PCTChelt Sure Start Report by asafwewe


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									                                                                                 Agenda Item 4

      Cheltenham and Tewkesbury Primary Care Trust Board
                             Tuesday 7th December 2004
                                   Sure Start Report
                       Directorate of Service Provision

1. Summary & Recommendations
1.1 This report details the progress made to date of the Sure Start project for health visiting
and midwifery services. The project has been in progress since October 2003 and highlights
the developments of the project across the two Sure Start areas within Cheltenham. This
report highlights that the Sure Start model of service delivery is effective in reaching
families who do not readily access traditional health care provision. My recommendation is
therefore to acknowledge the Sure Start method of service delivery and to replicate the
model across other areas of deprivation within the PCT.

1.2 It is recommended that :

1.2.1. The Board notes the content of this report to allow an informed debate regarding the
replication of the Sure Start model of health visiting and midwifery service delivery within
other areas of deprivation across the PCT.( To aid in these discussions at the Board meeting
time has been allocated for a presentation by Gill Newell, Sure Start health visitor and Tina
Duffy, Sure Start midwife)

2. Purpose
2.1 This report informs the Board of activities undertaken within the Cheltenham Sure Start
areas and highlights the alternative methods of delivering health care to local people . A
report ‘Picture of Health?’ written by the Sure Start health visitor and midwife highlights the
need for locally delivered support and services by residents living in these areas, and that
traditionally delivered health services have been ineffective in reducing the effects of poverty
and deprivation as they are not designed to reach those who need it the most.

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2.2 Areas covered in this report are:

   •   History and background of Sure Start Project nationally

   •   History and background of Sure Start Project locally

   •   Progress to date of work developed in the Sure Start areas

   •   Evidence of effectiveness in new model of delivering midwifery and health visiting


   •   Recommendations for developing the services further

3. Items for Report
3.1 History and background of Sure Start project nationally

3.1.1 Sure Start is a national government funded initiative to improve the life outcomes for
families with young children living in areas of deprivation. There are four strategic objectives
associated with the project.

   •   Improving social and emotional well being:

   •   Increasing the number of children with normal, social and emotional behaviour for
       their age.

   •   Implementing culturally sensitive ways of identifying, caring for and supporting
       women with postnatal depression

   •   Improving health:

   •   5% reduction in the number of parents who smoke

   •   5% increase in the number of women who breastfeed their babies

   •   10% reduction in children 0-3 years due to severe accidental injury, respiratory
       infection or gastroenteritis.

   •   5% reduction in the number of teenage mothers

   •   Find ways to support parents in caring for their children both before and after birth.
       eg, through classes, group work and working with fathers.

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   •   Enhancing play opportunities and learning

   •   Increase in the proportion of children with normal communication skills at the end of
       the foundation stage.

   •   Increase in the number of children with normal speech and language development at
       2 years

   •   Strengthening communities.

   •   Community involvement

Within each strategic objective the targets highlighted are those where the work of the
health visitors and midwives are specifically involved. These targets also reflect some of
those set out within the PCT Local Delivery Plan.

3.2 History and background of Sure Start project locally

The Sure Start Cheltenham project was launched in 2002 after the approval of the Delivery
Plan. The Sure Start midwife and health visitor were appointed in October 2003. Due to the
success of the first six months of the project additional funding was agreed to appoint a
further health visitor and midwife to the team. The team cover the two identified Sure Start
areas for Cheltenham which are, Hestersway and Whaddon. The team are based in
Whaddon at St.Michaels Cornerstone Trust.

Research has indicated that traditionally delivered services are ineffective at reducing the
effects of poverty and deprivation because they are not designed to reach those who need
them most. The Sure Start health visitor and midwife have been successful in designing their
services to meet the identified health needs and deliver services in a way that makes them
accessible and acceptable to local families.

After 6 months in post a report ‘A Picture of Health?’ was produced by the team which
highlighted the need for a multi agency approach to health improvement and of the
community development approach to service delivery. This way of working has provided
opportunities to develop much needed extra services to families particularly those belonging
to disadvantaged groups within small identifiable communities without the commitment of GP
attached caseload working.

