SURE START CHILDRENS CENTRES STRATEGIC PARTNERSHIP HEALTH by asafwewe

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									         SURE START CHILDREN’S CENTRES
            STRATEGIC PARTNERSHIP


               HEALTH PARTNERSHIP GROUP



                   MODEL OF
           COLLABORATION & PARTNERSHIP




                                                                                               May 2006



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                                                  INDEX


Page 3                                                 Executive Summary

Chapter 1 - Pages 4–5                                  Background Information

Chapter 2 - Page 6-7                                   Core Offer/Key Targets

Chapter 3 - Page 8                                     Current Situation

Chapter 4 - Page 9-10                                  Proposal

Chapter 5 - Page 11-12                                 Principles for Agreement


APPENDICES

Appendix 1 – Universal Health Visiting Service

Appendix 2 – Community Midwifery Services

Appendix 3 – Acute Paediatric Services

Appendix 4 – Community Paediatric Services

Appendix 5 – Early Support Programme

Appendix 11 – Children’s Centres

Appendix 12 – Action Plan Timeframe

APPENDICES PENDING
Appendix 6 – Community Dental Health Service

Appendix 7 – CAMHS

Appendix 8 - Health Promotion

Appendix 9 – Teenage Pregnancy Support Services




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                                   EXECUTIVE SUMMARY

This Model of Collaboration and Partnership outlines the key steps that local
providers of services for children and young people will take to ensure that the
local health economy is responsive to the core offer for Children’s Centres.


Chapter 1 highlights the background to the development of the first wave of 11
Children’s Centres in the City of Kingston upon Hull.


Chapter 2 considers the ‘core offer’ for the development of Children’s Centres, in
particular, the Public Service Agreement Targets and Service Delivery Targets
associated with Improving Health and Social and Emotional Development and
the key health indicators of Every Child Matters.


Chapter 3 establishes the current situation in relation to national policy and the
local drivers for change.


Chapter 4 sets out the proposal to develop a city wide sub group of the Sure
Start Children’s Centres Strategic Partnership to oversee the reconfiguration of
local health service provision based on a neighbourhood model aligned with
Local Authority Area Co-ordination Boundaries. It also proposes local area
health partnerships are further developed or formed to respond to local need in a
multi-agency context.


Chapter 5 outlines the initial agreements which provide purpose and impetus for
the development of the proposed model.


The Appendices reflect individual agency response to the model with, where
appropriate, consideration of the financial implications of commissioning new and
improved provision.


Samantha Bell
May 2006


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SURE START CHILDREN’S CENTRES HEALTH PARTNERSHIP SUB GROUP

            PROPOSED MODEL OF COLLABORATION & PARTNERSHIP

Chapter 1 - Background:

Sure Start Local Programmes are the Government’s flag-ships in its attempt to
demonstrate a ‘joined up’ approach to the delivery of services to meet the needs
of children aged 0-4 years of age, their families and deprived communities.

The Index of Multiple Deprivation (2004) demonstrates that the City of Kingston
upon Hull has significant areas of deprivation, and is ranked ninth from 354 local
authority districts in England.

Similarly, 76 of the City’s Super Output Areas (SOA) fall within 10% of most
deprived areas, and a further 19, are in the top 20% of most deprived Wards in
England.

 (Super Output Areas are groups of 2001 Census output areas of approximately
equal population (1,500) which are sub divisions of current local authority wards.
Hull has 163 SOA’s, 76 are in the 10% most deprived SOA’s in England)

In the city of Kingston upon Hull there are seven Sure Start Local Programmes
situated in the top 10% of deprived wards within the City.

    •    Sure Start Northern Hull (Trailblazer Programme)
    •    Sure Start Marfleet
    •    Sure Start Noddle Hill
    •    Sure Start Longhill and Bilton Grange (2sites)                                See Appendix 8
    •    Sure Start Myton and St Andrews
    •    Sure Start Newington with Gipsyville
    •    Sure Start Newland and Avenues

In addition to these programme the City boasts a Neighbourhood Development
Company Programme (PRNDC) operating in the Southcoates Ward.

Currently, all Sure Start Local Programmes, Neighbourhood Nurseries and
Maintained Nursery Schools in the City are in the process of becoming Sure Start
Children’s Centres. In addition to the above Sure Start Local Programmes the
following will also become designated Children’s Centres by April 2006:

•       Lambert Nursery School
•       Clifton School Nursery
•       Sidmouth School Nursery (spoke of Newland & Avenues Children’s Centre
        See Appendix 8
•       Child Dynamix (PRNDC) with Escourt Primary School

(Sure Start Newington with Gipsyville will join with Wheeler Primary School to
become a Children’s Centre)

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In April 2005 a Health Sub Group of the Sure Start Strategic Partnership was
formed to consider how the local health economy would co-ordinate their
contribution to, and meet the ‘core offer’ for local Children’s Centres
Chapter 2 - The Sure Start Children’s Centres ‘Core Offer’ includes:-

1. Early Education integrated with extended day:
      • “Early Education integrated with extended day care for babies and
         children until they reach school age
      • Day care suitable for working parents a minimum if five days a week,
         48 weeks a year, ten hours a day
      • Nursery places will be open to all, not just families in the immediate
         area, to provide the best educational outcomes for all children
         (admission fee policies will be determined locally)
      • Support for childminders, who may also offer linked care.
      • Early identification of children with special needs and disabilities, with
         inclusive services and support for their families”.

2. Family Support and parental outreach;
     • “Visits to all children in the catchment area within two months of birth.
     • Access to specialist services
     • Parenting support and information as well as specific support for
         families in need and ‘hard to reach families’.
     • Providing information and advice on parenting skills at significant
         transition points for the family (e.g. pre-birth, early days, settling into
         childcare).
     • Increasing parents’ understanding of their child’s development.
     • Increasing the involvement of fathers”.

3. Child and family health services:
      • “Antenatal advice and support for parents.
      • Information and guidance on breastfeeding, hygiene, nutrition and
         safety.
      • Identification, support and care for those suffering from Post natal
         depression.
      • Speech and Language and other specialist support.
      • Smoking cessation interventions”.

4. Links with schools and the Children’s Information Service (CIS);
      • Links to local schools, extended schools and out of hours activities
         (holiday play schemes, before/ after school play and learning).
      • Information to parents/carers about CIS

5. Links with Jobcentre Plus:
      • Linking in with local arrangements (e.g. via local authority’s service
         level agreement) for collaboration with jobcentre Plus Childcare
         partnership Managers.
      • Encouragement and support for parents and carers who wish to
         consider training and employment”.



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             Parental Involvement should include:
                   • Consultation with parents and carers, including fathers on what
                       services to offer, and systems to get user feedback on services.
                   • Ongoing arrangements in place to ensure parents and carers have a
                       voice.
                   • Mechanisms that enable parents and carers to self-refer for services.
                   • Specific strategies to include fathers.
                   • Ensuring family support and health advice is available at times suitable
                       for working parents and carers.

              Meeting existing and new PSA/SDA Targets;
             “Health targets to reduce health inequalities and improve life chances for children
             are particularly relevant to the Children’s Centres agenda.
             Sure Start local programmes and Children’s Centres will address a number of
             specific health issues likely to promote healthy pregnancy and provide a good
             foundation in early childhood. Health objectives to support teenage parents are
             also supported by the Sure Start agenda”.
             (DfES 2004 - Sure Start Guidance 2004-2006)

Table I
Public Service Agreement (PSA) and Service Delivery Agreement (SDA) Targets for
Improving Social and Emotional Development and ‘Improving Health’:

 Objective       Sure Start PSA Target                    Sure Start SDA Targets                        Every Child Matters
                                                                                                         Health Indicators
Improving       An (x) per cent increase in • All families with newborn babies • Death rate from suicide and
Social and      the proportion of babies       in Sure Start local programmes         undetermined injury
Emotional       and young children aged        and Children’s centres areas to      • Improvement in access to
Development     0-5 with normal levels of      be visited in first 2 months of their CAMHS
                personal, social and           babies’ life and given information
                emotional development for      about the services and support
                their age. (The target applies available to them.
                to Children’s Centres and
                SSLP areas)
Improving       A 6 percentage reduction    • Information and guidance on                         • Infant mortality rate
Children’s      in the proportion of          breastfeeding, nutrition and                        • Under 18s conception rate
Health          mothers who continue to       safety available to all families with               • Diagnostic rate of new
                smoke during pregnancy.       young children in Sure Start local                    episodes of Sexually
                (The target applies to all    programme and Children’s                              Transmitted Infections
                Children’s Centres and SSLP   centres areas.                                        among under 16years and
                areas)                      • Reduce by 10 per cent the                             16-19 year olds
                                              number of children aged 0-4                         • % Obese under 11years
                                              living in Sure Start local                          • Average alcohol
                                              programme and Children’s                              consumption
                                              Centres areas admitted to                           • % of Children who are
                                              hospital as an emergency with                         regular smokers
                                              gastroenteritis, a lower                            • % of children consuming 5
                                              respiratory infection or a severe                     portions of fruit and veg a
                                              injury.                                               day
                                             Antenatal advice and support                         • Harm caused by illegal
                                             available to all pregnant women                        drugs
                                             and their families living in Sure
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                                        Start local programme and
                                        Children’s Centres areas
Current Situation:

Currently, all Sure Start Local programmes have developed additional health
activities and initiatives. These activities have been developed specifically in
response to the expressed need of communities they serve and to tackle
normative need through a suite of national Public Service Agreements, Service
Delivery Targets and locally developed milestones.

