London Borough of Newham Children's Health Service 0-19

Updated 24 April 2019

The London Borough of Newham Children’s Health Service 0-19 registered with CQC in February 2017, and has a registered manager. This was the first inspection following registration. The service is registered to provide the following regulated activities:

• Treatment of disease, disorder or injury

The London Borough of Newham provided a range of services to children and young people from 0-19 years old across the borough of Newham including:

• Health visiting.
• School Nursing.
• Family Nurse Partnership – a home visiting programme for first time young mothers 19 years or under.
• Child Development Service – supporting children with disabilities up to the age of five years.
• Perinatal Mental Health Team.
• Safeguarding Advisors Team.

Practitioners deliver care and treatment to children and young people in their own home, in schools, in health centres and children’s centres across the local area.

Health visiting and school nursing within Newham was previously provided by a local NHS Foundation Trust. The school nursing service transitioned from the NHS to the London Borough of Newham in February 2017 followed by the health visiting team and family nurse partnership in August 2017.

Staff worked together in integrated teams, each led by a clinical lead and integrated team manager, and were based in four localities: West, South, East and Central across the borough of Newham.

Demographic data about the London Borough of Newham:

• 85,755 children living in Newham in 2018.
• 94% school children were from a black and minority ethnic group (School Census 2017).
• 19.8% children were living in poverty which was above the national average.
• Infant mortality rates were lower than the England average, whilst child mortality rates were higher than the England average (2014-2016).
• Family homelessness was the worst recorded within England (2016-2017).
• The number of children recorded as obese was higher than the England average (2016-2017).

Updated 24 April 2019

Newham Children’s Health Service 0-19 is operated by the London Borough of Newham. The service has approximately 200 staff operating within teams in four localities across the borough.

The service provides a range of health services for children and young people aged 0-19 years, and their families. These include health visiting, school health nursing, family nurse partnership, a child development team and perinatal mental health team. We inspected services for children and young people.

We inspected this service using our comprehensive inspection methodology. We carried out our announced inspection on 29 to 30 January 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

This is the first time this service has been inspected. We rated it as Good overall.

We found the following areas of good practice:

• Safeguarding processes were in place to protect children and young people from harm. The service had good multi-agency working to identify and share risks. Staff received regular safeguarding supervision and had access to support from safeguarding advisors attached to each locality.

• Equipment used by school health nurses and health visitors was readily available, with electrical safety testing undertaken on all the equipment we checked.

• Comprehensive risk assessments were undertaken with care plans developed to address risks identified.

• Recruitment following the transition of the service to the local authority had meant staffing levels and skill mix had improved.

• Staff were aware of their responsibilities for incident reporting, and many were able to describe lessons learnt from incidents within the service and from serious case reviews.

• Children and young people’s needs were assessed and treatment was delivered in line with current legislation, standards and recognised evidence based guidance.

• Staff were competent and had the right skills to do their job. There were good training and development opportunities open to staff.

• We saw a range of multi-disciplinary and collaborative working relationships with other professionals and agencies.

• All parents and carers we spoke with said they were happy with the service provided by the health visiting and school nursing teams. Staff were described as kind and caring, and service users were treated with dignity and respect.

• Service pathways and provision were targeted to the needs of the individual, and the service met the needs of those that were vulnerable in a variety of ways.

• School nurses and health visitors worked flexibly with children, young people and their families to encourage engagement with the service.

• Despite many significant issues facing the service since its’ transition to the local authority senior managers had taken steps to address these, and there was ongoing continuing improvement.

• Managers told us they felt listened to by senior managers and staff felt well supported by clinical leads and integrated team managers.

• Staff were engaged through several groups and forums. Service users had been involved in staff recruitment and a service user feedback forum was being introduced.

However, we also found the following issues that the service provider needs to improve:

• The service was not meeting their mandatory training targets for nine out of the 18 training modules. Staff were not meeting compliance rates for conflict resolution (30%), sepsis (41%) and fire safety (62%).

• There was no written formal guidance for escalating complex safeguarding concerns, although there were systems in place for good communication exchange, and staff were able to describe how they would escalate any concerns.

• The safeguarding policy was not easily accessed by staff. The document was saved under clinical policies on the intranet. Several staff found it difficult to locate and open the policy in a timely manner.

• Staff received training in the Mental Capacity Act (2005), however at the time of our inspection compliance was 67% falling below the service target of 90%. We saw Mental Capacity Act (2005) training was scheduled in the two months following the inspection which staff were expected to attend.

• Health promotion information was available on several topics. However, leaflets were much more widely available in some locations compared to others and were mainly provided in English and standard print size.

• Most service users we spoke with said that it was not clear to them how to provide feedback or raise a complaint. Senior managers acknowledged there was still work to do to make the complaints system clearer.

• The service was not always able to extract the relevant data from the system to run reports on the key performance areas of delivery. Managers were liaising with the relevant parties to ensure that the correct reporting requirements were in place and at the time of inspection, we were told this was still work in progress.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve.

Nigel Acheson

Deputy Chief Inspector of Hospitals (London and South East)

Updated 24 April 2019