunchtimes, after school and evenings)).
· In collaboration with local partners and feedback from service users, agree suitable locations for service delivery. Reviews will be undertaken periodically to ensure the locations are suitable to local needs.
· Carry out joint visits/contacts in partnership with other agencies where this is appropriate and reduces inconvenience forfamilies.
· Be delivered in accessible venues and community settings and prioritisation of resources shall be according to need so priority is given to most deprived areas.
35. Co-location
· The Service will work in partnership with North Yorkshire County Council to ensure that seamless andintegrated service delivery is facilitated and co-located where reasonably possible in line with the Early Help Service.
·
· Potential locations of delivery may be:
o Children’s Centre
o Schools
o Health centres
o Community venues
o Other suitable venues as appropriate
· Where provision is made from outreach sites, the Service is responsible for sourcing premises, negotiating and agreeing the terms of any leases or licences. This is outside of the Section 75 agreement.
36. Operating Hours
The Service will be available from 8am to 8pm (as appropriate and to the needs of children, young people and families), Monday to Friday. However, days and hours of operation are flexible, demand led and appropriate and are monitored in order to ensure optimum access/coverage in response to need.
The Service will ensure that access to the service is provided at dates and times which meet the requirements of those accessing the service. Take into account childcare provision and parental/carer responsibilities in order to facilitate access to the service for those with parenting/carer and other family responsibilities.
37. Service Environment
The Service in partnership with North Yorkshire County Council will:
· Be provided from an environment in which services are well maintained, easily accessible, with good public transport links, and have infection control and health and safety policies and procedures in place which meet national regulation and requirements.
· Ensure that consideration is given to the external environment of all delivery sites including the potential impact and effects on the local community and those using the service.
· Ensure compliance with all relevant CQC requirements
· Working within the confines of the lease/licence as per Section 75.
38. Inclusion Criteria
The Service will be delivered to residents within North Yorkshire – defined by the Council’s geographical boundaries. The Service must ensure equal access for all children aged 0-19 (25 for SEND) and their families regardless of disability, gender reassignment, marriage and civil partnership, sex or sexual orientation and race – this includes ethnic or national origins, colour or nationality, religion, belief or lack of belief.
39. Exclusion Criteria (to be agreed)
Looked after children who do not normally reside within North Yorkshire County Council’s geographical boundary will not be included within the service delivery described by this contract.
If the Service choose to provide a service including carrying out review health assessments to this particular population, it must ensure that this is not to the detriment of this contract and any costs incurred should be arranged with the responsible CCG and/or ICS commissioner.
40. Access and Referrals
The Service shall make any reasonable adjustments to ensure that the Service is accessible to all eligible service users, including people whose characteristics are included within the scope of the Equality Act 2010.
The Service must ensure equal access for all children and their families, irrespective of age, disability, gender reassignment, marriage and civil partnership and race – this includes ethnic or national origins, colour or nationality, religion, lack of belief, sex or sexual orientation.
Referrals, irrespective of source will be triaged in line with service criteria and will receive a response to the referrer within 5 working days, with contact made with the family within 2 calendar weeks, if the referral meets the service criteria).
Following the initial contact with the family the next steps will be negotiated with the family, based on the information available. Public Health Nurse will use their professional judgement as to the appropriate action to take. If no contact is made within 10 days of the original referral/notification to either the referrer or family a clear rationale as to why it has not been undertaken must be documented and reported.
The Service will:
· Ensure that any coverage/boundary issues that may arise will be dealt with proactively in collaboration with neighbouring providers. Delivery of a service that meets the needs (including safeguarding needs) of the child or family must take precedent over any boundary discrepancies or disagreements.
· Work within County/District wide pathways and processes to ensure service users can access advice, support and interventions that fall outside the scope of this Service Specification.
· Proactively engage with service users to develop a thorough and up-to-date understanding of the issues and barriers service users experience in accessing generic services, and using learning will be used to further develop the service.
· Be responsive to the changing needs of service users to enable innovation and development.
· Ensure that advice and information is made available via a range of communication channels, including, but not limited to; written, telephone, email, internet and social media, with the emphasis on access for young people in the medium they so wish to use, for example texting.
· Ensure that information is made available in a range of formats and languages that take into account the diverse population across the County and includes those with impairments and disabilities.
· Ensure that young people are able to make an appointment or have access to a Public Health Nurse, or the appropriately qualified/trained staff member, without having to go through a third party where they are actively being supported by the Service.
41.Interdependencies with Other Services
· The Service will be delivered as part of the 0-19 prevention and early intervention services and support and therefore integrated with relevant services.
· The Service will work with services across the County ensuring good partnership working to offer the best support for service users.
· The Service will work in partnership with other professionals, including for example but not restricted to Midwifery Services, Schools, Youth Services, Police, VCS, GPs, dental services and other Health and Social Care Practitioners (see Fig 2).
· The Service will establish good working relationships with key local partners, including representation on strategic and operational partnership groups and developing services in line with localities and county wide priorities.
· The Service will deliver a three locality based model structure and working together to deliver locality based model service for children and their families, with a focus on promotion, prevention and early intervention.
· The Service will ensure for children aged 0-6 that a named Public Health Nurse or appropriately trained staff member is linked to each appropriate setting to ensure:
o Liaison, information sharing and joint working with GP practices where necessary;
o Direct partnershipwith schools to provide improved access anddelivery of NCMP
o Promotion of support thatchildren and their families are entitled to, and, as part of that process,encouraging children and young people to access the service
o The promotion of an integrated approach to improving child and family health locally
· The Service should link to wider stakeholder and services (e.g. hospital and community based health services, VCS) delivering in conjunction with the key practitioners.
42. Moving out of Area
· Where a child moves out of area, the Service must ensure that thechild’s health records are transferred to the appropriate receiving equivalent 0-19 Service inthe new area within 2 weeks of notification.
· Procedures must be in place to trace and risk assess missing children and those whose address is not known with systems in place to follow up and trace children who do not attend for their assessments or appointments.
· Direct contact must be made to handover all child protection cases in other areas in a timely and responsive manner.
CHILD PROTECTION AND SAFEGUARDING
43. Child Protection and Safeguarding
Safeguarding is a core part of the Service, and runs through all levels of service delivery. The Service will provide appropriate and effective safeguarding services and will be expected to adhere to relevant national and local requirements and guidance, and implement wherever necessary.