Consequently, there is very little uniformity or standardisation of provision across
the programmes and despite some excellent examples of innovative practice
there is little opportunity to mainstream any particular model of service delivery.
The exception to this is the proposed delivery model developed by the Speech
and Language Service. (Appendix 5)

The current health agenda supports the integration of services and includes a
requirement to raise standards of care for children aged 0-16. These standards
are laid out in the National Service Framework for Children, Young People and
Maternity Services (2004), in addition to meeting the requirements of Every Child
Matters – Change for Children’ (2004), ‘Delivering Choosing Health -
Safeguarding Children’s Health’ (2004) and modernise primary care services as
recommended in the ‘Chief Nursing Officers (CNO) review of the nursing
contribution to vulnerable children and young people’ (2004)

In light of these competing agendas and the pressing call for a co-ordinated
approach to meeting local health need, the following proposal makes
recommendations for the way Sure Start Local Programmes, Children’s Centres,
other locality based initiatives and local health service partners plan and deliver
services to defined communities.




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Chapter 4 - The Proposal:

•   It is proposed that a representative Steering Group be formed to oversee the
    way forward and steer the development of a standard model of collaboration
    and partnership across the City, which ensures that the ‘Core Offer’ for
    Children’s Centres designation is met for all Children’s Centres, allows local
    flexibility to meet local need, both expressed and normative, and ensures a
    ‘joined up’ and partnership approach to service provision.

•   Furthermore, to meet the requirement to further integrate services as we
    move inextricably towards Children’s Trust Status it is proposed that, where
    practicable, all providers of services for children, young people and their
    families realign geographically with Local Authority Area Co-ordination Team
    boundaries.

•   That where there is more than one Children’s Centre designate in an Area
    boundary they will ‘cluster’ to ensure that there is no overlap or duplication of
    service provision, and no competition for the same client groups. The map
    below indicates that there are 7 Area Co-ordination Teams in the City of
    Kingston upon Hull.




•   Where no Health Partnership exists a Local Area Multi-agency Health
    Partnership will be formed to establish a ‘vision’ for that community, based on
    current demographic and epidemiological information, expressed need and
    national PSA and SDA Targets and outcomes for health improvement and
    community well-being.

•   That a sub group of the Local Multi-agency Health Partnership is developed;
           To provide a forum for practitioners to consult with parents about their
           needs and their children’s needs
           For parents to influence service development and delivery
           To recruit volunteers to support the delivery of locally based initiatives
           and parenting programmes
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             To build community capacity through training and the opportunities for
             parents to participate in the development of their community
             For the Partnership to formalise and co-ordinate activity and initiatives
             which supports parents to improve their parenting knowledge and skills
             The sub group‘s operational philosophy should be underpinned by the
             following National Occupational Standards (DfES 2004) for work with
             parents;

1. WWPA – Build and maintain effective and positive relationships with
           parents, colleagues and the wider community
2. WWPB – Develop parent’s awareness, knowledge and skills
3. WWPC – Update knowledge and reflect on own practice and support the
           development of others knowledge and practice
4. WWPD – Provide parenting services according to the values and principles of
           the sector
5. WWPE – Influence and contribute to policies, strategies and development
           opportunities for parenting services and projects
6. WWPF - Create and sustain a framework for ensuring and maintaining the
           quality of delivery of parenting




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    Chapter 5 - The following has already been agreed in principle:
         •   That at the outset Sure Start Local Programme Managers will, where
             no local Partnership exists, lead the development of Local Area Health
             Partnerships until a Local Partnership is formed and a Chair elected.
         •   The elected Chair will represent the Local Area Health Partnership on
             the City wide Sure Start Children’s Centres Health Sub Group of the
             Strategic Partnership.
         •   Primary Care Services for children and young people will nominate an
             Integrated Team Leader and/ or Senior Practitioner to represent the
             Service on the Multi-agency Health Partnership who will be responsible
             for co-ordination of universal provision and support a partnership
             approach to the development of public health initiatives.
         •   The Community Midwifery Service will further geographically realign to
             correspond with Local Area Co-ordination boundaries, thus creating 7
             Community Midwifery Teams across the City.
         •   The Midwifery Service will nominate a senior Community Midwife to
             represent the Service on the local Multi-agency Health Partnership
             who will be responsible for co-ordination of universal provision and
             support a partnership approach to the development of public health
             initiatives.
         •   Representatives from the Teenage Pregnancy Unit, Adult Mental
             Health Service, Acute Paediatric Nursing Service and the Community
             Paediatric Nursing Team and will join the City Wide Steering Group
             and actively support the proposed model and develop strategies to
             localise some specialist provision and outreach clinics.
         •   That an audit of community accommodation and facilities will support
             the above proposal to develop targeted outreach services.
         •   Existing service provision, including that provided by non-statutory
             agencies, will be mapped and, in addition to the City wide Service
             Directory, local health service directories will be developed, maintained
             and made generally available to the local people. Where there is
             duplication of services steps will be taken to co-ordinate provision.
         •   Gaps in health service provision will be identified and appropriate
             service providers will work together to develop new provision, which
             reflects national and local targets, and the 5 key outcomes for children
             and young people as rooted in ‘Every Child Matters, Change for
             Children’ (2004).
This proposal dovetails with the planned reconfiguration and modernisation the
following local health services and which are outlined in the following appendices;
             Appendix 1 - Health Visiting and School Nursing Service
             Appendix 2 - Community Midwifery Service
             Appendix 3 - Acute Paediatric Nursing Services
             Appendix 4 - Community Paediatric Nursing Service
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             Appendix 5 - Speech and Language Therapy Service
             Appendix 6 - Early Support Programme (KIDS)

See Appendix 12 for proposed timeframes
                                            Bibliography

Department of Education and Skills ( 2002) ‘Sure Start – Guide for 6th Wave
Programmes’, London.

Department of Education and Skills (2004) ‘Sure Start – Building for a Sure Start’,
London.

Department of Education and Skills (2004) ‘Every Child matters – Change for
Children’, London.

Department of Education and Skills (2003) ‘Sure Start Guidance 2004-2006’,
London.

Department of Education and Skills (2005) ‘A Sure Start Children’s Centre for
Every Community. London

Department of Education and Skills (2005) ‘A Sure Start Children’s Centre
Practice Guidance, London

Department of Health, (2004) ‘Chief Nursing Officers review of the nursing,
midwifery and health visiting contribution to vulnerable children and young
people’, London.

Department of Health, (2004) ‘Delivering Choosing Health-Safeguarding
Children’s Health’, London.

Department of Health, Department for Education and Skills (2004) ‘National
Service Framework for Children, Young People and Maternity Services’, London,
Hull City Council (2004) ‘Vision and Strategy for Children under Five’ Kingston
upon Hull.

Quinton, D (2004) ‘Supporting Parents – Messages from Research’ Jessica
Kinsley Publishers, London.




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                                                                                              Appendix 1
Universal Health Visiting and School Nursing Services
Introduction;

Prior to April 2006 health visiting and school nursing services were delivered to
defined clients determined by their registration with a General Practitioner or, in
the case of children over the age of 5 years, their designated school.

In response to the following national policy agendas and locally based initiatives
The 2 Hull City Primary Care Trusts have reconfigured universal service
provision and deployment of Health Visitors and School Nurses to strengthen
partnership working, provide opportunities for greater collaboration with other
local providers of services for children, young people, families and communities,
and provide a platform from which to further integrate services as the City moves
towards Children’s Trust status.

National Policies;

    •    NHS Plan (2000)
    •    Health for all Children (2001)
    •    Liberating the Talents (2002)
    •    Children’s Act (2004)
    •    Change for Children Programme (2004)
    •    The Children, Young People & Maternity Services NSF (2004)
    •    The Chief Nursing Officer's Review of the contribution of Nursing,
         Midwifery and Health Visiting to vulnerable children (2004)
    •    Delivering Choosing Health
    •    Sure Start Children's Centres
    •    Extended Schools
    •    Integrated Inspection Framework
    •    Common Assessment Framework

The Proposal;

    1. Health visitors and School Nurses will now deliver locally based
       services based on Area Co-ordination Team boundaries and an
       inclusive approach to service provision to include;

                  A corporate approach to provision of universal services to a post
                  code caseload
                  Children and young people not registered with a GP
                  Children and young people not registered in school
                  Children and young people excluded from school
                  Children who are privately educated or educated at home.
                  Hard to reach and marginalised families and communities.
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    2. Improved access to universal services, core surveillance and
       immunisation programmes;

                  A universal Immunisation policy based on current evidence
                  A strategy to improve the nursing contribution to the uptake of
                  primary immunisations.
                  A surveillance schedule which reflects current research (Hall 4) and
                  reflects the core Child Health Promotion Programme of the Children,
                  Young People and Maternity Services NSF for children and young
                  people aged 0-16 years of age.
                  One Operational Framework for children, young people and their
                  families which is evidence based, reflects current policy, signposts
                  practitioners to policy documents and legislation, and is mapped
                  against the 5 key outcomes of Every Child Matters.

