Lancashire baby check targets missed amid claim '20 health visitors are doing the work of 80' in some districts

Lorraine Beavers, deputy leader of the Labour opposition group on Lancashire County Council, cited the figures for the Fylde and Wyre area at a meeting of the authority’s cabinet last month.

It came amid concerns that the company contracted to deliver the service was missing targets for health visits county-wide.

A report presented to cabinet members revealed that the nationally-set timeframes for each of the five categories of pre and post-natal visits – provided in Lancashire by HCRG Care Services Ltd. – were not being met, because of vacancies and staff sickness.

The document noted that a formal “remedial action plan” had been utilised to improve performance at the start of the year – and that there had been a “broadly…significant improvement” since.

However, the figures for the fourth quarter of 2022/23 – covering the first three months of this year – showed that the service was still nowhere near achieving the target for 95 percent of visits to be carried out within a specific timescale.

The worst-performing category was concerned with the review of toddlers that should take place when they are aged between two and two-and-a-half. Between January and March, just 69 percent of families had received that check when they should have done.

During the same period, 72 percent of expectant mothers had had a face-to-face antenatal appointment with a health visitor 28 weeks or more into their pregnancy, while 79 percent of infants had received an in-person visit within a fortnight of them being born and 74 percent of youngsters had been given their 12-month review in the proper time.

The service came closest to achieving the 95 percent target for the proportion of newborns who received a review between six and eight weeks after their birth – which stood at 86 percent.

HCRG Care Services’ Lancashire operation was rated as “good” overall by the Care Quality Commission (CQC) following an inspection in October last year, with the subsequent report noting that the service “had enough staff to care for children and young people and keep them safe” – but it added that caseloads were “high”. The firm was told that it ‘requires improvement’ in terms of the effectiveness of its service in the county.

June’s cabinet meeting at County Hall was told that enhanced recruitment and staff incentives had seen 40 new health visitors taken on in recent months.

However, County Cllr Beavers said she was concerned that the improvements of late were a temporary fix, achieved through overtime, simply because the contract for the service was up for renewal.

“We’ve got a private company that is not doing the job that it was supposed to do…and we’ve got 20 people trying to do the work of 80 [compared to the previous NHS contract].

“So I want this to be absolutely looked at with a pair of tweezers…because we have got a responsibility to all the young mothers across Lancashire and all the young families [to ensure] that our children are [kept] safe.

“Without having the proper provision of health visitors going into people’s homes, we are not looking after our young people.

“Twenty people cannot do the work of 80 – and this is what’s going on right under our noses and we need it stopping,” County Cllr Beavers said.

She described it as “a disaster” that the NHS – which ran the service until 2019 – had lost out to what was then Virgin Care following a controversial procurement process. That company was bought by Twenty20 Capital in late 2021 and rebranded as HCRG Care Group.

However, the former cabinet member for health and wellbeing, Shaun Turner – who was in that post when the contract was last up for renewal and now holds the environment portfolio at County Hall – accused County Cllr Beavers of rewriting history in her assessment of how the service used to operate under the NHS.

He said that the authority had been getting “very poor value for money” from the previous arrangement, although he acknowledged that there were still “problems” with the current set-up.

His successor in the health and wellbeing role, Michael Green, acknowledged that “performance wasn’t what any of us wanted it to be” – but stressed the recent improvements. The cabinet report revealed that sickness was down from a peak of 7.27 percent in November 2022 to 4.87 percent earlier this year, while the firm says that its vacancy rate for health visitors has also reduced and currently stands at around seven percent.

County Cllr Green also said that nationwide “recruitment challenges” had to be recognised, but added: “It’s a challenge [that] needs to be addressed.

“It’s an absolutely key service. The quality of the service is the main criterion in this [new] procurement [process] and we will make sure that this is right moving forward, because this is so important to the residents of Lancashire.”