A new safeguarding model was implemented in September 2020 for the 6-19 service which describes more clearly the role and responsibilities of the Service in safeguarding. This is to enable the effective use of resources and to avoid duplication of efforts within the system.
In summary, the 0-6 Service will:
· Work in partnership with other key stakeholders to help promote the welfare and safety of children and young people.
· Work collaboratively to support children and young people with identified health needs to offer and referring children and families to specialist medical support, where appropriate.
· Contribute to reducing the number of children who enter the safeguarding system through preventative and early help work as part of their Community, Universal and Universal Plus role.
· Deliver accordingly in line with local inter-agency and internal safeguarding policies and procedures as determined by HDFT and the North Yorkshire Children’s Safeguarding Partnership
· Council to make the Service aware of children with an early help assessment, child in need, child protection or Looked After Child plan.
· Contribute to multi-agency decision-making, assessments, planning and interventions, relating to children in need, children at risk of harm, in accordance with the local Safeguarding Children Board policies and procedures and national guidance such as Working Together to Safeguard Children (HM Government, 2015).
· In line with our 0-6 service offer the child or young person is known to the Service, the Public Health Nurse will attend child protection conferences or meetings.
· Be responsible for all general enquiries, contributing to individual case management issues, handling or crisis and emergency situations with other partners as required, informing the Council of such activity through routine contract monitoring arrangements or directly where it relates to a crisis or an emergency that warrants this being shared as a matter of urgency.
· Contribute to the completion of an annual section 11 safeguarding children’s audit (Produced by the Safeguarding Children’s Board).
· Have a named nurse for safeguarding children and LAC to ensure that all staff (including administrative and voluntary staff) are compliant with child protection and Children and Adult Safeguarding Policies. For example, ensure all staff employed are aware of and trained to a level appropriate to their role in accordance with the intercollegiate document and abide by national and local guidance and legislation on safeguarding (children and adults).
· Ensure staff has access to sufficient safeguarding support, supervision, advice, training and guidance.
· Staff to work in partnership with safeguarding children team, specialist Looked After Teams and multi-agency partners in line with working together safeguard children and Trust and Local safeguarding Children Partnerships.
· Comply with the North Yorkshire Safeguarding Adults and Safeguarding Children Board’s policies and procedures These can be found at the following webpage links: North Yorkshire Safeguarding Children Partnership (www.safeguardingchildren.co.uk) and North Yorkshire Adults Safeguarding Partnership (http://www.nypartnerships.org.uk/index.aspx?articleid=17008).
· Have robust and accessible child protection and adult safeguarding policies and procedures. When working in outreach settings the Service shall ensure that all staff employed by the Service are familiar with and have due regard to the settings’ child protection policy and safeguarding procedures.
· Ensure compliance with the Mental Capacity Act
· Ensure it has Policies in place to safeguard the safety of its employed staff that may be lone working.
In summary, the 6-19 Service will:
· Work in partnership with other key stakeholders to help promote the welfare and safety of children and young people.
· Work collaboratively to support children and young people with identified health needs relevant to the 6-19 service offer and referring children and families to specialist medical support, where appropriate.
· Deliver accordingly in line with local inter-agency and internal safeguarding policies and procedures as determined by HDFT and the North Yorkshire Children’s Safeguarding Partnership
· Council to make the Service aware of children with an early help assessment, child in need, child protection or Looked After Child plan.
· Contribute to multi-agency decision-making, assessments, planning and interventions, relating to children at risk of significant harm in accordance with the local Safeguarding Children Board policies and procedures and national guidance such as Working Together to Safeguard Children (HM Government, 2015).
· Where appropriate and the child or young person is known to the Service, the Public Health Nurse will attend child protection conferences or meetings when they are the most appropriate health representative and there is a specific outcome to contribute.
· Be responsible for all general enquiries, contributing to individual case management issues, handling or crisis and emergency situations with other partners as required, informing the Council of such activity through routine contract monitoring arrangements or directly where it relates to a crisis or an emergency that warrants this being shared as a matter of urgency.
· Contribute to the completion of an annual section 11 safeguarding children’s audit (Produced by the Safeguarding Children’s Board).
· Have a named nurse for safeguarding children and LAC to ensure that all staff (including administrative and voluntary staff) are compliant with child protection and Children and Adult Safeguarding Policies. For example, ensure all staff employed are aware of and trained to a level appropriate to their role in accordance with the intercollegiate document and abide by national and local guidance and legislation on safeguarding (children and adults).
· Ensure staff has access to sufficient safeguarding support, supervision, advice, training and guidance.
· Staff to work in partnership with safeguarding children team, specialist Looked After Teams and multi-agency partners in line with working together safeguard children and Trust and Local safeguarding Children Partnerships.
· Comply with the North Yorkshire Safeguarding Adults and Safeguarding Children Board’s policies and procedures These can be found at the following webpage links: North Yorkshire Safeguarding Children Partnership (www.safeguardingchildren.co.uk) and North Yorkshire Adults Safeguarding Partnership (http://www.nypartnerships.org.uk/index.aspx?articleid=17008).
· Have robust and accessible child protection and adult safeguarding policies and procedures. When working in outreach settings the Service shall ensure that all staff employed by the Service are familiar with and have due regard to the settings’ child protection policy and safeguarding procedures.
· Ensure compliance with the Mental Capacity Act
· Ensure it has Policies in place to safeguard the safety of its employed staff that may be lone working.
Compliance and GovernancE
44. Clinical Governance
The Service will ensure that robust Clinical Governance systems are in place for all elements of the service delivery.
· Establish and implement the framework of clinical governance that clinical and non-clinical practitioners will be operating within.
· Undertake regular audits of clinical practice to ensure on-going service improvement is embedded into working practice.
· Undertake regular training needs assessment and provide evidence of completion of courses by staff to ensure continuing professional development is applied in support of clinical governance.
· Ensure clinicians and non-clinical practitioners are linked to an appropriate Responsible Officer for the purposes of revalidation where appropriate
· Ensure arrangements are in place to report and manage all Serious Incidents and Never Events, in line with HDFT procedures.
· Ensure there is a complaints procedure in place which is accessible to children, young people and families.
