School Nursing Review Stakeholder Event: Shirley Brierley Consultant in Public Health, Jeanette Crabbe Senior Public Health Manager, & Public Health Team and Partners 30 th September 2015

SETTING THE SCENE: 1.Background 2.Health and Wellbeing of Children and Young People 3.Why do we need to review School Nursing and Special School Nursing Services? 4.Agenda for the afternoon

Background The Health and Social Care Act 2012 transferred the responsibility for Public Health to the Local Authority in April 2013 The Act gave Local Authorities the statutory responsibility for commissioning a national public health programme for children and young people age 5-19 This includes the School Nursing Service which form an integral part of prevention and early intervention provision by delivering the Healthy Child Programme and addressing key public health issues through a universal and targeted programme Specials Schools - children with either special educational needs or disabilities are commissioned via CCGs Immunisations and vaccinations commissioned by NHS England

The School Nursing Contract is one of the larger value (single service) contracts within Public Health The School Nursing Contract is delivered by Bradford District Care Foundation Trust (BDCFT) and is incorporated within the wider BDCFT Contract. The Services have not undergone an overall review for some time; opportunity for jointly reviewing the School Nursing, and Special School Nursing Services Budget pressures on all services – Council including Public Health and NHS and continuing need to demonstrate effective commissioning delivery of high quality services which are evidence based and performance monitored Value for money and meeting New Deal priorities and principles of Council and Commissioning priorities of CCGs. Focus on improving outcomes for children and young people and reducing inequalities Today focus is on the School Nursing Services for 5-19 year olds (not Immunisations or Special school nursing but interlinkages are key) Background

Health and Wellbeing of Children and Young People

Key National Drivers Children and Young People are identified as a key priority in:  Government policy – based on Marmot Review - “Giving all children a healthy start in life” 2010  Getting It Right :for children, young people and families Maximising the contribution of the school nursing team: Vision and Call to Action 2012 and follow up key SN documents  Health and Wellbeing Boards (local authority, health & other partners)  Joint Strategic Needs Assessment (JSNA)  Transition of Public Health into local authorities –The need to deliver the Healthy Child Programme 5-19 years –The commissioning of school nursing services to meet local need  CCG Plans (GP led commissioning) for maternal and child health

Getting it right framework This process is informed by national School Nursing Guidance: Vision and Call for Action It is based on: The Healthy Child Programme 5-19 Public Health Outcomes Framework and the recommendations of the Children’s and Young People’s Health Outcomes Strategy Quality improvements through the standards as set out in ‘You’re Welcome’ and from service users views on what good would look like.

Key Local Drivers

Children and Young People in Bradford District Joint Strategic Needs Assessment 2014 One of the most deprived Local Authorities in England, ranking 26 th (out of 149) in the 2010 IMD The third youngest English city outside London Almost a quarter of the population is aged under 16 (23.6%) Most recent 2012 child poverty rate of 23.6% - equates to 33,135 children and young people A growing challenge - over the last decade there has been an increase of over 20% in 0-4 year olds Over the next ten years the number of under 16 year olds is predicted to increase by 13,200 – an increase of 10.7%

 Around 152,000 children and young people under 19 years of age  Diverse population - 54% of school children are from ethnic minority group  Rates for hospital admissions for all injuries (unintentional and deliberate) in the district are worse than the national average for ages 0-14 years and years  In Bradford district obesity rates are around 10% in Reception and 22% in Year 6  The proportion of children with dental disease at age 5 years was 46%; higher than regional (34%) and national (28%) figures. Children and Young People in Bradford District

In summary, children who live in the most deprived areas of Bradford are: more likely to die in their first year of life more likely to have lower life expectancy less likely to have a healthy weight (more likely to be overweight or underweight) more likely to be admitted to hospital for a range of conditions including respiratory illness and injury Less likely to be ‘school ready’ and to achieve at school Inequalities for Children and Young People in Bradford District (JSNA)

Public Health Outcome Framework: Domain 1 Improving the wider determinants of health Domain 2 Health improvement Domain 3 Health Protection Domain 4 Healthcare public health and preventing premature mortality  Children in poverty  School readiness  Pupil absence  First time entrants to the youth justice system  year olds not in education, employment or training  Domestic violence  Under 18 conceptions  Excess weight in 4-5 & year olds  Hospital admissions caused by unintentional and deliberate injuries in under 18s  Hospital admissions as a result of self-harm  Emotional wellbeing of LAC  Smoking prevalence – 15 year olds Vaccination coverage  Mortality from preventable causes  Mortality from communicable diseases  Tooth decay in children aged 5

Type of schoolNumberAge rangeAuthority/Dept Primary school Bradford LA Primary Academies183-11DfE Secondary School Bradford LA Through Academies33-19DfE Secondary Academies DFE Secondary Free Schools711-19Bradford LA Pupil Referral Units55-19Bradford LA Private schools TOTAL222 Diversity of Schools(2015)

 Established partnership working between health, public health, education, VCS & other partners  Involvement of children and young people through Lifestyle surveys (2013)  School nursing services commissioned by Local Authority (LA) since 2013  A refresh of the Service Specification and performance information for school nursing services (2015)  New Integrated Early Years Strategy for children 0-7 years and working closely with Children centres – Transition to school is key  Transfer of commissioning 0-5 services to LA (Health Visitors and Family Nurse Partnership) Oct 2015 Where are we now?

Why do we need to Review School Nursing

Drivers: Identify if and how the current service model meets current and emerging need Changing demographic profile of children and young people within the Bradford District Review how the service model fits with Children and Young Peoples services Identify opportunities to make improvements in prevention and early intervention

Agenda for the Afternoon

Two Sessions: Introduction and background to session Focus Group Discussion Feedback

Session One: The Current Service Model Questions: What are your expectations on the school nursing service and what do they contribute to your service? What works well? What doesn't work so well?

Session Two: The Future Questions: What needs to change? What are the future challenges?