Co-location helps Warwickshire take holistic view of needs

• Single director leads on commissioning all children's and adults health services and public health
• Mental health services have been overhauled so school nurses can focus on reducing referrals

ACTION

When local authorities took on duties to deliver public health services in 2013, Warwickshire County Council moved its public health department into its communities directorate. This enabled the team to have more influence on decisions made by departments such as education. However, in April 2018 the authority merged public health into the Strategic Commissioning Unit, putting a single director in charge of public health and strategic commissioning in the unit, with responsibility for commissioning public health, children's social care and adult social care. As a result, the authority's commissioning lead for children's public health Kate Sahota says she is now involved in every children's services commissioning decision.

This more joined-up way of working means all departments have a say in commissioning decisions. Through the council's Children's Joint Commissioning Board, Sahota can gather input from wide-ranging partners including, for example, police and crime commissioners, with whom the team has worked on providing support for children at risk of child sexual exploitation. "We're now at the table to work on things we potentially might not have had the opportunity to be involved in before," says Sahota.

This closer working happens in two ways. Public health and strategic commissioning members can reach out for input from partners in other departments - for example, to look at needs assessments, review service applications, or take part in the tendering process. Alternatively, a public health representative can be brought into performance management meetings led by other departments to ensure services are being delivered.

"We've got lots of different touch points where we can influence and help guide what providers are doing and what's being commissioned," says Sahota.

Prevention is a priority for the council. A recent example is a new strategy to tackle domestic abuse. "We know that there are services for families where they've been subjected to domestic violence," says Sahota. "But actually we tend to see the same perpetrators causing issues going around different families." As a result, the unit is considering how to direct services at perpetrators to prevent future cases.

Mental health services for young people have also undergone a major redesign.

Since 2018, the local mental health trust has worked in partnership with the Coventry and Warwickshire branch of charity Mind to deliver more preventative services. It hopes this will reduce the number of young people being referred to intensive services, which have significant waiting times.

The partnership uses school nurses to deliver a school resilience programme, called Boomerang. The council introduced a new post into the school nursing team that specifically links them with mental health services. School nurses gather data on pupil mental health and have identified that teachers at some schools with high referral rates have limited mental health support skills. The authority now plans to train teachers to deliver mental health support themselves.

Last year, Sahota took on responsibility for recommissioning Warwickshire's children's centres to become children and families centres. The council has reduced the number of centres from 39 serving 0-5 year olds and their families, to 14 that will focus on 0-19 year olds and their families. The centres will be more prevention focused, with different services working from the same location. For example, when a baby group is running, Citizens Advice Bureau, family support workers, occupational therapists, or speech and language therapists may hold drop-in clinics at the same time.

Despite the broader pool of contributors in the commissioning process, Sahota says signing-off contracts is no more complicated than it was before the council adopted the closer-working style.

IMPACT

Providing measurable outcomes to demonstrate how the new commissioning arrangements are improving the lives of children will take several years, says Sahota. But in the example of mental health services, the authority hopes to see waiting times fall in the future and for there to be fewer referrals.

Sahota says the council is seeing evidence of improved partnership working within the local authority, as funding is increasingly aimed towards different departments working together.

Click here to read more in the Commissioning Children's Services Special Report