· Ensure arrangements are in place to manage the collection, storage and disposal of clinical waste.
· Ensure infection control arrangements are in place to reduce the risk of transmission of infections.
· Prescribe in line with HDFT Managing Medicines Policy and NMC prescriber proficiency standards.
· Participate in inspections, where required, in relation to the safe and secure handling of medicines (for example, the Council, CQC, etc).
45. Data Requirements
The Service will be wholly responsible for maintaining up-to-date datasets and will implement dataset changes as required and adhere to data reporting requirements as agreed in partnership with the Council.
The Service is responsible for the submission of nationally agreed datasets adhering to reporting requirements and submission deadlines which include (subject to change in line with reporting requirements) but not limited to:[12]
· National Child Measurement Programme (NCMP) – NHS Digital
· Community Services Dataset (CSDS) – NHS Digital
· Health Visiting Service Delivery Metrics – PHE
· Review Health Assessments – DofE and DoH
The Service is required to generate data extracts for the datasets relevant to the service that are created during the life of the Contract (e.g. local outcome framework measures – Schedule 5 of the Section 75 Agreement) and specified additional reporting requirements to ensure activity and performance is quantified.
The Service will be compliant with the requirements and data flows to the current local Child Health Information Service (CHIS)[13] to:
· Enable data collection to support the delivery, review and performance management of services; and
· Ensure compliance with the clinical system which requires all clinical systems to be able to receipt and process a range of child health informatics and be interoperable with other service providers for the secure and timely transfer of electronic data.
The Service will work collaboratively with commissioners and NHS England as part of the developing redesign Healthy Children: Transforming Child Health Information NHS England 2016)[14].
The Service will be required during the mobilisation period, to develop a system which will capture data to evidence the outcomes required in this Specification and to demonstrate compliance and quality standards.
The Service will discuss data analysis with the Council at contract management meetings to enable informed partnership decisions relating to activity and trends.
The Service shall contribute through the mandated contacts to health needs analysis using tools such as the Early Years Profile.
The Council may request anonymised data extracts including local level district population and if possible will be provided as soon as is reasonably feesibale as per the Data Sharing Agreement.
The Service will be responsible for all generalenquiries, contributing to individual case management issues, handling or crisis and emergency situations with other partners as required, informing the commissioner of such activity through routine contract monitoring arrangements or directly where it relates to a crisis or an emergency that warrants this being shared as a matter of urgency.
46. Information Technology (IT) System
The Service will use a government approved system identified in the NHS’ GP Systems of Choice (GPSoC) framework for its Electronic Health Care Record (EHCR) which is able to integrate, where possible with the primary care’s system so that:
· There is a shared care record available at the point of care between this service and primary care in North Yorkshire, where SystmONE is in place
SystmONE is the system used by the primary care system in the North Yorkshire and the Service should ensure that the system that it uses is The system needs to be able to share with midwifery and GP, and needs to be able to allow tracking across services using identifier (NHS number). The Service will also need to share data for the purposes of improving health, care and services through research and planning.
Appropriate records will be kept in the Child Health Information System (CHIS) or similar system to enable high-quality data collection to support the delivery, review and performance management of services in line with national service level agreements with CHIS where necessary.
The Service will ensure that employees are trained to use the IT system effectively.
The Service will be responsible for the provision of and on-going support, upgrades, maintenance and replacement of any IT system hardware, software and associated licenses.
47. Information Governance (IG)
The Service must have in place a robust IG framework.
The Service will ensure that all employees understand their obligations in relation to IG and training is provided where necessary.
The Trust is required to demonstrate that they are either:
· registered with the NHS Digital IG Toolkit achieving Level 2 for all requirements; or
· the same standards are met through a different IG quality system of a similar standard.
The Service will:
· ensure the processing, transfer and storage of Service User identifiable data is secure and complies with all relevant and current legislation and guidance.
· establish a secure process to share patient identifiable data with urgent and emergency care services.
· be registered with the Information Commissioner Office (ICO) and comply with the standards set by the ICO.
48. Confidentiality
The Service must demonstrate that robust confidentiality processes are in place and Caldicott Principles are adhered to in the interest of patient safety:
· justify the purposes of using confidential information
· only use it when absolutely necessary
· use the minimum that is required
· access should be on a strict need to know basis
· everyone must understand his or her responsibilities
· understand and comply with the Law
· the duty to share information can be as important as the duty to protect patient confidentiality
These Caldicott Principles as well as the Data Protection Act 2018 and The Common Law Duty of Confidentiality should not be a barrier to sharing relevant, proportionate information to safeguard and protect children and young people.
The Service must have a named Caldicott Guardian, who shall be responsible for ensuring that all employees comply with the data standards produced by the Information Standards Board for Health and Social Care.
The Service will ensure that data is not revealed or passed on to any third party who is not authorised to receive such data.
Where there is any doubt as to whether or not someone has legitimate access to information, checks should be made before any information is disclosed, in cases where the right to confidentiality is overruled by issues of safeguarding, the Individual concerned should be informed wherever possible if other agencies are to be involved.
The Trustshould also referto ‘Record Keeping: Guidance for Nursesand Midwives’, NMC, 2015.[15]
49. Data Information, Systems and Confidentiality
Schedule 6 of the Section 75 Agreement and Clause 21 of the Section 75 Agreement sets out the provisions in relation to Information Sharing and Data Protection for the Service with those terms clearly defining the processing which is to take place under the Contract.
· Transfer and Storage of Data:
o The Service shall at all times adhere to requirements of the General Data Protection Regulations and Data Protection Act 2018 in the transfer and storage and processing of data specific to this contract. Where data is held on Trust IT systems, The Trust will also comply with the requirements below.
· Data sharing / consent:
o The Service shall obtain all appropriate consents prior to the sharing of any data to a third party.
· Freedom of Information:
o The Service shall comply with all reasonable requests for information made under the Freedom of Information Act 2000 in relation to the services provided.
· Confidentiality:
o The Service will receive Confidential Information from the Council or other stakeholders and shall undertake to keep such information secret and strictly confidential and shall not disclose any such Confidential Information to any third party, without the Discloser’s prior written consent, subject to the provisions outlined in Clause 30 of the Terms and Conditions specific to this contract.