    3. ‘A Public Health Nursing function for children and young people’
       (CNO 2004)
    • A local and needs led approach to the delivery of public health
       activities and initatives in partnership with other local providers of
       services for children, young people and their families. In particular;

                  A systematic assessment of the health needs of children in the
                  community
                  Individual health needs assessment of children, young people and
                  families using the Common Assessment Framework.
                  Identification of vulnerable children, young people and families and
                  the provision of support through effective programmes of
                  intervention that promotes health and wellbeing
                  A named practitioner for each General Practice within the defined
                  neighbourhood
                  Links between Local Authority departments, who are leading the
                  integration of children’s services, community and voluntary
                  organisations and the wider local health economy.
                  To act as the lead professional where it is the choice of the child
                  and/or parent or where the needs of the child will be best met by a
                  health professional
                  To support community based activity that improves the environment
                  within which children live.
                  To bring nursing and public health expertise to integrated services
                  and initiatives for children and young people.
                  Named Nurse for each Children’s Centre and Extended School
                  within the defined area.

   4. A proactive response to the city wide roll out of Children’s Centres
      and the national agenda for Extended Schools;

                  A named practitioner for each Children’s Centre, private nursery
                  and Extended School within the Local area boundary
                  Developemnt of a shared vision for the defined commmunity
                  /neighbourhood

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                  Joint planning and delivery of services to prevent duplication and
                  overlap
                  Where practicable, co-location of social services, education and
                  health service staff.
                  Opportunities for joint training with social services, education and
                  voluntary/community staff
                  Sharing of skills, knowledge and resources with social services,
                  education and voluntary/community staff.

The Benefits:

•   The geographical alignment of health visiting, school nursing and midwifery
    services with Local Area Co-ordination Team Boundaries will ensure that
    health visitors, school nurses and midwives will be able to take full advantage
    of the opportunity to work collaboratively and in partnership with other local
    providers of services for children, young people and their families, including
    the following Area based services;

                  Youth Forums
                  Sports Developemnt Teams /Play Development Teams
                  Social Services Children and Family Resource Teams
                  BEST / BIP Schemes, National Healthy Schools Initiative
                  Other locality based initiatives and the Health Promotion
                  Department

•   By planning and developing services in partnership with existing locality
    based services there is less likelihood of overlap and duplication of service
    provision and waste of finite resources

•   Through pooling of knowledge, skills and resources teams will maximise
    opportunities for the delivery of public health activity and initiatives to meet
    local need.

•   Geographically based Multi-agency Partnerships will support the development
    of a corporate working model that will provide universal services to defined
    communities and be in a position to target support and resources where they
    are most needed. In particular, to families who are not registered with a GP,
    transient and marginalised and hard to reach families and communities, and
    to children, young people and families who are currently ’invisible’ to universal
    service provision.

•   There will be an increase in public health activity which is directly linked to
    national and local targets for improving health as rooted in Delivering
    Choosing Health (2004) and the development of new initiatives designed in
    partnership with other local providers to meet local need.

•   There will be a continuum from universal through to specialist services for
    children, young people and their parents underpinned by the Common
    Assessment Framework and Information Sharing and Assessment
    Frameworks.

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•   By way of existing forums, there will be consultation with children, young
    people and their families on where and how services are delivered within the
    community.

•   There will be no overlap or wasteful duplication of service provision within the
    defined communities or neighbourhoods, rather a sense of shared purpose
    and local commitment.
•   There will be an increase in joint activity to support initiation of breastfeeding
    and local support to continue

•   Women with Post Natal Depression will be identified and helped to access
    local family support services.

•   There will be local access to Immunisation and a co-ordinated approach to
    the delivery of Parenting and Baby Massage Programmes to meet the needs
    of the whole community

•   Health visiting services are localised and more accessible, particularly for
    hard to reach families


Samantha Bell
Modernisation Practitioner for Children & Young People’s Services
West Hull PCT

Bridget Horner
Community Team Manager
East Hull PCT




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                                                                                              Appendix 2
Community Midwifery Services

Introduction

The Community Midwifery Service provides antenatal intra-partum and postnatal
care for all pregnant women in Hull and East Yorkshire.
This includes;
   • The provision of 24 hours 7 days a week cover for emergencies
   • Midwifery support for home confinements.
   • Parent Education/Health Promotion

The area covers Hull and East Yorkshire, providing care for up to 5,300 women
and their families who access our services each year.
Care is delivered at Women’s and Children’s Hospital and the Jubilee Birth
Centre, by midwives, clinicians and support staff.
The majority of care given to these women is provided in the community setting.
Community Service is divided between the Hull City boundary and the rural area
of East Yorkshire. For the purpose of this document we will concentrate on the
area within the Hull boundary.

Our midwifery teams are geographically based and work from Health Centres
across the city.

We have already commenced re-aligning the boundaries to fit in with this
initiative.

We currently have:

    1. Bransholme Team – situated at the Bransholme Health Centre with links
       into the Noddle Hill Sure Start.

    2. Saltshouse Team – situated at the Princess Royal Hospital with links to
       the Longhill Bilton Grange Sure Start (The Acorns Children’s Centre). This
       team now provides an antenatal clinic in The Acorns, having transferred
       from the Bilton Grange Clinic.

    3. East Hull Team – situated at Morrill Street Health Centre with links into the
       Marfleet Sure Start programme and some input into Child Dynamix
       (PRNDC) on Preston Road, where an antenatal booking clinic has been
       introduced.

    4. North Hull Team – reconfiguration of this team is well established to offer
       further integration with the Sure Start Northern Midwives resulting in 2
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         Midwives from the mainstream service based at the McMillan Sure Start
         Centre.

    5. Newland & Avenues - The remainder of the team are based at Orchard
       Park Health Centre and have developed close links with the Sure Start
       Newland & Avenues Sure Start Programme. Team Midwives are now
       providing a service in the current temporary building in the Newland
       Primary School and will move with the team into the new Children’s
       Centre in 2006. Lambert Street & Sidmouth Street Nurseries are within
       this area and there are plans for Midwifery involvement in the future.

    6. West Hull Team – this remains 1 larger team based in Marmaduke Health
       Centre, the team is within the boundaries of 3 Sure Start programmes -
       Newington with Gipsyville
       Myton & St. Andrews
       Newland & Avenues
       We have already modified the boundaries within the Hessle team to fit
       more easily with the Gipsyville Sure Start programme. We are currently in
       the process of reconfiguring the team to fit in geographically with the Sure
       Start/Children’s Centres.

Links to National Regional and Local Policies

National Service Framework for Children Young People and Maternity Services
(NSF)
National Institute for Clinical Excellence (NICE)
Children’s Act (2004)
Every Child Matters – Change for Children
Strategy Development for Women’s Mental Health
Confidential Enquiries into Maternal and Child Health (CEMACH)
Chief Nursing Officers Review
Tackling Health Inequalities
New G.P Contracts
Early Labour Support and Assessment (ELSA)
Teenage Pregnancy Strategy (DFES)

Proposal
To continue to re-design the midwifery teams in the community, in line with the
Area Co ordination Team Boundaries.

There is a need to modify the recently changed boundaries to ensure 7 smaller,
more defined teams are created. These will directly link in with the Children’s
Centres.

This may have to be continually reviewed and modified in line with increased
number of Children’s Centres.

Consideration must be given to the number of midwives available for these
teams (currently in the Hull boundary we have 27.96wte midwives) as there
needs to be a minimum number of midwives in each team. This may mean that

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one team covers more than one Children’s Centre in the future and as part of any
review of the teams skill mix will be a key consideration.

Monitoring of the accessibility of these facilities for women and their families is a
key area; otherwise the initiative may lead to exclusion rather than inclusion in
some areas of the city.

Impact / Implications on the Service


NICE
   • Introduction of NICE guidelines for Ante Natal Care has presented a
     challenge to the model of community midwifery care provision.
   • Introduction of NICE post natal guidelines may impact on post natal
     support
   • selected extended post natal visiting anticipated (due out 2006)which will
     impact on the model of care provision

G.P’S
   • New GP contracts have led to many GP’s withdrawing ante natal services
      and neo natal examination of the baby. This service is now incorporated
      within the midwifery service.

ELSA
  • The ELSA (Early Labour Support and Advice) trial due to finish in April
     2006 and its findings may impact on current model of Midwifery care.

CHILDREN’S ACT
  • Common Assessment Framework – Midwives are expected to undertake
     common assessments under the new Children’s Act Framework. These
     are time consuming and some anxieties have arisen around this.

NSF
  •      Standard 11 - ‘women have easy access to supportive, high quality
         maternity services, designed around their individual needs and their
         babies’.

Key Areas:

    •    Improving access to Midwives
    •    Choices for Women
    •    All women to have a named Midwife
    •    Risk Assessment
    •    Care of women from disadvantaged groups
    •    Pre-conceptual care
    •    Early pregnancy
    •    Birth
    •    Postnatal period
    •    Breastfeeding
    •    Teenagers

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    •    Domestic Violence
    •    Fathers
    •    Midwifery workforce
    •    Maternity supporting workforce
    •    Strategic planning & user involvement

Jan Rowe
Community Midwifery Manager
Women & Children’s Services
November 2005

                                                                                              APPENDIX 3

Acute Paediatric Services

In line with all the recommendations of the children’s NSF and Every Child
Matters, the hospital-based children’s team recognises the need to review its
current services in order to determine the future of children’s service provision
both within the hospital setting and in the community.

