Agenda item

The Committee held its fifth witness session into its review of the Stronger Families Hub. This session focused on partnership working with health representatives. Witnesses in attendance were the Head of Service, First Response, MASH and Out of Hours Social Work; the Assistant Director for Safeguarding Adults, Safeguarding Children and Children Looked After; the Named Nurse for Safeguarding Children (Hillingdon)/ CNWL Interim Head of Safeguarding Children), and the Head of Children’s Services for Hillingdon.

The Head of Service, First Response, MASH and Out of Hours Social Work introduced himself and his role with the Stronger Families Hub. It was noted that this session related to partnership working with health representatives and that a future session would be held with education representatives. The partners worked with families who were under pressure, and also dealt with impacts of COVID-19 and the cost of living. Despite the challenges, the partners remained committed to providing support, and there was close collaboration between health partners and the Stronger Families Hub. The main source of referrals had come via the Police, with up to 11 officers on site within the Multi Agency Safeguarding Hub (MASH*) to enable the quick exchange of information. The second most referrals had come via health partners.

(*MASH was the Stronger Families Hub's safeguarding element where professionals shared information quickly about police referrals of domestic abuse (Merlins) and referrals where there were concerns about a child's safety or welfare.)

The Head of Children’s Services, CNWL, noted that their portfolio included children aged 0-19, health visiting, school nursing, child development centres, community paediatricians, children integrated therapy, occupational therapy, paediatric occupational therapy, physiotherapy, speech and language, children’s community nursing team and working with those with life-limiting conditions. Health representatives were a large partner of the Stronger Families Hub. The above noted services had been asked about their experiences with the Stronger Families Hub prior to this witness session, and the feedback was positive, despite some teething problems. Partners highlighted the benefit of the Stronger Families Hub as one forum for a range of issues, and this was linked to the early identification of needs. It was also noted that partners had a strong relationship with the Local Authority.

The Named Nurse for Safeguarding Children (Hillingdon)/ CNWL Interim Head of Safeguarding Children noted that they worked with all children’s services when they had safeguarding concerns and delivered training to staff. They line managed the MASH Health Practitioner within Hillingdon. There was lots of interaction with MASH and these services used the Stronger Families Hub a lot. The Named Nurse further noted the initial teething problems but that they were pleased with the work of the Stronger Families Hub.

The Assistant Director for Safeguarding Adults, Safeguarding Children and Children Looked After at CNWL NHS North West London worked in close collaboration will all health services including Primary Care, Primary Medical Care, Acute Trusts and Community Trusts. Part of their role was to ensure that health colleagues were discharging their safeguarding responsibilities appropriately. The Stronger Families Hub came under this remit. They noted that there had been issues for the Acute Trust with the online portal when initially launched but commended the Local Authority for its response to this. A sub-group has been established which had discussions around the initial operational issues with the online portal, which had helped to resolve some of these issues and to reduce anxieties. It was noted that there was still some work to do with Primary Medical Care via support for GPs in terms of accessing and using the portal. A positive aspect was the useful guidance document that had come out alongside the launch of the portal. This had been well received by Primary Care.

Members questioned how feedback was received from or on behalf of non-verbal children with special education needs and disabilities (SEND). Witnesses noted that training was ongoing with key workers as well as social workers which included training on communication tools, such as parent-child observations for non-vernal children. Continuous improvement was reviewed on a four-weekly basis through one-to-one supervision, while there was also peer supervision and group supervision. There were also workshops taking place with partners. There was a reliance on universal services for information sharing, but once information was shared, the process was more streamlined that it was prior to the establishment of the Stronger Families Hub due to its one number, one email, one online portal that children, parents, carers and professionals can access.

Partners further noted that training was assertive in knowing that children with SEND were at higher risk of safeguarding concerns. This was linked to the Early Health notification.

Members questioned how feedback was received from young people after any case of safeguarding breach. Partners noted that there was a focus on getting better at obtaining feedback and that the Care Quality Commission (CQC) asked for evidence of this feedback. Reference was made to the Teddy Bear’s picnic but it was noted that improvements were needed and so partners gave a partial assurance to the Committee on partners getting feedback from young people.

