Child Health Special Report: Early years and health link up

Suspicion and animosity were seriously undermining the relationship between healthcare workers and children's centre staff in Walsall as health visitors were uneasy about delegating tasks to family support workers at centres.

Information sharing was another cause of friction. Health data managers refused to share even general information, even though children's centres and primary care trusts (PCTs) share the same performance indicators.

To address these issues, NHS Walsall and Walsall Metropolitan Borough Council teamed up to create the jointly funded role of health development co-ordinator for children's centres - a post dedicated to healing such rifts.

A year on and the change has been startling, says Carl Britton, head of child, family and extended services support at Walsall's children's services department. "The co-ordinator has been able to organise meetings, bring different professionals together and explain the importance of partnerships and sharing information," he explains.

Dawn Lewis took up the co-ordinator post after working as a midwife in the area. In her role she has met with health information managers and clarified job descriptions to help those in health and social care better understand each other's roles. Joint meetings involving centre and health professionals looking at individual cases are now more frequent and joint training is in the pipeline.

"Six months ago, I think both health visitors and children's centre managers would have viewed the other as 'fitting in' to their team," says Lewis. "Now I see much more focus on a one-team approach, looking at who is best placed to deliver a certain aspect of care or support to families in the area."

An NHS Walsall insider says her background in midwifery has helped: "There was a real problem between health visitors and children's centres - lots of wariness. But midwives were outside the problem, which helped bring the different sides together."

Maxine Bretherton-Budd, strategy and partnerships director at Together for Children, says having a co-ordinator is a great way to integrate services. "What they have done in Walsall is brilliant: having that person whose job it is to bring people together, address areas of contention and question how work is being carried out," she says.

Specialist roles

Relationship building is particularly important, she adds, especially to reassure health professionals that their specialist roles are not being taken over by untrained generalists. One example she gives is weighing babies. "Anyone who is numerate can do that. But only a health visitor will know what to do if the weight is not as it should be. But, as long as they know when to refer on, having a family support worker doing the weighing should be fine," she says.

The child health strategy, due this month, is set to urge others to follow Walsall's lead. "Partnerships between children's services and health are inevitable and there is a growing realisation that services need to look at families as a whole," says Dr Cheryll Adams, lead professional officer at health union Amicus CPHVA.

She believes the most successful link-ups will be those where centre staff and health professionals are co-located. "If they see each other every day then relationships grow. Areas where different professionals are not coming into contact with each other on a regular basis will struggle," says Adams.

However, the latest figures from Amicus CPHVA suggest co-location is rare. Just seven per cent of health visitors surveyed by the union this year were located in a children's centre.

One area where families and staff are seeing the benefits of co-location is in Ashington, Northumberland. For the last seven years, Ashington Children's Centre has employed its own midwife, Leigh Murphy (pictured above left), who specialises in helping children with complex health needs.

Murphy says co-location helped her to feel part of the team. However, this sense of camaraderie was not initially shared by local midwives. "I'm in a new role, more of a hybrid between a midwife and a health visitor, and my remit goes beyond pregnancy and birth to look at areas such as breastfeeding and parenting. This meant a lot of the community midwife team were suspicious and thought I was threatening the traditional role of a midwife," says Murphy.

But, within months of her appointment, even the most wary midwives began to see her as a help rather than a threat. "I deal with very complex needs - some have mental health issues; some are victims of domestic violence. Midwives now see my role is designed to run alongside theirs and I get most of my referrals from them," says Murphy.

Gill Physick, locality manager at charity Action for Children (formerly NCH), which manages the children's centre, says this is a model that can work elsewhere in the country.

"It depends on the locality but for us, because we have a number of families with complex needs, it really helps having Leigh here. The families she sees are very vulnerable, but they know and trust her. She can guide them through the system and make sure the right professionals are involved," says Physick.

Another focus of Murphy's role is engaging both children's centre staff and health professionals in projects. "This teamwork is one of the most satisfying parts of the job - helping to set up a service and then training staff to handle it. Baby massage and teenage parent groups are now handled by health visitors, health trainers and family support workers. I have also trained teenage parents to become volunteer experts," says Murphy.

Funding challenges

This emphasis on delegation and trusting non-health professionals to handle health projects is at the centre of Ashington's model, says Physick. "We are a team of experts and we all trust each other and appreciate everyone's areas of expertise. We are not diluting roles or looking to replace anyone."

Murphy only has one gripe about her role: funding. Being funded directly through Sure Start budgets for Ashington Children's Centre means her role is reviewed every year. "Each year I wait to see if the role is being funded. I don't know if I will be here next year, but they always manage to find the money. I've been here seven years now," says Murphy.

Physick explains the centre has had to be creative to ensure it can keep Murphy. This year, when funding for the role was once again under threat, Action for Children came up with a plan whereby she spends part of her week at some of its other centres - in Biggin Hill and Lynemouth. These centres then pick up part of the tab for her funding. "We have had to juggle funding but, fortunately, because we manage a number of centres, we can look at this area-wide," says Physick.

Geethika Jayatilaka, deputy chief executive of the charity 4Children, hopes the forthcoming child health strategy's emphasis on partnerships between centres and trusts will help create longer-term funding streams.

"My hope is that this strategy will make trusts and local authorities take a closer look at the need for stability and long-term planning in their funding if they want health and children's centre partnerships to succeed," she says.

JOINT WORKING IN BIRMINGHAM

"We had one mother come in with her little girl, who was just two and a half years old and had just been diagnosed with a life-limiting condition. The mother was devastated but, because of the way we do things here, we were able to support her across the board with health, housing, benefits, everything," says Laura Brodie, head of Allens Croft Children's Centre.

The centre opened in Easter, through a joint venture between Birmingham City Council and South Birmingham Primary Care Trust, combining health and children's centre facilities.

"We offer families just one experience. Instead of having to travel around or spend time on the phone arranging appointments they can go to a clinic, see a physiotherapist, get advice on housing and attend nursery all under one roof," explains Brodie.

Co-location has also improved collaboration on individual cases. Regular family support meetings now take place, involving professionals such as family support workers and nurses. This avoids the need for parents to have to explain their story to several different team members.

Sue Sidaway, senior nursery nurse, describes life prior to the move. "Where we were before was an old school clinic, but we had outgrown it. It was so small we had to turn families away. Now we can support everyone who comes in," she says.

Staff training has also received a boost. Health and children's centre teams regularly attend joint training sessions and offer advice to each other on education or health.

"We have one child at the nursery who has a tube with fluid going into her brain. Having health staff here has really helped us," says Brodie.

Working in the same building has also helped to break down cultural barriers between professionals. "We have always respected different professionals with particular specialisms but now we can learn so much more from each other," adds Brodie.