· Contract closure:
o The Service must comply with obligations relating to document retention and destruction in accordance with statutory guidance and the NHS Records Management Code of Practice for Health and Social Care 2016 as referenced in the Data Schedule at Schedule 6 of the Section 75 Agreement.
· Data ownership / Intellectual property rights:
o Under the General Data Protection Regulations, for the purposes of this Contract, the Council is the Data Controller and the Trust is the Data Processor.
o All Intellectual Property Rights furnished to or made available to the Trust by the Council shall remain the property of the Council, along with those prepared by or for the Service for use, or intended use, in relation to the performance of its obligations under the Contract shall belong to the Council. Further information regarding Intellectual Property can be found at Clause 29 of the Terms and Conditions specific to this contract.
50. Technical Security Requirements
The Service will:
· Ensure that any Council data which resides on a mobile, removable or physically uncontrolled device is stored encrypted using a product which has been formally assured through a recognised certification process.
· Ensure that any Council data which it causes to be transmitted over any public network (including the Internet, mobile networks or un-protected enterprise network) or to a mobile device shall be encrypted when transmitted.
· Must operate an appropriate access control regime to ensure users and administrators are uniquely identified.
· Ensure that any device which is used to process Council data meets all of the security requirements set out in the National Cyber Security Centre (NCSC) End User Devices Platform Security Guidance.
· At their own cost and expense, procure an IT Health Check from a certified supplier and penetration test performed prior to any live data being transferred into their systems.
· Perform a technical information risk assessment on the service supplied and be able to demonstrate what controls are in place to address those risks.
· Collect audit records which relate to security events in delivery of the Service or that would support the analysis of potential and actual compromises. The retention period for audit records and event logs shall be a minimum of 6 months.
· Must be able to demonstrate they can supply a copy of all data on request or at termination, and must be able to securely erase or destroy all data and media that the Council data has been stored and processed on.
· Not, and will procure that none of its sub-contractors, process the Council’s data outside the European Economic Area (EEA).
· Implement security patches to vulnerabilities in accordance with the timescales specified in the NCSC Cloud Security Principle 5.
· Ensure that the service is designed in accordance with NCSC principles, security design principles for digital services, bulk data and cloud security principle.
· Implement such additional measures as agreed with the Council from time to time in order to ensure that such information is safeguarded in accordance with the applicable legislative and regulatory obligations.
51. Future Proofing
The Service will:
· Keep up to date with technical developments as they become available and shall ensure that provision is made to build innovative solutions into the service model, without compromising on compliance or quality. This should be achieved so that the delivery of a high quality and responsive service is maintained.
· Review and continuously improve the Service making use of technology and computer applications where appropriate and will seek and act on Service User, and staff feedback to support continuous improvement and development.
· Ensure service and support reflects local health needs and priorities including the sustainability and transformation of services. The Service will prioritise babies, children’s and young people’s health. There will be an appreciation that the health and wellbeing needs of babies, children and young people are crucial to securing long-term population health and reducing the local burden of healthcare provision.
A TRANSFORMED WORKFORCE
The workforce is critical to the vision of the service for children, young people and families and transforming the workforce is the key to achieving this whilst being aware that there are system barriers that prevent frontline practitioners from working with families in the way they know best. Over the life of the contract, the Council will work with the Service and other local partners to identify and where possible remove these barriers and create enabling working cultures and environments.
The Service will play an important role in the achieving this transformed workforce through the right leadership and workforce competency and development.
52. Strategic and Operational Leadership
The Service will:
· Have in place an organisational management structure (OMS) which provides a description of the key leadership roles and responsibilities, reporting relationships and accountabilities.
· The OMS will support delivery of a safe, effective and efficient service in line with the requirements of this Service Specification.
· For the purpose of delivering an integrated 0-19 service, show the links between the organisation’s roles, responsibilities and accountabilities and those of all other local organisations.
53. Workforce Competency and Development
The Service will:
· Have in place a multi-disciplinary team of appropriately qualified Public Health Nurses and a skill mix of staff which is diverse and reflects the needs of the population.
· Ensure all public health nurses are registered or working towards additional registration with the Nursing and Midwifery Council.
· Have in place a governance structure, responsible for ensuring clear and consistent governance processes are in place, and will be accountable for the clinical quality of the Service working closely with the senior leads in other key partners.
· Ensure supervision arrangements are in place for all staff, in line with national guidance, and measures are in place to maintain competency standards of all Staff.
· Develop a robust workforce development plan which should demonstrate service development in response to client experience, feedback from families and staff.
· Align and prioritise delivery in line with local population needs, inequalities and outcomes.
· Ensure a focus on Building Community Capacity and collaborate in interagency approaches and training, to enable innovative and creative Public Health nursing services to meet local needs and to add to the body of research evidence for theprofession.
· Ensure robust workforce analyses and plans are developed which include: numbers of new students needed; number of apprentices/trainees; recruitment/retention plans; numbers of retirees; potential other leavers; and
· Ensure organisational processes and managerial support are in place to ensure that mentors and practice teachers are able to provide high quality placements for students.
· Ensure all employees, including bank staff can demonstrate professional competency and understand all relevant policies and processes.
· Have in place individual training and development plans for all employees, including bank staff , and will undertake annual appraisals, with peer review where appropriate, to ensure their CPD.
· Ensure all staff are up to date and competent in training as identified in the training needs analysis matrix – e.g. stop-smoking, smoke free homes, substance misuse, sexual health, obesity, infant nutrition, immunisations, breastfeeding and it will promote and support a healthy workforce.
Mobilisation
54. Mobilisation Plan
· The Service will have in place a detailed mobilisation plan, which will set out how each aspect of the Service will be mobilised, including key milestones.
· The Mobilisation Period will be from 1st September 2021 for a 12 month period. The Service will be expected to start provision of the service on the 1st September 2021.
· The Service and the Council will meet as agreed during the mobilisation period to ensure key milestones have been met and that any remedial/corrective action has been taken.
PERFORMANCE AND CONTRACT MANAGEMENT
55.Quarterly Service Performance Reviews
Quarterly service review meetings will be held between the Service and the Council. The Service shall provide a quarterly report of activity data and performance against the measures identified in the Performance and Monitoring Framework. Performance reports shall be produced and sent to the Council at least one week in advance of the review meeting.
The format of the performance report will be agreed between the Council and the Service.