Members further highlighted other voluntary groups such as scouts and girl-guides, and sports teams as avenues for feedback or for direction to the Stronger Families Hub. Partners further noted Young Health Watch, the Children in Care Council, and the Child’s Voice Panel as other avenues for feedback. Feedback was also received during the statutory SEND process. It was, however, noted that sometimes feedback was sought from the easier-to-reach groups as opposed to all groups. A possible future group for children with epilepsy was referenced as a potential new route for engagement as part of the plan for 2023.

Partners noted that for children with disabilities, when a referral was made, partners had close relationships to identify which professionals know that individual child well, for example a Speech Therapist or Occupational Therapist, who could identify their communication needs and identify which tools to use to get the child’s voice heard.

Reference was made to Speech and Language therapists within the Youth Offending Service – these were key in the communication process and were often linked to undiagnosed cases of Attention Deficit Hyperactivity Disorder (ADHD).

Members asked about the challenges faced and what areas of improvement could be identified. Partners noted that quality assurance of referrals being made was one area to look at, as well as mental health services. On quality assurance, partners further noted that this was tracked, and there was practitioner-to-practitioner tracking where possible. This had led to less escalation to managers. Partners noted other partner organisations such as Border Force and noted an increase in quality in Early Help Assessments. Partners noted that the form on the online portal had been amended to be more concise, and now consisted of drop-down boxes. Further noted was the importance of ensuring that staff were supported in quality assurance.

Members referred to the next agenda item and asked if there was a capacity issue. Partners noted that some staff were on lean contracts and there were some vacancy issues around Paediatric Occupational Therapy, although this reflected a national issue. It was acknowledged that funds were tight but that an Asylum-Seeking Health Visitor would be beneficial as well as a Paediatric Occupational Therapist. It was noted that there was a struggle with the increase in the number of Education, Health and Care Plans (EHCPs), and that the number of referrals to the Child Development Centre for concerns regarding Autism Spectrum Disorder (ASD) were increasing. Creative and innovative ideas were often pursued as a way around capacity issues.

Members commended the more joined-up nature of the service with partners, and asked about any issues with data sharing between agencies and how these were overcome. Partners noted that GDPR should not be a barrier to keeping children safe. It was noted that the Stronger Families Hub was a consent-based service, and it was recommended through a review that parents and carers be better informed that consent meant to more than one agency. This was known as universal consent.

There was also a named nurse for Child and Adolescent Mental Health Services (CAMHS), who was trained in information-sharing. Data was provided through the Safeguarding Children Partnership for CAMHS. It was noted here that a CAMHS post within MASH would be beneficial.

Members asked the partners about their work with other Local Authorities and how this differed from its work with Hillingdon. Partners noted that most of their work was with Hillingdon and that the service being 24-hours was impressive, as not having to use emergency teams outside of core hours kept the quality of service high. Also, having the one front door was beneficial. Partners noted that there was not enough experience of other Boroughs to give an accurate comparison. Partners again referenced the earlier point about quality assurance as an area for improvement. It was noted that the voice of the child runs through all sub-groups, and this was something that Hillingdon did well.

Members asked about the percentage of children with additional needs being identified through ASQ checks, how many were missed, and where any were missed, what was done to bridge this gap, in particular between children with and without SEND. It was noted here that further information could be shared outside of the meeting.

Partners noted the importance of early identification, and that they worked with a designated officer for SEND. The multi-agency approach of the EHCP was noted, and there was good signposting to, for example, resources available in alternative languages. Partners noted that the multi-agency work around SEND was strong.

Members asked partners for their input into possible recommendations for the major review. Partners noted that there were concerns around new arrivals in hotels, and so an Asylum-Seeking Health Visitor would be beneficial in terms of early identification of needs. Partners also had concerns over the number of vacancies within their services. Investment into children’s integrated therapy services was recommended, as was more focus on children with ASD. ASD navigators or pathways was suggested as a new approach to ASD. Stronger integration was needed between children’s services and adult services, as well as the transition when young people more from children’s services to adult services. The new Transition nurse was highlighted as a recent benefit. More focus on mental health provision and on neurodiversity support was recommended.

Members sought clarification on, and partners confirmed that, communication within the partners’ services was good, but communication with other agencies was what required improvement. It was further noted here that quality assurance was a high priority for the Stronger Families Hub sub-group.

RESOLVED: That the Committee asked questions of the witnesses and noted the updated scoping report.