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Best start in life and beyondImproving public health outcomes forchildren, young people and familiesGuidance to support commissioning of the healthy child programme 0 to 19.Guide 1: Background information on commissioning and service model1

Best start in life and beyond: Improving public health outcomes for children, young people and familiesCommissioning guide 1: Background information on commissioning and service modelContentsIntroduction . 3The Healthy Child Programme . 4Support for children in mainstream education with additional health needs . 6Purpose of the guidance . 6Commissioning responsibilities for child health and wellbeing . 7Commissioning public health services for children and young people 0 to 19 . 7Health visiting and school nursing services (public health nursing workforce) . 8Regulation and employer issues . 13Safeguarding. 13Associated tools and guidance . 142

Best start in life and beyond: Improving public health outcomes for children, young people and familiesCommissioning guide 1: Background information on commissioning and service modelIntroductionThis is one of 3 supporting guides to assist local authorities in the commissioning ofhealth visiting and school nursing services to lead and co-ordinate delivery of publichealth for children aged 0 to 19.Public Health England supports local authorities and the NHS in securing the greatestgains in health and wellbeing and reductions in health inequalities through evidencebased interventions. In October 2014, PHE published From Evidence into Action:Opportunities to protect and improve the nation’s health. This is closely linked to theNHS Long Term Plan, the Prevention Green Paper and the NHS Five Year ForwardView.Ensuring every child has the best start in life is one of PHE’s key priorities. Best Start inLife has been identified as a priority within Public Health England's 5-year strategy,which runs from 2020 to 2025.A major contribution to achieving these ambitions and strategies is the modernisation ofthe Healthy Child Programme. The Healthy Child Programme is a universal programmeavailable to all children and aims to ensure that every child gets the good start they needto lay the foundations of a healthy life.Universal and targeted public health services provided by health visiting and schoolnursing teams are crucial to improving the health and wellbeing of all children and youngpeople.The foundations for virtually every aspect of human development including physical,intellectual and emotional, are established in early childhood. Sustaining this across thelife course for school-aged children and young people is important to improve outcomesand reduce inequalities through universal provision and personalised response. Theremay be challenges within a child’s or a young person’s life and times when they needadditional support (No Child Left Behind, PHE 2020). Children in care, for example,experience more frequent moves of home and school so may face additional challenges(Stability Index, Children’s Commissioner, 2019).Modernising the Healthy Child Programme is intended to enable effective, focusedservices where additional needs are identified along with use of the latest evidence oneffective practice and helping to bring councils, the NHS and partners together toachieve priority outcomes for children and families. Delivering this vision is reliant upon awide range of partners working together and embracing change in order to:3

Best start in life and beyond: Improving public health outcomes for children, young people and familiesCommissioning guide 1: Background information on commissioning and service model ensure high quality services for children, young people and families from actions toimprove women’s health before, during and after pregnancy (MaternityTransformation Programme)give every child the best start in life (childhood obesity, speech, language andcommunication, immunisations)support school readiness and improve resilience for school-aged children.support young people transitioning to adult servicesKey public health priorities are supported by national enabling actions in shaping localservices to plan the design and delivering for the populations identified health needs.Forexample, the Social Mobility Action Plan for Education (Department for Education,2017): ‘Unlocking Talent, Fulfilling Potential’ includes a plan for the early years with afocus on improving early language acquisition. The importance of effective outcomesrelies on strong collaborative partnerships with the child, family or carers and all partnersin health (primary and secondary), local authority including early years services, andvoluntary sector services.The Healthy Child ProgrammeGood health, wellbeing and resilience are vital for all our children now and for the futureof society. There is good evidence about what is important to achieve this throughimproving children and young people’s public health. This is brought together in thenational Healthy Child Programme 0 to 19, which includes: Healthy Child Programme: Pregnancy and the first five years of life (DH and DCSF,2009)Healthy Child Programme rapid review to update evidence (PHE, 2015)Healthy Child Programme: From 5 to 19 years old (DH and DCSF, 2009)PHE have published a rapid review of the evidence in relation to safeguarding guidancein the Healthy Child Programme for 5 to 19 year olds. The review focuses on the areasof child abuse and neglect, child sexual abuse and exploitation, intimate partner violence(IPV), female genital mutilation (FGM) and gang violence. In line with the remit of theHealthy Child Programme for 5 to 19 year olds, the focus is on prevention and earlyintervention.The 0 to 5 element of the Healthy Child Programme is led by health visiting services andthe 5 to 19 element is led by school nursing services. Together they provide place-basedservices and work in partnership with education and other providers where needed. Theuniversal reach of the Healthy Child Programme provides an invaluable opportunity fromearly in a child’s life to identify families that may need additional support and childrenwho are at risk of poor outcomes.4