Children’s Clinics
It is recognised by all clinicians as well as the management team, that certain
services currently provided within the hospital setting should be delivered nearer
to, or within, the child’s home.
This should include specific outpatient clinics – namely the general paediatric
clinics. Work is currently underway to determine those areas of the city that have
the highest ‘did not attend’ (DNA) rates in order to understand the reasons given
for the DNA and whether providing clinics nearer to the child’s home could
reduce this.
 The proposed audit of the suitability of accommodation offered by Health
Centres, Children’s Centres etc. will be collated with the DNA information to
determine the best locations for any proposed outreach general paediatric clinics.
It is clear that it would not be feasible, cost effective or appropriate for such
clinics to be provided in all the current and proposed Children’s Centres. It would
therefore be more appropriate to limit such clinics to a number of strategically
placed Children’s Centres within the City tied to the DNA and facilities work
outlined above. Other children’s centres would then ‘cluster’ around those
identified.

A&E Access
The current provision of Primary Care within the City has resulted in an increase
in the number of children accessing the hospital’s A&E department, many of
which are self-referrals. Work is underway to determine the reasons why parents
feel the need to access A&E rather than Primary care or Minor Injury Units.
This work could form the basis for better engagement between Primary and
Secondary care as well as determining what other, if any, services for children
should or could be provided using Children’s Centres or Primary care.




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Cost and resources
It would need to be made implicit at this time that any extra costs arising from the
provision of secondary paediatric services outside of the hospital setting would
need to be picked up in the Local Delivery Plan (LDP) from those commissioning
the service. This would include Consultant and Nursing time outside of the
session, travel and any extra equipment above and beyond that already provided
within the hospital.

Amedo Craven
Paediatric Services Manager
Hull Royal Infirmary
November 2005


                                                                                              Appendix 4
Child Development Service

The Child development service within the Children’s Centre in Hull was
established in 1995 to provide a one-door integrated service to children with
special needs and their families.

The Children’s centre; child development services places the child at the centre
of treatment delivery.

The child development service endeavours to deliver a family focused service,
which recognises genuine partnership with parents and carers to support the
child’s development.

Parent / carers participate in decision-making, planning and choice of services as
well as activities including self-help and parent group opportunities. There is a
single point of access to a multi-disciplinary team.

Team Members
• 0.6 wte       Band      22.5hrs pw
• 0.8 wte       Band      30hrs pw
• 0.4 wte       Clinical Support Worker 16hrs pw
• 0.6 wte       Nursery Nurse x 2
• 0.4 wte       Nursery Nurse x 1
•
There are two experienced children’s nurses supported by a clinical support
worker, who work alongside consultant paediatricians, community doctors,
community children’s nurses, speech therapists, physiotherapists, occupational
therapists, nursery nurses, social workers, and educational staff.
The nurses give valuable input into diagnostic screening clinics as well as
enabling children with nursing needs to attend the centre for therapy sessions (i.e.
children with complex care needs e.g. tracheostomy care, oxygen dependence,
gastrostomy feeds etc).



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The nurses have specialist knowledge in children with Downs Syndrome and
provide input from diagnosis (usually within 48hrs of birth). This assists the child
and family in accessing appropriate medical and developmental help.
This care continues into the child’s own environment with the nurse liaising with
other professionals and agencies appropriate to the child and families specific
needs to suit their lifestyle.

Children from Hull and East Yorkshire have the benefit of this service, which was
established seven years ago.

As the nurses have specialist knowledge on a wide variety of syndromes and
conditions they are often accessed by parents / carers for information on
conditions and are able to provide information and useful contacts.
Within the clinic setting a child is often given a diagnosis – therefore it is
important to have the support and knowledge the nurses can provide to help
them through what can often be a very difficult and stressful time.
The nursery nurses are also very experienced in their role with children with
special needs / developmental problems. They plan, prepare and deliver
structural play and language sessions working closely with the speech and
language therapists.

The nursery nurses are able to assess children who attend their play sessions
and provide detailed written reports of the child’s development (in accordance
with approved developmental tools) for doctors, therapists and educational staff.

The nurses and nursery nurses are regularly involved in multi-agency
assessment and review meetings in relation to specific children with who they are
involved.

Area
• Cover Hull & East Riding, all four PCT areas.

Training & Development
• Nurses provide training and development to student nurses at Hull university
   undertaking the BSc in Nursing and the Diploma in nursing.
• The senior nurse also works as a community practice teacher supervising
   post registered children’s nurses who are taking the BSc in Children’s
   Community Nursing at Hull or Leeds Universities.
• The nursery nurses provide training to the student nursery nurses from Hull
   College as well as providing placements for school pupils on work placement
   schemes.

Access to the Service
There is an open referral system so parents, carers, professional’s etc can
access the service.


Managerial Arrangements
Managed by Community Children’s Nursing Manager.
Service Aims and Objectives
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•   The child development service aims to respond to the complexity of a variety
    of conditions seen in children by establishing appropriate multi-disciplinary
    health care systems for their management.
•   To ensure care input conforms to accepted national standards and published
    clinical guidelines and is monitored by objective
•   Teaching of other professional colleagues.

Discharge Arrangements
On discharge to another service there is often a transition period which enables
the nurses/nursery nurses to build up a relationship with the new providers of the
child’s care alongside the child and family.
This may involve training of staff in procedures pertinent to the child’s care,
educational staff visits to see the child in their established setting or visits to the
new placement.
Report summaries are provided so that new services are well informed of the
child’s needs and assistance can be given prior to full discharge form our service
if necessary.

Monitoring and Performance
• Service users are given questionnaires, which are analysed and reviewed.
• Team leaders and managers regularly supervise staff.
• Personal development reviews are carried our annually.




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                            Community Children’s Nursing Team

The team has developed and expanded over the last ten years to meet local demand
and support local delivery.
The new children’s NSF states that Community Children’s Nursing teams “should
be integrated and work in partnership with other local services to meet local
need”. More services are delivered outside hospital in the community or in the
home.

The community children’s nursing team enable the following outcomes:-
• Nursing care and support within the child’s own environment be it, home, or
   school.
• Prevent hospital admission or reduce length of stay.

Team Members
•   1.00 wte          Band 7
•   4.08 wte          Band 6
    5.08 wte          Total

Area
•   Cover Hull & East Riding, all four PCT areas.

Training:

•   All qualified children’s nurses.
•   Also some team members have BSc in Community Children’s nursing or
    working towards.

Access to the Service
Referrals are accepted from
                      •    GP’s
                      •    Paediatricians
                      •    Health Visitors
                      •    School Nurses
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                 • Hospitals – both regional and national.
The vast majority of referrals are received from Hull Royal Infirmary paediatric
unit. Referrals are faxed directly to the team.

Hours of Work
Monday 9 – 5pm however the hours are flexible to meet the needs of the service. If a
child is identified to have a need after school or at the weekend, then nurses will cover
their care according to need.
Managerial Arrangements
Managed by Community Children’s Nursing manager.
Activities forming part of the Community Children’s Nursing teams caseload

•   Teaching aspects of practical care to parents and children, e.g., giving
    injections
•   Support to families at home.
•   Teaching of other professional colleagues.
•   Education of children and parents with specific medical problems.
•   Care of children with stomas e.g. tracheostomy / gastrostomy.
•   Post operative wound care
•   General health education.
•   Administration or supervision of medication.
•   Dressing or wound care following trauma
•   Administration of intravenous drugs.
                                                                                           (Whiting 1998)

Skills and Abilities required by CNN’s
•   To work with a high level of independence in a child’s home, without
    immediate recourse to other clinicians.
•   To assess complex needs of children requiring nursing in the community, and
    of their families.
•   To formulate individual care plans.
•   To teach and support families in carrying out their child’s nursing care.
•   To monitor the child’s progress, solve problems, and adapt the care plan
    accordingly.
•   To manage their time and workload to provide a reliable and responsive
    service.
•   To liaise with and teach other professionals and co-ordinate their input.
•   To establish and audit service stands, policies and procedures.
•   To teach and support other team members.

The Seven Broad areas in which CCN’s work (Whiting 1998)
•   Neonatal and post-neonatal care, including care of babies with congenital
    disorders and those with sequelae of prematurity.
•   Caring for children with acute nursing needs to reduce the length of hospital
    admission.
•   Supporting children undergoing planned surgery.
•   Supporting the families of children with long-term nursing needs.

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•   Follow-up care of children requiring emergency treatment to enable early
    discharge from hospital.
•   Supporting children with a disability.
•   Supporting children’s palliative care.