Review meetings will be held on the Council’s premises unless the parties agree otherwise.
The Council will not pay for any expenses for attendance at any of these review meetings. The Service will provide, when requested, exception reports where there are queries or anomalies in their performance reports and/or data. Exception reports may also be requested where there have been good outcomes to demonstrate what has been effective.
An annual contract review meeting will be held to assess performance over the previous year. At this meeting the Service shall produce an annual report. The annual review meeting will include a review of budget and performance against measures as well as agreeing any developments or new performance measures for the Service for the forthcoming year. The performance measures will be reviewed annually and may be amended to specifically address emerging needs or trends.
56.Service Users Feedback and Engagement
The Service will be able to evidence that the experience and involvement of families is regularly gathered and taken in to account to inform service delivery and improvement.
· They will use established consistent tools for measuring outcomes.
· Service impact will also be demonstrated through service user feedback.
· The Service should also have a well-publicised feedback and complaints procedure which includes quality standards related to how complaints are dealt with and responded to.
The Service is required to have a process for dealing with and responding to Serious Incidents including those related to safeguarding and child protection.
57. Staff performance
The Service shall provide exception reports where staff performance is identified as having an adverse impact on the delivery of the service.
58. Partnership Performance
The Service and the Council will work together to demonstrate the value of this contract in delivering outcomes for children, young people and adults, for example when either organisation is subject to an inspection by a government or professional body.
The Service shall provide information to support needs assessment and any other monitoring reports required by the Council, the Children’s Safeguarding Partnership, the Health and Wellbeing Board or other relevant Committees or Boards, as set out in the Information Sharing Agreement set out in Schedule 6 of the Section 75 Agreement.
59. Auditing Impact and Outcomes
To provide assurance that frontline practice is safe and delivering its stated objectives, the Service shall carry out relevant audit exercises and use the findings to inform and improve practice. The Service will submit an annual audit/service transformation plan to be agreed with the Council.
Appendices
Appendix 1: Table Illustrating Number of Children and Young People by Early Help Service Team Area
|
Early Help Service Team Area |
Number of Children & Young People |
|||||||
|
0 to 19 Pop |
Under 5 Pop |
5 to 19 Pop |
Eligible for FSM (Jan 20) |
Children subject to CPP |
Children subject to CiN Plan |
0-19 Early Help cases |
Open Early Help Households |
|
|
Craven |
11142 |
2439 |
8703 |
594 |
11 |
86 |
142 |
72 |
|
Hambleton |
18120 |
3992 |
14128 |
1269 |
30 |
120 |
284 |
172 |
|
Harrogate |
9348 |
2313 |
7035 |
603 |
11 |
75 |
150 |
82 |
|
Knaresborough |
12525 |
2694 |
9831 |
794 |
28 |
79 |
189 |
103 |
|
Ripon and Rural |
13802 |
2570 |
11232 |
663 |
12 |
76 |
211 |
103 |
|
Richmondshire |
11378 |
2625 |
8753 |
666 |
21 |
86 |
168 |
93 |
|
Ryedale |
10834 |
2425 |
8409 |
782 |
23 |
84 |
226 |
106 |
|
Scarborough |
16504 |
4066 |
12438 |
2157 |
123 |
228 |
428 |
213 |
|
Selby |
11503 |
2883 |
8620 |
818 |
35 |
98 |
255 |
121 |
|
Selby Rural |
8736 |
2179 |
6557 |
384 |
14 |
39 |
113 |
51 |
|
Whitby |
4928 |
1062 |
3866 |
419 |
17 |
58 |
137 |
70 |
FSM – Free School Meals
CPP – Child Protection Plan
CiN – Child in Need
DSF – Developing Stronger Families
TAC – Team Around Child
Appendix 2 - National Policy, Guidance and Applicable Quality
North Yorkshire Local Transformation Plan for Children and Young People’s Emotional and Mental Health 2015-2020 October 2019 Refresh
Young and Yorkshire 2 – North Yorkshire Children and Young People’s Plan 2018
Working Together to Safeguard Children A guide to inter-agency working to safeguard and promote the welfare of children, (DfE March 2018)
North Yorkshire Early Help Strategy, 2018
Hope, Choice and Control – North Yorkshire Mental Health and Wellbeing Strategy 2015-20
Future in Mind - Improving mental health services for young people. (DHSC 2015)
Rapid Review to Update Evidence for the Healthy Child Programme 0–5. (DoH 2015)
Safeguarding children and young people: roles and competencies for health care staff. Intercollegiate document. (Royal College of Paediatrics & Child Health 2014).
NHS Outcomes Framework 2014 to 2015 (DH, 2013)
Public Health Outcomes Framework 2013 to 2016 (DH, 2014)
The Marmot Review (2010) Strategic Review of Health Inequalities in England, post-2010
Conception to Age two: The Age of Opportunity. WAVE Trust and DfE
UNICEF UK Baby Friendly Initiative
Rapid Review to Update Evidence for the Healthy Child Programme 0–5 (PHE, March 2015)
Promoting children and young people’s emotional health and wellbeing: A whole school and college approach (PHE and The Children and Young People’s Mental Health Coalition, March 2015)
Healthy Child Programme – Pregnancy and the first five years of life (DH, 2009 amended August 2010)
Better health outcomes for children and young people Pledge
Allen, G. (2011a) Early Intervention: The Next Steps. HM Government: London
Allen, G. (2011b) Early Intervention: Smart Investment, Massive Savings. HM Government: London
Promoting the health and wellbeing of Looked After Children (DH and DoH 2015)
Looked After Children Rolls and competencies of Healthcare Staff Intercollegiate Document: December 2020 (RCN & RCPCH)
CQC Essential Standards of Quality and Safety 2010
UK National Screening Committee Standards and Guidelines
Newborn Bloodspot Screening
Newborn Hearing Screening
Newborn Infant & Physical Examination
The Green Book- (Imms)
Key NICE public health guidance includes:
NICE guidance summary for public health outcome domain (PHE 2013) https://www.gov.uk/government/publications/nice-guidance-summary-for-public-health- outcome-domain
Please note: For all reference seethe NICE website.