Best start in life and beyond: Improving public health outcomes for children, young people and familiesCommissioning guide 1: Background information on commissioning and service modelThe Healthy Child Programme provides a framework to support collaborative work andmore integrated delivery. It aims to: help parents, carers or guardians develop and sustain a strong bond with childrensupport parents, carers or guardians in keeping children healthy and safe andreaching their full potentialprotect children from serious disease, through screening and immunisationreduce childhood obesity by promoting healthy eating and physical activitypromote oral healthsupport resilience and positive maternal and family mental healthsupport the development of healthy relationships and good sexual and reproductivehealthidentify health and wellbeing issues early, so support and early interventions can beprovided in a timely mannermake sure children are prepared for and supported in all childcare, early years andeducation settings and are especially supported to be ‘ready to learn at 2 and readyfor school by 5Being ready for school is assessed as every child reaching a level of development whichenables them to: communicate their needs and have good vocabularybecome independent in eating, getting dressed and going to the toilettake turns, sit still and listen and playsocialise with peers, form friendships and separate from parent(s)have good physical health, including dental healthbe well nourished and within the healthy weight for height rangehave protection against vaccine-preventable infectious diseases, having received allchildhood immunisationsIt also involves continued support through school age years to help every child to thrive and gainmaximum benefit from education, driving high educational achievementidentifying and helping children, young people and families with problems that mightaffect their chances later in life, including building resilience to cope with thepressures of life5

Best start in life and beyond: Improving public health outcomes for children, young people and familiesCommissioning guide 1: Background information on commissioning and service modelSupport for children in mainstream education withadditional health needsChildren with additional or complex health needs often require additional support toensure a seamless transition into school, and to feel supported to learn within aneducation setting (Children with special educational needs and disabilities, SEND).Commissioning arrangements should be developed to clarify the contributions frompartners in health, social care and education to ensure that children with additional orcomplex needs are school ready and supported within education settings.Commissioning guidance 2, appendix 2 provides an overview which local partners maywish to consider. This is underpinned by the Healthy Child Programme 0 to19 (HealthyChild Programme 0 to 5 and Healthy Child Programme 5 to19) and SEND Code ofPractice 0 to 25 Years.Local commissioning arrangements should focus on the needs of children and youngpeople and ensuring children are ready for school within: mainstream education for those with additional health needs, for example, emotionalor behavioural issues, mobility issues, asthma or continence (bladder or bowel)problemsspecial schools for those with complex health needs, for example, a child withrespiratory support needs or complex learning disabilities and or neurodevelopmentissues, autism or ADHDPurpose of the guidanceThe Health and Social Care Act 2012 sets out a local authority’s statutory responsibilityfor commissioning public health services for children and young people aged 0 to 19years.This guidance supports local authorities in commissioning ‘public health services forchildren and young people’. The Healthy Child Programme aims to bring together health,education and other key partners to deliver an effective programme for prevention andsupport.Whilst recognising the contribution of other partners, there will be some elements whichrequire clinical expertise and knowledge that can only be provided through services ledand provided by the public health nursing workforce, for example, health visiting andschool nursing teams. Consequently, this guidance:6

Best start in life and beyond: Improving public health outcomes for children, young people and familiesCommissioning guide 1: Background information on commissioning and service model describes the health visiting and school nursing high impact areas and relatedoutcomesprovides a national template for local authorities to use and adapt to meet localneedssupports integrated delivery and provides opportunities for local authorities toconsider integration and co-commissioningoffers quality and standardisation of service delivery whilst recognising the need forlocal adaptabilityCommissioning responsibilities for childhealth and wellbeingUnder the terms of the Health and Social Care Act 2012, upper-tier local authorities areresponsible for improving the health of their local population. Local authorities are keycommissioners and hold an array of statutory duties for children, including: establishing arrangements to reduce child povertypromoting the interests of children in the development of health and wellbeingstrategies (joining up commissioning plans for clinical and public health services withsocial care and education to address identified local health and wellbeing needs)leading partners and the public to ensure children are safeguarded and their welfarepromoteddriving the high educational achievement of all childrenleading, promoting and creating opportunities for co-operation with partners andparents or carers to improve the wellbeing of young peoplesafeguarding and promoting the welfare of looked after childrenproviding or commissioning oral health improvement programmes and oral healthsurveys to improve the health and wellbeing of children and young people (NHSBodies and Local Authorities (Partnership Arrangements, Care Trusts, Public Healthand Local Healthwatch) Regulations Statutory Instrument SI3094 (United Kingdom,2012)Commissioning public health services for childrenand young people 0 to 19Regulation requires all families with babies to be offered 5 mandated health visitorreviews before their child reaches 2 and a half years old.The early years reviews are offered to all families. However, this is not the extent of thehealth visiting service offer for families who may also require additional support from thehealth visiting team, for example a nursery nurse. There are no mandated reviews for7

Best start in life and beyond: Improving public health outcomes for children, young people and familiesCommissioning guide 1: Background information on commissioning and service modelschool aged children. However, there are opportunities to develop a framework ofreviews based on evidence, intelligence, professional judgement and service user voicewhich provides op