Health visiting: Royal Borough of Windsor and Maidenhead

The vision for children’s services is to respond to children and young people’s needs at the earliest possible opportunity – integrated services are key to this. Therefore, the council felt there would be a better fit with local need if they brought the contract in-house (as opposed to delivery of the service through an NHS provider through a whole of Berkshire contract)


The original plan was to bring the school nursing and health visiting service together in house. However, following discussions with the provider, the school nursing service was brought in house in April 2016 and health visiting brought in house October 2016.

On 1 August 2017, the council transferred all of its children’s services to a community interest company owned by the council and two other local authorities.  Currently both the school nursing and health visiting service are integrated with children’s services and the council is working through what closer integration from a service delivery perspective will look like.

Berkshire Healthcare Foundation Trust had to disaggregate both the school nursing and health visiting service to meet the Royal Borough’s requirement.  In order to manage the process effectively, a project team across BHFT and the council was put in place, comprising key leads across the service, HR and IT, and this met weekly to deliver against the agreed project plan.

HR considerations

Contracts (ie terms and conditions) of both health visitors and school nurses have been matched to NHS terms and conditions at the point they transferred to the council. New recruits are appointed on the council’s terms and conditions.

The council has built a relationship with the local training college which means it approaches health visitor/school nurse students directly in relation to work opportunities.

Requirements around maintaining health visitor/school nursing practitioner registration has not been an issue. The council already supports registration for social workers so have mechanisms in place.

CQC registration

The council has a good relationship with the local Care Quality Commission (CQC) inspector through its adult services. This relationship has been important in supporting the registration of health visitor/school nursing services and a good point of contact to check issues/queries in relation to the registration process saving valuable time.

The council did seek advice on whether an NHS monitor licence would be needed but found that they did not meet the criteria (clear advice on this from all councils from the Department of Health (DH) would be helpful).


The council needed to migrate data from Berkshire Healthcare Foundation Trust (BHFT) to their LA system which was different. BHFT uses Open RIO and extracting the relevant data was difficult and required resource investment to achieve. 

To help support a smooth transfer, the council used the existing BHFT IT system for three months following bringing services in house.

The council then procured the health visitor module for its case management system (used by social care and early help services) and customised this module for health visiting services involving health visitors in the design process.

Clinical supervision

At the point of transfer, there were existing arrangements for clinical supervision and safeguarding through a clinical commissioning group (CCG) contract with BHFT which covered a range of services including health visiting. The council has continued with this arrangement. This contract ends in March 2018 so the council will need to determine what happens next, including potentially negotiating a separate contract with the CCG.

The impact

On the operational side there has been positive benefits. School nurses can more easily access and integrate with a wider range of services that support schools and there is a better sense of own destiny in terms of shaping what the service delivers and how it meets local needs.

Working with health visitors to design the process and system in which they want to work in has been really positive. The health visitors feel less regulated and see their relationship with the council as more of a partnership. This has resulted in them being open to the opportunities that the new transfer has to offer.

For further information contact Hilary Hall, Deputy Director Strategy and Commissioning, Windsor and Maidenhead Borough Council,