· PH3 – Prevention ofsexually transmitted infections and under 18 conceptions
· PH6 – Behaviour change atpopulation, community and individual level (Oct 2007)
· PH8 – Physical activity and theenvironment
· PH9 – Community engagement (July 2010)
· PH11 – Maternal andchild nutrition
· PH12 – Social and emotional wellbeing in primary education
· PH14 – Preventing theuptake of smoking by children and young people
· PH17 – Promoting physical activity for children and young people
· PH21 – Differences in uptake in immunisations
· PH24 – Alcohol-use disorders: preventing harmful drinking
· PH26 – Quitting in smoking in pregnancy and following childbirth (June 2010)
· PH27 – Weight management before, during and after pregnancy (July 2010)
· PH28 – Looked-after children and young people: Promoting the quality of life of looked-after children and young people (October 2010)
· PH29 – Strategies to prevent unintentional injuries among children and young people agedunder 15 Issued (November 2010)
· PH30 – Preventing unintentional injuries among theunder-15s in the home
· PH31 – Preventing unintentional road injuries among under-15s
· PH40 – Social and emotional wellbeing – early years: NICE public health guidance 2012
· PH42 – Obesity working with local communities
· PH44 – Physical activity: brief advice for adults in primary care
· PH48 – Smoking cessation: acute, maternity and mental health services http://www.nice.org.uk/guidance/PH48
· PH49 – Behaviour change: individual approaches
· PH50 – Domestic violence and abuse: how health services, social care and the organisations they work with can respond effectively. NICE public health guidance http://www.nice.org.uk/guidance/PH50
· CG43 – Obesity: Guidance on the prevention, identification, assessment and management ofoverweight and obesity in adults and children
· CG45 – Antenatal andpostnatal mental health: clinical management and service guidance (February 2007)
· CG62 – Antenatal care: routine carefor the healthy pregnant woman (March 2008)
· CG89 – When to Suspect Child Maltreatment (July 2009)
· CG93 – Donor milk banks: the operation of donor milk bank services
· CG110 – Pregnancy and complex social factors:A model for service prevision for pregnant women with complex social factors
· CG170 – Autism: the management and support of children and young people on the autism spectrum http://www.nice.org.uk/guidance/cg170
· QS22 – Quality standards for antenatal care
· QS31 – Quality standard for the health and wellbeing oflooked-after children and young people
· QS37 – Postnatal Care
· QS59 – Antisocial behaviour and conduct disorders in children and young people http://www.nice.org.uk/guidance/QS59
· QS43 – Smoking cessation:supporting people to stop smoking
· QS46 – Multiple pregnancies
· QS48 – Depression in children and young people
· QS51 – Autism http://www.nice.org.uk/guidance/QS51
· Suite of Evidence based pathways and interventions
· Svanberg P O, Barlow J & TigbeW The Parent–Infant Interaction Observation Scale:
· Reliability and validity of a screening tool. Journal of Reproductive and Infant Psychology,
· 2013: Volume 31, Issue 1, 2013
· Milford R, Oates J. Universal screening and early intervention for maternal mental health and attachment difficulties. Community Practitioner, 2009; 82(8): 30-
Appendix 3 – Health Reviews
|
Review |
Description |
|
Universal
Antenatal health promoting visits – a robust referral process will need to be developed and agreed with Local Maternity Services |
Contact should be universal and include preparation for parenthood messages.
Promotional narrative listening interview.
This should be done as a blended approach including face-to-face at home or via a virtual platform following an cumulative risk assessment. If a vulnerability is identified a face-to-face contact would be required. Identified potential vulnerabilities could include:
· domestic abuse; · young parent · poverty; · homelessness. · Mental health · substance misuse; · recent arrival as a migrant; · asylum seeker or refugee status; · difficulty speaking or understanding English; · Previous LAC
|
|
Universal
New Baby Review |
Face-to-face home contact between 10-14 days with mother and partner to include:
· Initial relationship building with family following birth · Infant feeding · Promoting sensitive parenting · Promoting development · Assessing maternal mental health · SIDS prevention including promoting safe sleep · Keeping safe · Promoting community support services · Discussing consent to share information
· An assessment of baby’s growth · On-going review and monitoring of the baby’s health · Assessment of safeguarding concerns · Promotion of secure attachment. · Include promotion of immunisations specificallyAdherence to vaccination schedule for babies born to women who are hepatitis B positiveAssess maternal rubella status and follow up of two MMR vaccinations (to protect future pregnancies). · Checking of the status of all screening results and take prompt action to ensure appropriate referral and treatment pathways are followed in line with UK NSC Standards, specifically: · Newborn blood spot; ensuring results for all conditions are present · Results of NIPE examinations · Hearing screening outcome. · Contraception (all families): provision of post-natal contraception to reduce sexually transmitted infections and subsequent unplanned pregnancies
Additional/ complex health needs –where a child remains in hospital contact will be negotiated and the service will play a key part of discharge planning and support.
|
|
Universal
6 – 8 Week Assessment |
This should be done as a blended approach including face-to-face at home or via a virtual platform following an cumulative risk assessment. If a vulnerability is identified a face-to-face contact would be require.
Includes:
· On-going support with breastfeeding involving both parents · Assessing maternal mental health o Assessment of the mother’s mental health at six to eight weeks, by asking appropriate questions for the identification of depression, such as those recommended by the NICE
1. The baby’s GP (or nominated Primary Care examiner) will have responsibility for ensuring the 6-8 week NIPE screen is completed for all registered babies 2. Include promotion of immunisations specifically: a. Adherence to vaccination schedule for babies born to women who are hepatitis B positive b. c. Checking of the status of all screening results and take prompt action to ensure appropriate referral and treatment pathways are followed in line with UK NSC Standards as above in initial check.
· Promoting community support services · Discussing consent to share information · Agree plan of ongoing care
|
|
Universal
9 – 12 months |
This should be done as a blended approach including face-to-face at home or via a virtual platform following an cumulative risk assessment. If a vulnerability is identified a face-to-face contact would be require.
Includes:
· Assessment of the baby’s physical, emotional and social development and needs in the context of their family using evidence based tools, for example, Ages and Stages 3 and SE questionnaires; · Promote language development; · Supporting parenting, provide parents/carers with information about attachment and developmental and parenting issues; · Monitoring growth; · Health promotion, raise awareness of dental health and prevention (ensuring that all children are accessing primary dental care services for routine preventive care and advice), healthy eating, injury and accident prevention relating to mobility, safety in cars and skin cancer prevention; · Check newborn blood spot status and arrange for urgent offer of screening if child is under 1 year; · Adherence to vaccination schedule and final serology results for · Babies born to women who are hepatitis B positive; status of · · Promoting community support services · Discussing consent to share information · Agree plan of ongoing care
|
|
Universal
By 2 – 2½ Years |
This should be done as a face-to-face.