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       Link Names &
       Telephone Number                                                                   Link Names & Telephone Number

                                                                     Special               Childrens             IQUOLS            St Johns     Childrens Centre
                                            Special                  Schools               Community
                                            Nurses                                         Nursing
                                            Hilary Linford           Sue Kmuk              Janet Turner          Margaret          Jackie       Helen
       East                                 (Diabetes)               Tel 305693            Tel 585760            Riley             Griffiths    Perring
                                            Chris Morley                                                         Tel 617635        Tel 587011   Tel 221261
                                            (Epilepsy)
                                            Karen O’Sullivan
                                            (Respiratory)
                                            Tel 221261
                                            Hilary Linford                                 Janet Turner          Margaret          Jackie       Helen
       Park                                 (Diabetes)                                                           Riley             Griffiths    Perring
                                            Chris Morley             ------------------
                                            (Epilepsy)
                                            Karen O’Sullivan
                                            (Respiratory)
                                            Hilary Linford                                 Penny Abethell        Margaret          Jackie       Helen
       Riverside                            (Diabetes)                                     Tel 585760            Riley             Griffiths    Perring
                                            Chris Morley             ------------------
                                            (Epilepsy)
                                            Karen O’Sullivan
                                            (Respiratory)
                                            Hilary Linford                                 Penny Abethell        Margaret          Jackie       Helen
       Wyke                                 (Diabetes)                                                           Riley             Griffiths    Perring
                                            Chris Morley             ------------------
                                            (Epilepsy)
                                            Karen O’Sullivan
                                            (Respiratory)
                                            Hilary Linford                                 Penny Abethell        Margaret          Jackie       Helen
       West                                 (Diabetes)                                                           Riley             Griffiths    Perring

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                                            Chris Morley             ------------------
                                            (Epilepsy)
                                            Karen O’Sullivan
                                            (Respiratory)
                                            Hilary Linford           Jenny Crofts         Sheena                 Margaret          Jackie      Helen
       North                                (Diabetes)               Tel 331799           Turnbull               Riley             Griffiths   Perring
                                            Chris Morley                                  Tel 585760
                                            (Epilepsy)
                                            Karen O’Sullivan
                                            (Respiratory)
                                            Hilary Linford           Vanessa              Sheena                 Margaret          Jackie      Helen
       North Carr                           (Diabetes)               Howbridge            Turnbull               Riley             Griffiths   Perring
                                            Chris Morley             Tel 825311
                                            (Epilepsy)
                                            Karen O’Sullivan
                                            (Respiratory)




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       East Riding Multi-agency                                                             Link Names & Telephone Number
       Teams

                                                                                         Childrens                                             Childrens Centre
                                                     Special Nurses                      Community            IQUOLS              St Johns     Tel 01482
                                                                                         Nursing              Tel 01482-          Tel 01482-   221261
                                                                                         01482                617635              587011
                                                                                         Tel 585760
                                                     Trudy Tapson (Diabetes)             Sharon Peck          Margaret            Jackie       Helen
                                                     Chris Morley (Epilepsy)                                  Riley               Griffiths    Perring
       Beverley                                      Karen O’Sullivan
                                                     (Respiratory)
                                                     Trudy Tapson (Diabetes)             Karen                Margaret            Jackie       Helen
                                                     Chris Morley (Epilepsy)             McNicholas           Riley               Griffiths    Perring
       Bridlington & Driffield                       Karen O’Sullivan
                                                     (Respiratory)
                                                     Trudy Tapson (Diabetes)             Ann Connor           Margaret            Jackie       Helen
                                                     Chris Morley (Epilepsy)                                  Riley               Griffiths    Perring
       Goole                                         Karen O’Sullivan
                                                     (Respiratory)
                                                     Trudy Tapson (Diabetes)             Sharon Peck          Margaret            Jackie       Helen
                                                     Chris Morley (Epilepsy)                                  Riley               Griffiths    Perring
       Haltemprice                                   Karen O’Sullivan
                                                     (Respiratory)
                                                     Trudy Tapson (Diabetes)             Ann Connor           Margaret            Jackie       Helen
                                                     Chris Morley (Epilepsy)                                  Riley               Griffiths    Perring
       Holderness                                    Karen O’Sullivan
                                                     (Respiratory)
                                                     Trudy Tapson (Diabetes)             Karen                Margaret            Jackie       Helen
       Wolds & Dale (Pocklington)                    Chris Morley (Epilepsy)             McNicholas           Riley               Griffiths    Perring
                                                     Karen O’Sullivan
                                                     (Respiratory)


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                              Paediatric Epilepsy Specialist Nurse


The paediatric epilepsy specialist nurse provides care, advice, support and
education to children age 0 – 18 with epilepsy, within their own homes and nurse
led clinics.
Children on caseload - over 600.

Team Resource
• 1.00 wte Band 7

Managerial Arrangements
• Managed via Community Nursing Manager

Area
• Covers Hull and the East Riding (all four PCT areas)

Training
• Qualified children’s nurse trained to degree level and diploma in epilepsy plus
   over 5 years experience in present field.
• Provides training to health, education, social services, families and carers.

Access
• Open access to the service, referrals can come from primary or secondary care,
   parents, schools and social services. Provides service to special schools, so
   that children with complex health needs are not marginalised.

Discharge
• Children discharged only when either seizure free or transferred to adult
   services.

Outcomes
• Keep children out of hospital.
• Provide optimum care to control seizures allowing the child to get on with their
  life.




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                              Paediatric Diabetes Specialist Nurse

Offers diabetes education and support to children and their families on diagnosis,
and thereafter following NSF and NICE guidelines, and ensuring 24-hour
telephone support by the paediatric diabetes service.
Current caseload is 213 and approximately 30 –33 newly diagnosed children with
diabetes annually.

Team Resource
• 2.00 wte Band 7

Managerial Arrangements
• Managed via Community Nursing Manager

Area
• Covers Hull and the East Riding (all four PCT areas)

Training and Development
• PDNS’s provide education to schools, university and nurseries etc

Access
• GP referrals via the diabetes nurses or A & E admission for under 16 year olds.

Discharge
• Once discharged (usually very short stay due to follow up at home), visited at
   home within 5 days and first clinic appointment within 2 weeks then 3 monthly.

Outcomes
• To ensure children with diabetes achieve their full educational potential and
  lead to self-management.
• To maintain children within home environment and minimise hospital
  admissions.
• Offers 24 hour telephone support line.




                                            I.Q.U.O.L.S Team
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                               Improving Quality of Life Services
                                  (Children’s Palliative Care)


Homecare Team and Bereavement Service
Children’s Palliative Care service will offer support and advice and be a resource
during the palliative and terminal phases of the child’s illness, providing a high level
of expertise in pain and symptom management.

The IQUOLS team has the responsibility to ensure that there is provision of an
active, honest and holistic approach to the care of all children with life threatening
conditions focusing on enhancement of quality of life for the child.

Physical, emotional, social and spiritual support will be made available for the child
and family whenever it is needed from diagnosis, throughout the illness and
through death and bereavement. Confidentiality of the child and family will be
respected at all times ant the same time being aware of the child’s legal and moral
rights.

Because of the devastating yet intimate nature of the child’s conditions, it is very
important to build up good relationships with the child and family to promote trust,
honesty and understanding yet recognising the need for privacy and dignity.

The team work closely with the community children’s nursing team, hospital trust
and primary care trusts and all other statutory and voluntary agencies ensuring the
highest standards of nursing care is available for these children and their families
at all stages of the illness trajectory.

The team maintains a high level of clinical expertise and knowledge in all aspects
of care of the children with cancer and other life limiting conditions and their
families to live with their illness and maintain quality of life throughout.

When the child is in the terminal phase of their illness the team will provide 24-hour
on call service to support the child and their family in whatever way is needed.

Following the death of a child it is the responsibility of the team to ensure that
bereavement support is offered to all the families and is provided by the most
appropriate person.

The bereavement team provide emotional and spiritual support for parents, siblings
and close family members of children who have died from a life-limiting or life
threatening condition for as long as they need it or is appropriate.

All siblings will have a choice in attending the WYNGS group approximately six
months following the death of their brother or sister.


Team Members
• 1.00 wte  Band 7                        Nurse
• 1.00 wte  Band 6                        Nurse

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•   1.00 wte         Band 5         Nurse
•    .08 wte         Band 4         Play Specialist
•    .5 wte          Social Worker
•    .1 wte          Clinical Psychologist
•    .5 wte          Creative Therapist
•    .67wte          Administrator

Area
• Cover Hull & East Riding, all four PCT areas.

Training:
• Qualified multi professional team

Access to the Service
• Open referral, referrals received from
                • GP’s
                • Paediatricians
                • Health Visitors
                • School Nurses
                • Community Children’s Teams
                • Families

Hours of Work
Monday 9 – 5pm however the hours are flexible to meet the needs of the children
24 hour cover during the terminal stage.




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                                        School Nursing Team
                                        Special Schools (Hull)

The school nursing team within the Hull special schools provide nursing
care, support, advice and training to enable children to attend school.

The Chief Nursing Officers report on Nursing and Midwifery services for children
(August 2005) stated the need for more school nurses to improve health services
for school age children.

The school nursing team (special school) has therefore developed to meet the
increasing number of children with special needs, incorporating nursing and health
provision within their care.

School Nursing Team Outcomes
• Enable children with special needs to remain at school.
• Support teachers / parents / carers.
• Developing services to meet the public health agenda.

Team Members
•    .64 wte Band 6
• 2 .27 wte Band 5
• 1 .14 wte Band 4

Managerial Arrangements
• Team manager and managed by Community Children’s Nursing Manager.

Area
• Covers special schools within Hull
• Due to the needs of the children, on site cover in
            • Frederick Holmes
            • Tweendykes
            • Northcott
• Need to develop further nursing support for Teskey King,(on site cover not
   necessary.)

Training
• Due to the wide variety of need, within the schools, the nursing team skill mix
   includes qualified children’s nurses and learning disability nurses.

Access to the Service
• The nursing team provide care for all children attending school as appropriate,
   including under 5’s and over 16’s.