Responding to the issues raised at the meeting, Michelle Lee, Regional Director at HCRG Care Group, later told the Local Democracy Reporting Service: “Our health visiting service has experienced the same challenges as those across the country following the COVID-19 pandemic and we have responded with a comprehensive recruitment and retention programme which is having a positive impact on our performance.

"Our vacancy and sickness rates have significantly reduced and we are performing above the national average for the number of completed contacts with families from the new birth check to the 2-2.5-year review. We remain committed to providing the ‘good’ standard of service that was recognised by the CQC and to continually improving for the benefit of families across Lancashire.”

The firm’s website notes that the firm has brought together over 500 colleagues into a single healthy young people service in Lancashire – it having previously been split between two NHS providers – “in order to give people across the county easier access to better and more efficient healthcare, with improved outcomes, whilst saving money”.

The service has hubs in Preston, Burnley and Lancaster, but also offers a virtual single point of access to ensure “better communication with professionals and families”. There is also a dedicated team to look after the needs of children in care.

The company says that mobile working that it has instituted means “more time is spent with patients”, while the CQC inspection report concluded that staff were competent, worked well together for the benefit of children and “advised them and their families [about] how to lead healthier lives”.

The firm’s contract to provide the overarching 0-19 years Public Health Nursing Service – which includes school nurses as well as health visitors – ends on 31st March next year.

At the same cabinet meeting, the county council agreed to put the new contract – worth an estimated £204m if it runs for the maximum possible term of eight years – out to tender. It will initially last five years with the possibility of a 36-month extension – and could be subcontracted by the eventual winner.

A procurement report presented to county councillors stated that the contract duration “reflects the high cost and effort involved to implement the contract in the event a new provider is appointed” and also “provides a greater degree of stability for the successful provider to commit to and deliver their service proposal”.

The bid evaluation will be based 80 percent on quality criteria and 20 percent on finance – but a “ceiling figure” will limit the flexibility interested parties have in terms of the price they can charge.

The last time the contract was put up for renewal in 2017, the process ended up mired in controversy when the two NHS trust who were then delivering the service – Lancashire Care NHS Foundation Trust and Blackpool Teaching Hospitals NHS Foundation Trust – lost out to Virgin Care, which was handed a £104m, five-year deal with County Hall.

The two trusts later challenged the decision in the high court, where a judge ordered that the bids be reassessed after concluding that the county council had failed to follow the evaluation and procurement process correctly.

However, after re-running the process, the authority once again awarded the contract to Virgin Care almost a year after it had first done so.

WHAT DOES THE SERVICE DO?

Lancashire’s Public Health Nursing Service is delivered in a range of settings, including families’ own homes, local community or primary care settings and schools.

According to Lancashire County Council’s procurement document for the new contract, due to begin next April, it co-ordinates the Healthy Child Programme in the county – a range of early intervention and prevention public health initiatives that are provided at what was described as “a crucial stage of life”.

“It provides an invaluable opportunity to identify families that are in need of additional support and children who are at risk of poor outcomes at the earliest possible stage,” the document notes.

Health visitors lead the 0-5 year-olds element of the programme and school nurses take charge of those aged between five and 19 years – or up 25 for young people with special educational needs and disabilities.

The newly procured service from next spring will:

***deliver the five mandated universal health checks for young children;

***deliver core statutory functions, including the National Child Measurement Programme.

***deliver a universal framework of health and wellbeing needs assessment reviews for the school aged population;

***deliver targeted post-16 health and wellbeing reviews for young people who are transitioning to adult services;

***focus on a ‘whole family’ approach to public health nursing, which is personalised to individual families.

***ensure safeguarding and the promotion of the welfare of children within its work;

***ensure a universal prevention offer and targeted support which will make a difference to the health and wellbeing of children and young people.

***ensure better integration with the authority’s children and family wellbeing services and other relevant services, making services more accessible to meet the needs of children, young people and their families.

Source: Lancashire County Council