Includes:
· Review with parents/carers the child’s social, emotional, behavioural and language development using ASQ 3 and ASQSE(Social-Emotional); · Respond to any parental/carer concerns about physical health, growth, development, hearing and vision; · Where weight management issues are identified families will be encouraged and supported to access an appropriate evidence based intervention. · Offer parents/carers guidance on behaviour management and opportunity to share concerns; · Offer parent/carer information on what to do if worried about their child; · Promote language development; · Encourage and support to take up early years education; · Give health information and guidance; · Review immunisation status; · Offer advice on nutrition and physical activity for the family; · Raise awareness of dental care, accident prevention, sleep management, toilet training and sources of parenting advice and family information;
This review should be integrated with the Early Years Foundation Stage two year old summary as described in the service model. · Promoting community support services · Discussing consent to share information · Agree plan of ongoing care
|
1.1 This Schedule details the Council Health Related Functions that will be exercised by the Trust under this Partnership Agreement. This Schedule may be subject to amendment from time to time.
2 COUNCIL HEALTH RELATED CARE FUNCTIONS – 0-5 SERVICE
2.1 The Council Health Related Functions include the functions under Regulation 5A of The Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) Regulations 2013, as amended.
2.2 The Regulations described in paragraph 2.1 above require local authorities to carry out five mandated child development reviews, providing a national, standardised format to ensure universal coverage and ongoing improvements in public health (as set out in Regulation 5A(2) of the Regulations referenced in paragraph 2,1 of this Schedule 2).
2.3 the five mandated reviews are:
2.3.1 the antenatal health promoting visit;
2.3.2 the new baby review;
2.3.3 the six to eight week assessment;
2.3.4 the one year assessment; and
2.3.5 the two to two-and-a-half year review.
3 COUNCIL HEALTH RELATED CARE FUNCTIONS – 5-19 SERVICE
3.1 The Council Health Related Functions include the functions under the 2006 Act, specifically Schedule 1, paragraph 1 which requires local authorities to:
“provide for the medical inspection at appropriate intervals of pupils in attendance at schools maintained by [the local authority] and for the medical treatment of such pupils.”
4 Trust NHS functions - 0-19 Service
4.1 The NHS Functions which the Trust will exercise in conjunction with the Council Health Related Functions include those functions that the Trust exercises to deliver the following NHS services:
4.1.1 Specialist children’s services (complex health needs and disabilities);
4.1.2 Speech and language therapy;
4.1.3 Acute and community paediatrics;
4.1.4 Specialist safeguarding service for children; and
4.1.5 Childhood immunisations.
Schedule 3– financial CONTRIBUTIONS
1.1 This Agreement is proposed to continue in force for a period of two years, nine months with three potential extensions of three, two and two years respectively, totalling a maximum of nine years and 9 months.
1.2 Subject to paragraph 1.5 below, the Council agrees to pay the Financial Contributions set out in the row in the table below called “Revised service 0 -19 after savings applied” to the Trust in respect of the delivery of the Council’s Health Related Functions:
1.3 The Council’s Financial Contribution for each Financial Year will be paid quarterly in advance in four equal instalments. The Trust is not required to issue an invoice.
1.4 If the Partners do not agree to extend the Agreement in accordance with Clause 2.3 of this Agreement (or otherwise), the Council may reduce the payment for the final Quarter of this Agreement by £67,500 which will represent the previously agreed funding support provided by the Council to the Trust in the Financial Year 2022-23 (see above table) as part of the Financial Contributions for that year.
1.6 If the process outlined in paragraph 1.5 above introduces a level of risk to the Service, or a financial risk to either or both Partners, the Partners agree to act at the earliest opportunity to understand the potential scale of any shortfall and develop options for how this could be managed. Jointly-developed proposals will be shared with the Healthy Child Board for further development or approval. The Partners agree to use reasonable endeavours to work together to reach a position where there is a good outcome for both Partners, and importantly the children and families this Service serves.
2.1 Any costs arising out of the Trust’s use of Council Premises to provide the Services will be addressed in a separate licence agreement.
3.1 As at the Commencement Date, the Services are exempt from VAT and VAT is therefore not payable in additional to the Financial Contributions.
Schedule 4– GOVERNANCE STRUCTURE
1.1 The purpose of this Schedule 4 is to set out the governance structure for the Partnership Arrangements under this Agreement which will apply from the Commencement Date.
1.2 This Schedule includes the terms of reference of the groups directly involved in the governance of this Agreement and describes those of relevance to it.
2.1 The Healthy Child Board will oversee the strategic implementation of this Agreement, ensuring the terms of this Agreement and the spirit of the Partnership Arrangements are adhered to.
2.2 This Healthy Child Board will be chaired by the Council’s Director of Children and Young People’s Services and the vice-chair will be the Trust’s [Deputy Chief Executive/Finance Director]. In the absence of the chair or vice chair, a deputy chair will be appointed by members in attendance at the relevant meeting.
2.3 The arrangements set out in paragraph 2.2 of this Schedule 4 will continue until the Expiry Date. If the Partners agree to extend this Agreement, the arrangements will be reviewed by the Partners.
2.4 The Healthy Child Board will have responsibility for:
2.4.1 Overseeing the provision of the Services;
2.4.2 Ensuring the Services meet the public health mandate and the financial; performance; quality; and safeguarding requirements as set out in this Agreement;
2.4.3 Developing integrated partnerships and pathways between children’s services to improve outcomes for children, young people and families, reducing duplication and increasing efficiency (including “Early Help”; “No Wrong Door”; acute and community paediatrics; and other relevant services);
2.4.4 Developing a work programme to address the factors set out in paragraph 2.4.3 above;
2.4.5 Reviewing opportunities for integrated provider management approaches between the Council and the Trust;
2.4.6 Resolving issues escalated to the Healthy Child Board by the Healthy Child Mobilisation Group;
2.4.7 Overseeing progress against, and agreeing any further required action in respect of, the Service Improvement Plan;
2.4.8 Review and approval of an annual report (formulated in accordance with Clause 17 of this Agreement) on all service, financial, performance, quality and safeguarding issues for further review and approval by the Trust’s Board and the Council so that the Healthy Child Board can be assured that this Agreement is being delivered effectively and the public health mandate met; and
2.4.9 Review and approval of the Service Transformation and Development Plan (formulated in accordance with Clause 8 of this Agreement) which shall set out how the Services are delivered at the time the Service Transformation and Development Plan is developed, achievements and future plans for review and approval by the Healthy Child Board.
