Kaela Francioli doesn't see how her children's centre can provide a"first-class" family support service now her team has shrunk from fivemembers to two part-timers.
Four staff have left Bacup & Stacksteads Sure Start in Lancashire in thepast three months, and the centre manager expects more to leavefollowing a drop in the centre's funding as it loses its ringfencedstatus in 2008/09.
The financial crunch also comes as primary care and hospital trustsacross England pull health staff back into the NHS.
Children's centre managers fear work to integrate children's serviceswill be torn apart. How local authorities and primary care trusts handlethe mainstreaming of Sure Start is becoming a thorny issue.
Francioli says her centre's income is set to fall to 250,000, aquarter of its original budget. It's a drastic drop and has left thecentre with little time for contingency plans.
"When Margaret Hodge (the then children's minister) visited us prior tothe 2005 elections, she said we could expect twice that amount perchildren's centre. We thought, that's okay, we can manage on thatwithout drastically reducing services to people," she recalls.
"We're grateful for the extra money, but the drop is so drastic andsudden. People are now starting to apply for other jobs."
And because the council can't guarantee even that amount as theGovernment's spending review of funding is still under way, it adds tothe uncertainty, she says.
New ways of working
Anne Longfield, chief executive of 4Children, says the long-term aim ofSure Start has always been to demonstrate the value of different ways ofworking, which primary care trusts and local authorities would theninvest in and expand.
But the success of this has been a "mixed bag". Although someorganisations are doing well, others are unprepared. And primary caretrusts have financial pressures of their own. "Primary care trusts ingeneral have started working in a preventative way. But changeoverstrategies have not happened in most cases."
Under the Childcare Act 2006, local authorities must ensure they managethe children's centre market, reorganising resources to fill gaps andimprove services. But most are not working closely enough with healthservices to bring about measures such as pooled budgets that are neededto do this, continues Longfield.
This means specialised posts, such as family support workers, will belost from more Sure Starts next year as they switch to the samefinancial footing as children's centres.
One manager, whose Sure Start funding has run out, told Children Nowthat the local primary care trust is to take over health visitorfunding.
While the health visitors will be based in children's centres, themanager warns they will no longer work as part of the integrated teamdelivering innovative services, such as baby massage, parentingprogrammes or weaning parties.
As primary care trust-funded health visitors they will be managedseparately from the children's centre's team and restricted totraditional core work, such as immunisation. The health trust alsointends to stop employing family support workers.
"There will be no discussion between the family support worker, healthvisitor, midwife and family co-ordinator. Families will get piecemealservices again. The point of Every Child Matters is that we worktogether in an integrated way. As services are suspended, fewer familieswill be able to access the help they need to prevent further breakdown,"the manager told Children Now.
Equity of access to services
There has been similar controversy in Newcastle, where managers claimthat joint working will fall apart as health visitors return to theNHS.
But Jill Prendergast, head of generalist services at Newcastle PrimaryCare Trust, believes the move is a positive one. She says it means bestpractice learned by children's centre-based health visitors will bespread more widely. "If we want to create equity of access we have tolook at a common system, otherwise we're creating inequality."
Few health visitors have been based in the city's 10 children's centres'she points out. New arrangements will see health visitors moved awayfrom GP centres and clustered around children's centres. "The onlydifference now will be some health visitors won't have a nine-to-fivebase in centres."
Back at Bacup & Stacksteads Sure Start, Francioli says the centreaverted initial despair over the loss of health posts by persuading theprimary care trust to adopt an integrated approach. For example,following negotiations, from next month the speech and languagetherapist will no longer be based at the centre. But the therapist willrun drop-in sessions at a number of centres. And under plans still beingnegotiated, health visitor services could see closer links with familyhealth workers through supervision.
But though the situation is improving, non-health staff are stillleaving.
"It is worse to give a community something then pull the plug, than tohave not given it in the first place," says Francioli. "We are making avast difference to the lives of children in Bacup, but will be back tosquare one if support is reduced too drastically, too soon."
THE SITUATION IN BRIEF
- "Health visitors are being absorbed back into the primary care trustbut children's centres will still work closely with health visitors tocontinue services" Pauline Pestell, children's centre lead, NewcastleCity Council
- "Centres are going into this too soon for some local authorities tocope. Sure Start is falling off the edge slightly in terms of funding.What is needed is transition funds" Anne Longfield, chief executive,4Children.