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Activities forming part of the school nurses caseload
• Teaching aspects of practical care to parents, children and teachers, and
   education around specific medical problems.
• Support to families.
• Care of children with stomas.
• Wound care.
• Health education.
• Administration of medication.

Developing role in relation to Hall 4

Needs
• Volume of need is increasing; both Frederick Holmes and Tweendykes have an
  increasing number of children requiring nursing care, with special needs.
• Variety of age from 2 – 19.
• Hoping to enhance the service in the new year with PHSE skills after member
  of staff finishes the course.
• Planning to develop nurse led clinics across the schools.




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                                                St Johns House

St Johns House is a purpose built short breaks unit providing short breaks for
children aged 0-18 years who have complex health needs.

There are nine bedrooms

Children are referred by secondary care providers, parents and carers,
Paediatricians, social services and community nursing staff.

All referrals are discussed at the Disability panel if the child lives in Hull and an
assessment of need is completed.

Children from the East Riding of Yorkshire area are referred directly to the Unit
manager who assesses eligibility.

The Unit is staffed by registered nurses who provide 24 hour cover, health care
support workers, nursing assistants and play co-ordinators.

The Unit is nurse led by the Manager, who is a Nurse Practitioner, and Nurse
Prescriber. There is little medical input to the Unit. The GP Out of Hours Service is
used if required. Children and young people with an acute illness are transferred to
Hull Royal Infirmary.

The Unit provides a base for the Children’s Palliative Care Team who cares for
children and young people with life threatening conditions.

The Unit does not have emergency beds, however, an extra bed made available is
staff are available to provide extra care.

Service provision is based on the needs of the family and child, and bookings are
completed for a three month period, three months in advance. The Unit always
aims to provide the care that the fam8ly have asked for.

Short term care episodes are provided which may enable children to be discharged
from hospital earlier than expected as a step down approach.

Links with the Local Authority Social Services Department are strong. The Unit
provides care for children and young people who are difficult to place in the Looked
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After System until a suitable placement is found. In addition, the Unit provides care
for children and young people whose care package is being set up within the home
environment.



Staffing

9.84 WTE Qualified Staff, including Child-branch and Learning Disabilities Nurses
12.5 WTE non Qualified Staff
 Margaret Appleyard
Community Paediatric Nursing Services Manger
The Children’s Centre
Walker Street
Hull




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                                                                                                APPENDIX 5

                      Speech and Language Therapy Services

             Outline of a Proposed Speech and Language Therapy Service to
                         Sure Start Projects within the City of Hull.

1.       Introduction

Speech and Language Therapists (SLT) work within the Sure Start projects to help
achieve the local and national targets, namely:

Objective 1: Improving social and emotional development

PSA 1 In fully operational programmes, achieve by 2005-6 a [x] per cent increase
in the proportion of babies and young children aged 0-5 with normal levels of
personal, social and emotional development for their age

Objective 3: Improving learning

PSA 3a In fully operational programmes, achieve by 2005-6 a [x] per cent increase
in the proportion of children having normal levels of communication, language and
literacy by the end of the Foundation Stage

PSA 3b In fully operational programmes, achieve by 2005-6 a [x] per cent increase
in the proportion of young children with satisfactory speech and language
development at age 2 years

SDA 8 To increase the number of children who have their needs in line with early
years action plus of the SEN code of practice and who have either a group or
individual action plan in place

Objective 4: Strengthening families and communities

SDA 14 An increase in the proportion of families with young children reporting
personal evidence of an improvement in the quality of family support services

SLTs working within Sure Start provide additional support to a family that is not
provided within the mainstream SLT service. These additional services can be
seen as:

     •   Health promotion: giving information to parents/carers on how they can best
         support their child’s language learning. This should be available for all
         children, not only those identified as having language learning difficulties.

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     •   Providing therapy to ‘at risk’ children: this includes those showing language
         delays who may not have been referred/seen for therapy.

     •   Training: training others to provide best practice in supporting children’s
         language learning.

Sure Start has given SLT the opportunity to investigate new ways of working and
to look at how best use could be made of an expensive and finite resource. It
enabled the service to look at what was essential for the SLT to do and what
others should do with support and training. It was soon apparent that it was
necessary to work with the whole team and that it was essential to impart
knowledge and develop the skills of the other members of the team.

In order to support the initiative to mainstream the work undertaken in Sure Start, a
more consistent approach across the city is required.

2.       Current Situation

Within each of the projects, where there is SLT input, therapists now do all or some
of the following:

     •   provide parents/carers with information as to how best to support their
         child’s language learning through home visiting, group sessions and training.

     •   offer more accessible services through visiting families at home or visiting
         children within the nursery setting.

     •   provide training to develop the skills of those working with families with
         young children.

Because of the need to be working towards the Sure Start targets involving the
measurement of language learning, communication skills and social and emotional
development of the children in the area, there needs to be a programme of
activities which promotes language learning in the under 2’s, leading up to the time
of the SSLM, and for the over 2’s leading into the Foundation stage and profiling of
the children at the end of this stage.

To achieve best practice it is necessary for Sure Start staff and pre-school workers
within each local programme to become skilled in supporting babies and young
children’s language learning and so it is essential that there is a continuous,
consistent training programme offered. It is also important for those children who
are “at risk” or in need of speech and language therapy to receive that support at
the opportune moment.

3.       Outline of Future Activities

Within each programme the following type of activities should be developed in
order to achieve the targets set. A time line is also included (appendix 1)

To promote language learning in all children:

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Under 2’s

Each programme should have a strategic approach to reach as many families as
possible in order to promote best practice in supporting the child’s learning. These
are currently being undertaken in some of the programmes but not all. This can be
facilitated by Play and Learn teams following training from SLT.
Over 2’s

A training programme should be set in place to raise awareness of good practice
for supporting language learning with staff that are facilitating toddler groups,
crèche facilities and working in nurseries.
Parent training

Groups/workshop activities designed to offer direct information to parents on best
practice in supporting their child’s communication skills e.g. ABC and Hanen
should be offered. This has been done on an individual basis within the local
programmes where SLT is part of the programme and it should continue as local
need dictates. This work needs to be undertaken by SLT supported by a trained
play team member.

Children with identified SLT needs

Children may be identified at any age where SLT input is needed. However there
are two periods where this appears to happen most frequently. One is at the SSLM
visit and the other is when the child enters nursery. There are also referrals from
other professionals within the community.

Under 3’s and those children not attending nursery

For the ‘at risk’ under 3’s the SLT may provide home visits and suggest a
programme for the parent to follow. It is envisaged that a trained play team
member will be able to support the parent with the guidance of the SLT.

Over 3’s and those attending LEA nurseries

If the child is attending nursery then they will be supported by the speech and
language support groups that we have devised. The SLT will need to assess the
children but the sessions may be supported by a trained play team member.

Over 4’s

Those children over the age of 4 who require continued direct support from SLT
would be transferred to the main SLT service.

4.       Requirements:

In order to carry out the above activities a city wide rolling training programme
should be delivered through the new Children’s Centres and as part of the core
offer. This would facilitate the continual updating of current staff and training for
new staff members both within Sure Start and in the wider community. Some of the
training sessions should be delivered centrally rather than in each Sure Start patch
in order to be more cost effective and ensure consistency within the city.
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This approach is supported by:

The national document ‘A Sure Start Children’s Centre For Every Community
Phase 2 Planning Guidance 2006-08’ states that Children’s centres in the 30%
most disadvantaged areas must include ‘speech and language and other specialist
support’

Hull City Councils Vision and Strategy document for Children under Five
(December 2004) states ‘the city aims to improve language development through
universal preventative measures, led by speech therapy, but delivered by all
professionals, coupled with multi-agency screening and speedy intervention by
speech therapy services as need dictates.’

The training packages needed are outlined in the attached flow charts (see
appendix 2) and are hierarchical in nature:

    •    Level 1: To support workers who will be in contact with families rather than
         working directly with the children and needing to give advice to
         parents/carers for supporting language development.

    •    Level 2: To promote early communication development in all children whilst
         working directly with them in group sessions. This will also be suggested for
         early educators in the local nurseries.

    •    Level 3: To support children identified as having speech and language
         delays under guidance of a SLT during proposed home visits.

The structure of the training packages is as follows.

For staff in direct contact with children:

    •    Basic Understanding of communication skills - 2 sessions for all staff in Sure
         Start to enable them to have an understanding of speech and language
         development and how to promote communication skills in young children
         (including admin and health staff)

    •    Hanen - 6 sessions and video feedback sessions. All staff in direct contact
         with children and this should be offered to teachers, nursery nurses in the
         local nurseries

For people working with parents to provide best practice:

(The sessions will need to be supported by coaching and supervision of the
workers in their own workplace)

    •    Working with parents – 1-2 sessions for presenting ABC programme (baby
         signing), running groups e.g. parent and toddler, baby sessions,

    •    To carry out SSLM - 1 session

For workers intending to follow SLT programmes:

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      •   Working within the nurseries to carry out ‘speech and language support’
          groups - 1 session

       • Following SLT home programmes - 2 sessions
     (These sessions will be in addition to the earlier training packages.)

Some development would be required within the Sure Start teams to discuss the
proposals, to identify the roles of staff and to ‘customise’ the training packages to
be appropriate for each staff member.