2.4.10 Putting in place periodic Service audits and deep dives, as agreed between the Partners, to give assurance as to the progress being made by the Trust against the Service Improvement Plan.
2.5 Membership of the Healthy Child Board will include:
2.5.1 For the Council:
(a) Director of Children’s Services;
(b) Public Health Consultant;
(c) Assistant Director of Strategic Resources; and
(d) Assistant Director of Children and Young People’s Services.
2.5.2 For the Trust:
(a) Deputy Chief Executive and Director of Finance;
(b) Operational Director;
(c) Head of Safeguarding and Lead Nurse for Public Health and Quality; and
(d) Clinical Director.
2.5.3 Non-voting members:
(a) Chief Nurse for the relevant clinical commissioning group (or an equivalent clinical commissioning representative)
2.6 Other relevant officers may attend any meeting of the Healthy Child Board by invitation, as and when required, and as agreed by both Partners. Any invited attendee who is not a member or appointed deputy may contribute to the discussion but does not have a say in decision making i.e. their agreement is not required for the Healthy Child Board to make a decision in accordance with paragraph 2.11 below.
2.7 Where a member of the Healthy Child Board is unable to attend a meeting, the relevant Partner will appoint a deputy to attend on their behalf. Where a deputy is appointed, the relevant Partner will ensure that the deputy has appropriate authority to take decisions as required and that the appointment is recorded in writing and sent to the chair and vice chair ahead of the scheduled meeting.
2.8 The Healthy Child Board will meet as frequently as required to undertake its business, but shall hold a minimum of 4 meetings per annum. In the first year of this Agreement the Healthy Child Board will meet on a bi-monthly (8 weekly) basis.
2.9 The Council will provide the secretariat to the Healthy Child Board and will collate and distribute the agenda for each meeting, with papers being sent out a minimum of 5 Working Days in advance of each Healthy Child Board meeting
2.10 In order for any meeting of the Healthy Child Board to be quorate, there must be at least 2 members (or appointed deputies) from each Partner in attendance.
2.11 Subject to paragraph 2.12, decisions of the Healthy Child Board can only be taken where all the members (or their deputies) in attendance at the meeting agree.
2.12 Where a decision to be taken by the Healthy Child Board is a decision that for the Trust is a decision that is delegated to the Deputy Chief Executive only (being any decision which would otherwise be a Board decision save for such delegation), the Healthy Child Board may only take a decision where that decision is agreed by the Deputy Chief Executive on behalf of the Trust and the Council members.
2.13 Where members of the Healthy Child Board do not have the requisite authority to make decisions, they must escalate such decisions to the relevant authority holder in line with their respective organisation’s constitution and governance arrangements.
3 healthy child mobilisation group
3.1 The Healthy Child Mobilisation Group will oversee the mobilisation and delivery of the Service, ensuring that the Service is delivered in accordance with the Partnership Arrangements.
3.2 The Healthy Child Mobilisation Group will be co-chaired by the Trust General Manager and the Commissioning Manager, Health, Inclusion (CYPS) for the Council.
3.3 The Healthy Child Mobilisation Group will have responsibility for:
3.3.1 Overseeing the delivery of the mobilisation plan;
3.3.2 Implementing the healthy child mandate and the Services;
3.3.3 Resolving issues escalated to the Healthy Child Mobilisation Group by either Partner or where this is not possible, escalating issues to the Healthy Child Board.
3.3.4 Overseeing and facilitating the following work streams:
(a) Contracting
(b) Safeguarding board concerns;
(c) Relevant operational meetings; and
(d) Transformation work streams.
3.3.5 Subject to the direction of the Healthy Child Board, developing integrated partnerships and pathways between children’s services to improve outcomes for children, young people and families; reduce duplication; and increase efficiency including ‘Early Help’, ‘No Wrong Door’, acute and community paediatrics and other services.
3.3.6 Preparing an annual report (formulated in accordance with Clause 17 of this Agreement) on all service, financial, performance, quality and safeguarding issues for review by the Healthy Child Board.
3.3.7 Developing the framework and content for the Service Transformation and Development Plan (in accordance with Clause 8 of this Agreement) which shall set out how the Services are delivered at the time the Service Transformation and Development Plan is developed, achievements and future plans for review and approval by the Healthy Child Board.
3.4 Membership of the Healthy Child Mobilisation Group will include:
3.4.1 For the Council:
(a) Commissioning Manager;
(b) Lead Consultant in Public Health; and
(c) Representative of Children and Young Peoples Service
3.4.2 For the Trust:
(a) General Manager;
(b) Service Managers;
(c) Safeguarding Lead;
(d) Head of Charity; and Business Development Project Manager
3.5 In the first instance, the Healthy Child Mobilisation Group will meet on a fortnightly basis with a view to transitioning to a timetable that is determined as appropriate by the Healthy Child Mobilisation Group.
3.6 The Council will provide the secretariat to the Healthy Child Mobilisation Group and will collate and distribute the agenda for each meeting, with papers being sent out in advance of each meeting.
3.7 In order for any meeting of the Healthy Child Mobilisation Group to be quorate, there must be at least 1 Council member and 2 Trust members in attendance.
3.8 The Healthy Child Mobilisation Group can make decisions by consensus through its membership but only if the members in attendance have the relevant authority to make such decisions.
4 Governance structure chart
4.1 The diagram below illustrates the governance arrangements agreed between the Partners.
Partnership Governance Framework for Integrated 0-19 Healthy Child Service
Schedule 5 –
PERFORMANCE MANAGEMENT FRAMEWORK
Schedule 6 – INFORMATION SHARING AGREEMENT [TO BE INSERTED PRIOR TO COMPLETION]