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3.3 Progress of work to date

3.3.1 As the health visitors and midwives are not expected to carry caseloads they have the
additional capacity to develop links with other agencies and work in partnership to develop
services identified by health data and the expressed need of the community to reduce health
inequalities. To date the following have been developed:

   •   The ‘Picture of Health?’ Report which acts as a foundation for further developing the
       Sure Start model across other areas as of deprivation within the PCT.

   •   Greater multiagency working utilising other peoples skills.

   •   Consultation with parents including parental involvement via health sub groups and
       individual feedback from drop in sessions.

   •   Drop in Sessions- antenatal and postnatal including family ‘drop ins’ across both
       Sure Start areas.

   •   Breast feeding support group based in Whaddon – BEARS

   •   Smoking cessation drop in clinic

   •   Teenage ‘drop ins’ at Whaddon Oasis Youth Centre and Hestersway Youth Centre

   •   World Mental Health Day project

3.4 Evidence of effectiveness in new model of delivering midwifery and health
visiting services

The health visitors and midwives have developed a community development approach to
service delivery whereby services are designed and implemented by service users rather
than service providers. This is not a familiar model for health professionals, yet is widely
used by non health agencies eg. The Neighbourhood Project. Service providers facilitate the
groups and respond to requests for health advice/information but do not impose an agenda
or programme on a group. The community development approach developed with
geographical working produces a very different model of service delivery. It is characterised
by developing good relationships with families, listening to them and working with them to
provide services they want and value.

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Within the Sure Start areas parents have been involved in deciding on venues for groups
taking into account places where there has been a very poor uptake of existing services,
little community involvement, and few services available in the community for parents and
young children. Parents have been involved with the designing of leaflets and programmes
of activities for the groups. Due to the success of one ‘drop in’ group a venue with greater
capacity needed to be identified. As a result of the implementation of this social model of
health parents have improved self esteem, ability to build social networks as well as enjoying
health related activities.

3.5 Recommendations for developing the model of service delivery further

Due to the success of the project so far and the implementation of the community
development approach model of health visiting and midwifery service delivery, it is
recommended this model of delivery is emulated in other areas of deprivation within the PCT
such as Priors Park and St.Pauls. It is recommended the teams comprise of health visitors,
midwives, nursery nurses and psychotherapists. The teams would work geographically but
maintain links with the GP attached health visitors and midwives. They would not be
expected to carry caseloads in order have capacity to develop and implement new services
and provide extra support to families as required.

With the future development of Children’s centres the health visiting and midwifery teams
could be well placed geographically to continue to work with other agencies in improving
health and reducing health inequalities across the PCT

4. Implications
4.1 Financial                               The ongoing commitment of employing the
                                            current midwifery and health visiting team once
                                            the Sure Start funding ceases. The additional
                                            costs of employing further teams of health
                                            visitors,midwives, nursery nurses and
                                            psychotherapists. The accommodation costs,
                                            although if teams are based in Children’s
                                            Centres this maybe cost neutral

4.2 Clinical                                Not Applicable

4.3 Legal                                   Not applicable

4.4 Human Resources and Training            Require fulfilment of PREP requirements and
Needs                                       additional training maybe required if new areas
                                            of health need are identified

4.5 IT                                      The teams will require IT links to their bases.

                                            Availability of quality data to inform service
                                            development and identify health needs

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4.6 Governance                       Process for managing consistent standards
                                     across the service

                                     Develop process for risk management involving
                                     incidents and complaints

                                     Ensuring policies and procedures implemented
                                     across new service

4.7 Health and safety                Lone working issues, which are relevant to all
                                     health visiting and midwifery staff

4.8 Environmental                    Not applicable

4.9 Public and Patient Involvement   Communities have been extensively consulted
                                     and process is ongoing

4.10 Human Rights and Diversity      Not Applicable

Background papers                    Not Applicable

Contact officer                      Cate Carrington-Green

                                     Patch Manager

                                     01242 548873


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