Number of Training sessions needed to provide 1 full set of courses per year
Type of training         Number           Staff group          Number of           SLT staff needed
                         of staff                              sessions
                         in each
                         session
Basic                       20         All                            2           Senior+Rotational

Early                        20        Facilitating                   6           Senior+mid-grade
communication                          groups
Hanen                        16        Early                     6 group          Hanen trained
                                       Education/LEA             32 video         therapists x 2
                                       nurseries
Specific
SSLM                         20        Identified play                1           Senior
                                       team
                                       worker/admin
Babies                       20        Identified play          2 + local         Mid-
                                       team worker             supervision        grade+rotational
Special Talking              10        Identified play          2 + local         Senior+mid –grade
Time                                   team worker             supervision
Nursery Groups               10        Identified play          2 + local         Mid-
                                       team worker             supervision        grade+rotational

Total                                                                53                   105
                                                                                  Rotational         6
                                                                                  Mid Grade         12
                                                                                  Senior            87

5.        Current Input from SLT:
Programme             Senior SLT Junior SLT Rotational   Assistant                                Current
                      sessions   sessions   sessions per sessions                                 SLT
                      per week   per week   week         per week                                 costs
Northern Hull              4*         0           5           0                                    74,554

Marfleet                     2                   0                   4                  7           38,343

Newington with               2*                  0                   3                  0           10,881
Gipsyville
Myton and St                 2                   0                   3                  0           20,030
Andrews
Longhill   and               1                   0                   2                  0           9,439
Bilton
Newland and                  1                   0                   2                  0           9,503
Avenues

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Noddle Hill                  0                   0                   0                  0              0

Total                12           0              19                                     7         162,750
(* 2 sessions bought by Newington with Gipsyville).

Total = 3.1 W.T.E. therapist time and 0.77 wte assistant over 6 projects (average 5
sessions per project).

None of the programmes have the same number of schools or population,
therefore there should be some flexibility of SLT staffing to provide greater equity.
However there would be a requirement for increased funding if the level of activity
increased to cover another programme (Noddle Hill). On current resourcing, it
would be necessary to increase staffing by 5 sessions to 3.6 W.T.E. However the
population figures and schools would need to be considered in order to apportion
the correct number of sessions.

6.       Future Staffing:

Currently there are 4 senior posts and 5 rotational posts allocated to 6
programmes with no mid-grade posts in the 6 programmes. One programme has
assistant time, and one programme has no allocated time.

For the developments outlined above, a greater skill mix is needed, but the
opportunity to work with Sure Start should be maintained for junior staff. The
juniors form the future of all SLT services and knowledge of Sure Start and
supporting whole populations is invaluable.

 Each programme requires a named therapist, but therapists may work in more
than one programme. Senior time can be also be shared

The future requirement would be for:

     •   10 sessions senior time (2 part time staff to share all programmes)
     •   15 sessions mid-grade time (3 or 4 part time staff to have 1or 2 programmes
         each)
     •   15 sessions rotational time(5 part time staff to have 1or 2 programmes each)
7.     Projected Costs:
An estimate of costs is attached: if the proposal goes forward these will need to be
submitted for closer scrutiny and the potential outcome of the Agenda for Change
process taken into consideration
Staff grade                                           Current pay costs with on-costs and
                                                      4% uplift
Senior 37 – 39 x 10 sessions                                         49,348
Mid grade     27 – 29 x 15 sessions                                  49,343
Rotational    19 – 24 x 15 sessions                                  41,177
Sub-Total                                                           139,868

Estimate of other costs:
Travel                                                                       8000
Trust costs                                                                 14,787
Total                                                                      162,655
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* Equipment and stationery costs are funded directly at present, so it is not
possible to estimate this.

8.      Recommendation:
It is recommended that the Sure Start Managers Group support the proposal and
take it forward to the Partnership Boards.

Liz Buckles, Liz Ford, Karen Griffiths, Gill Miles, Senior Sure Start Speech
and Language Therapists.

Jane Phillips, Head of Speech and Language Therapy.




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                                                                         Central Training for Sure Start
                                                                                  Programmes



                                                                                                                                                Staff whose primary role
                                                                                            All staff
                                                                                                                                                is developing
                                                                           Basic understanding of communication skills
                                                                                                                                                language/communication
                                                                                           2 sessions                                           skills

             Promoting early communication development in all children                        Hanen Learning Language and Loving It
                                  6 sessions                                                  6 seesions + 4 video feedback sessions



                                                                                                                                How to help parents facilitate baby’s communication skills
                           Staff who facilitate                                                                                                                 2 sessions

                        activities with parents and
                                  children                                        Specific training
                                                                                                                                                            SSLM – 1 session
                         (Creche workers, toddler                                 for identified
                                   groups)                                        staff
                                                                                                                                                   Special Talking Time – Home Visits
                                                                                                                                                               2 sessions




                                                                                                                                   Working within nurseries to carry out speech/language support groups




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                                                            Central Training for Local Sure Start Programmes

                                                              Early Childhood Educators working in the area


                                                                      All staff




                                                              Basic understanding of communication skills
                                                                              2 sessions
                                                                                                 Nursery nurses, teachers and other
                                                                                                 staff within education up to the end
        Promoting Early Communication                 Hanen Learning Language and Loving It      of the Foundation Stage
           Development in all children
            Staff working in
            private nurseries,
            playgroups, child                                                           Working with nurseries to carry out speech/language support groups
            minders


                                                                                                      Main SLT service training packages




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                                                                             APPENDIX 6

Early Support Programme Proposed Model of Collaboration and
                       Partnership

Introduction to Service Area

The Early Support Pilot Programme (ESP) was initiated nationally in order to support the
implementation of the Together from the Start Guidance issued in May 2003.

The aims of the guidance were to ensure that families who had disabled children aged
between 0 -3 yrs encountered a greater level of input in the very early stages of their
children’s lives. The guidance documents key aims were for:

       Better initial assessment of need
       Better co ordination of multi agency support
       Better information and access for families
       Improved professional knowledge and skill
       Service review and development partnership across agencies and geographical
       boundaries.

As the ES pilot was developed, with a view to national role out from March 2006,
pathfinders were established each developing the principles of the guidance within their
local authority areas.

Via Kids Hull was a pathfinder as part of the national pilot and has developed an ES
programme of delivery across the city over the past three years.

Links to national policies and agendas

Since the issue of Together from the Start in May 2003 extensive additional guidance
has been issued all embedding the principles of Together from the Start and the Early
Support Programme (ES) within national government policy.
See:
       Improving the Life Chances of Disabled People
       Removing Barriers to Achievement
       National Service Framework for Children, Young People and Maternity Services -
       Core Standards
       Every Child Matters – Change for Children
       Choice for parents, the best start for children: A ten-year strategy.
       Child poverty review.

The Children’s Act 2004 provides all those involved in the planning and delivery of
services for disabled children an opportunity to transform traditional service planning and
delivery.

The Children’s Act (2004), National Service Framework for Children, Young People and
Maternity Services (2004), Delivering Choosing Health (2005), Chief Nursing Officers
Review (2004) and the Early Support Programme all offer a comprehensive review of
service delivery, with the OFSTED Framework for Inspection of LEA’s and The Joint
Annual Review process being put into place to monitor and improve quality and
standards of care.




                                                                                        46
Proposal

A proposal to deliver a designated key-worker provision across Hull has been agreed
following the model delivered by Kids during the pilot phase of the Early Support
programme.

This model currently employs a full time co-ordinator and three 24 hr key-workers who
are all managed through Kids. The key-workers take referrals from across the city and
have implemented the Common Assessment Framework (CAF) as well as liaising
directly with the disability team and The Children’s Centre (Walker St.) multi agency
processes.

In order for this key-worker provision to ultimately be further developed to include the
Children’s Centres developments across the city the following proposal has been
submitted to Sue Atkins, Sue Cornwall and Pauline Dumble who have all contributed to
funding the work for 2006–07 with further discussion taking place regarding future
provision (see extract from proposal document below)


Where do we want to get to 2007 - 8

A combined working Key-worker model across Hull

It is proposed that by 2007 Kids could extend the Key-worker provision to cover the
whole city and increase capacity by merging the staff deployed within the local Sure
Start programmes into the Key-worker provision and having a central management,
reporting and monitoring structure.




                                                                                       47
                                       Keyworking Model 2007-8
                                                                 Multi Agency Management Group
Kids Management Structure                                        reporting to CAF/lit and CYPSP
                                                                 boards


                                                                   •      Promotion and info sharing
                                                                   •      Care first data base
                                                                   •      Reporting
   Project Co-Ordination
                                                                   •      Monitoring/Evaluation/
   1X FTE
                                                                   •      Audit
                                                                   •      Management of Senior Key-
                                                                          workers
                                                                   •      Management of CAF and
                                                                          links to disability team


                                                                  •       Line Management and
                     Area Two                                             Supervision of Key-workers
Area One                                 Area Three
                     East                                         •       Support within CAF
North Senior                             West Senior
                     Senior                                       •       Responsibility for 5-14’s
Key-Worker                               Key-worker
                     Key-worker                                           case work
0-14                                     0-14
                     0-14                                         •       Ensure delivery of Together
                                                                          from Start Guidance
                                                                  •       Ensure standards and
                                                                          equity of provision


                                                                      •        Cover all Children’s
                                                                               Centres
                                                                      •        Based in patch or
                                                                               centrally at KIDS
   Outreach Inclusion Key-workers X7                                  •        Undertake CAF
                                                                      •        Key-work 0-5’s


                                                                                                        48
How to get there during 2006 – 7

The merging of Keyworking and Local Sure Start involvement
The existing Key worker provision needs to remain intact and will form a sound basis for
the merging of the two areas of work, with work being undertaken to develop clarity
regarding the job description and standards for Hull Key-workers as well as their link with
the disability team.

Staffing issues:
The following year 2006–07 would be used to redefine the Job Descriptions for the
Inclusion Workers within the Sure Start programmes and to up skill the staff with a view
to them re applying for the revised positions during 2006-07.

Salary structures would have to be revised with careful attention to employment
legislation.

Some local Sure Start Programme Managers are aware of these considerations and
have been party to discussions with me over the past six months as we have discussed
the future role of the Kids workers within the programmes.

The funding to be discussed with local programmes for management and professional
development (£1960 per programme) could be used to fund this and Kids are aware that
several of the Local Programmes are considering an under spend that will be lost from
March 31st 2006. If paid in advance to Kids it can then be carried forward to the 06-07
financial year and therefore not affect the 06-07 budgets of the local programmes.

Professional development proposed would consist of the following depending on what
staff already has and what might be appropriate.

      Accessing the 3 day Portage training
      To access Common Assessment Training
      To be familiar with relevant Government documents e.g. Audit Commission
      Report (2003), Removing Barriers to Achievement Children Act (2004), Every
      Child Matters–Change for Children (2004), The National Service Framework for
      Children, Young People and Maternity Services(2004) and Together from the
      Start.
      To understand the purpose, structure and use of the Early Support Service Audit
      Tool (ESSAT)
      To understand that the focus of ESSAT is on outcomes for families
      consider how the ESSAT supports service improvement planning
      To understand the importance of parents’ views in evaluating services
      To cover topics such as Disability Discrimination Act, the Special Educational
      Need Code of Practice and Individual Education Plans (IEP’s).
      To understand the role of the Key-worker
      To consider what is required for localised implementation of the ESSAT.

*It should be noted that Kids staff have been trained to deliver the ESSAT training by the
DfES Early Support Team




                                                                                        49
Strengths / Challenges / Weaknesses

       Strengths / Opportunities

       No dual management of workforce
       More cost efficient and cohesive
       Links to single point of referral proposals.
       ES approach city wide cover
       Links into universal services for children aged 0–5
       Provides an equitable structure for early identification and intervention.
       Clarifies and unifies Kids role within Children’s Centre
       Strong, centralised management structure for Keyworking. (Care Co-ordination
       Network UK recommendation).
       Builds on existing model and expertise and minimises set up costs
       Instant win re JAR in September 2006
       Builds on disability tem structure with opportunities for further development
       Increased reach.

   Challenges

      Funding 2006 – 7/8
      Retaining skilled and experience workforce
      “fit” re Sure Start (Kids) employees to revised positions
       Equal opportunities for all to apply (might not be able to protect Kids employees
       within local programmes)
       Sure Start Local programme and Children Centres Managers to buy into training
       and accept proposal for Early Support Approach to Keyworking and use of Audit
       Tool.
       Decision re management of CAF within universal services such as Children’s
       Centres. Propose that Key-workers undertake for children with complex needs
       linking and maintaining existing structure within CAF and ES pilots and other
       professionals undertake for “other” children
       Change of roles and structure for existing Early Support staff team, additional
       responsibilities for senior key-workers and possible resistance.

   Weaknesses

       Is there an issue re removing a worker from the local Sure Start Programmes
       and managing centrally?
       Staff to re apply for new positions 2006–07 (some will not wish to as salary
       scales may well be lower)

Outcomes for children, young people and their families

The background to the issue of ‘Together from the Start’ was a growing recognition and
concern amongst professionals and families of the increased need with fast growing
evidence of confusion and poor co ordination of service for disable children and their
families.

The Family Resources Survey 2002–03 estimates that there are approximately 700,000
disabled children under 16 in Great Britain. In the last ten years the prevalence of
severe disability and complex needs has risen, this is due to a number of factors
including the increased survival of pre- term babies and an increased survival of children
after severe trauma or illness.

It is known that 25 years ago 20% of babies born before 28 weeks gestation survived;
today 80% of these premature births survive.

                                                                                       50
Locally it has been difficult to obtain accurate data relating to the numbers of disabled
children (this is further complicated by a variation in views amongst agencies regarding
the criteria used to define disability). However, some figures are available that can assist
in identifying the extent of support required locally.

An audit of Health Visitors’ records was carried out in Kingston Upon Hull in 2004 where
it was identified that 120 children under 5 years were assessed as disabled, 63% of
these children were identified as having two or more types of disability.

In addition, in 2004 population figures showing children registered with GP’s in Hull were
259,582.

The locally delivered Early Support Pilot funded by the DfES via Kids, has been able to
demonstrate significant success in meeting some of the requirements of Together from
the Start and thus meeting some of the performance indicators of the OFSTED
Inspection framework, the JAR and the NSF.

There is also significant evidence of local ‘user satisfaction’ which is reported by the Kids
project both to the DfES as part of their monitoring of the pilot and within a wider report
to the NSF Local Implementation Group for Standard 8, The Disabled Child.

Recommendations

         In order to meet the requirements of Government guidance within Every Child
         Matters-Change for Children agenda and to satisfy the JAR and APA, it is
         essential that commissioning and agreement on a structure for Early Support is
         put in place from March 2006.
         The integrated action plan developed (and attached with this proposal) will
         move forward this piece of work considerably.
         Integrated Commissioning and equity are key factors for success.
         It would be advisable to build on existing practice and developments from the
         ESP project rather than to start from scratch with a new approach for key-
         working across the city.
         The development of this provision will effectively reduce workloads in some
         areas.
         A key-worker service should link closely with the CAF and Children’s Centres
         roll-out across Kingston upon Hull.
         There will be training implications associated with the role out of a key-worker
         system and use of the audit tool, however staff at Kids have received training
         in this area of work and could deliver in line with CAF training,
         The ES audit tool will be an asset in the monitoring of all provision for services
         for disabled children, specifically across the early years.
         Families must remain closely involved with all future developments.


Anna Heddle
Regional Director Kids Yorkshire and The Humber
Revised April 2006




                                                                                          51
Framework for inclusion of an appendix in this document

If you or you agency are in the process of modernising and reconfiguring services to
respond to the core offer for Children’s Centres, Community Focused Schools or in line
with the Neighbourhood Management Model of Service Delivery and would like to
contribute an appendix to this document please it set out using the following guidelines.
Please send your contribution, electronically to; Sam.bell@whpct.nhs.uk

Framework:

Section 1 – Introduction

An introduction to the agency/organisation
Current service delivery model
Links to national policy pertinent to the propped changes to service delivery

Section 2 – The proposal

What and how the agency/organisation will deliver services in the future
The timeframe for implementing changes
If reconfiguration or modernisation has taken place, please give details of where
teams are based and provide contact details and details of how to refer clients to
the service
Please refer to particular targets or expected outcomes

Section 3 – The Benefits

For children, young people, families and communities
For staff and or practitioners
Relative to national and local targets

Section 4 - Funding or commissioning issues.

If this service delivery model requires additional funding or is dependant on re
commissioning please give details

If you have contributed to this document and your service delivery model has
changed please send an updated version to; sam.bell@whpct.nhs.uk

Thank you




                                                                                       52
                                                                                                         Appendix 11



            Sure Start Northern Hull
            The McMillan Centre

                                                                                Sure Start Noddle Hill

          Sidmouth Nursery




       Lambert Nursery School

                                                                                             Sure Start Longhill &
                                                                                             Bilton Grange
     Sure Start Newland & Avenues



Sure Start Newington with Gipsyville
                                                                                             Sure Start Marfleet




                                                                                     Child Dynamix (PRNDC)

                     Sure Start Myton and St Andrews

                                                       Clifton Nursery School




                                                                                                                53
                                                                                                                         Appendix 12

                                                 SUGGESTED ATION PLAN & TIMEFRAMES
Action                                                       Oct   Nov   Dec 05   Jan   Feb   March   April   May 06   June 06
                                                             05    05             06    06    06      06

Steering Group formed and Proposal Document and
project Terms of Reference agreed -

Proposal launched to interested parties -

Local Communication Strategy instigated -                                                                              On going

Local Area Health Partnerships formed, Chair elected                                                                   To be
and aims and objectives agreed                                                                                         determined
                                                                                                                       locally
Local Area Health Partnerships complete mapping                                                                        To be
exercise and have the basis for a Community Directory                                                                  determined
                                                                                                                       locally
Local Area Health Partnerships have identified Gaps in                                                                 On going
service provision

City Wide steering Group have undertaken an audit of
community accommodation and facilities.

Primary Care Health Visiting and Community Midwifery
services are geographically aligned with Area Co-
ordination Team Boundaries.

Further integration of services is being developed in                                                                  On going
partnership with the Local Authority Children’s Trust
Board.
Further development of the proposal                                                                                    On going
(the document will be reviewed annually and updated
accordingly – By S Bell until April 2007 and thereafter by
a ‘Guardian’ of the Document appointed by the multi-
agency Steering Group)



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