In January 2015, Redcar and Cleveland Borough Council went out to tender for the school nursing service and didn't receive any bidders. Between January and March, they did an options paper and Cabinet decided in March 2015 to transfer the service in-house and propose that they should subsequently explore also bringing health visiting in-house.
A project board was set up in March/April 2015 to enable to transfer of the school nursing service. The service transferred into the council 1 October 2015.
There are only a couple of authorities in the south who had taken all their community services in-house post primary care trusts (PCTs) including the existing infrastructures including management. In contract, Redcar and Cleveland were ‘peeling a service’ away from a large acute trust – a bit of a challenge.
They drafted a project plan and developed task and finish sub-groups. The project board met every two weeks. The school nursing service group is just under 30 people but Frances Anderson considered that there would be the same amount of work no matter what the size of the workforce.
IT was the biggest challenge. An option appraisal concluded that they wanted to continue to use SystmOne but at that time did not have N3 connectivity. However as they were IG Toolkit compliant, came to an arrangement with South Tees Hospitals Foundation Trust, the previous provider of the service so that they could access SystmOne through their network for the first six months (October – April 2016). However, when they transferred health visitors in, they had to install their own N3 connection. There was no in-house SystmOne expertise in Redcar and Cleveland Borough Council and they explored the option of recruiting someone but didn’t have time to do it. Neighbouring Middlesbrough Council had opted to go back out to tender for their full 0 -19 healthy child offer and that is now provided by Harrogate and District Foundation Trust. Redcar and Cleveland commission them for SystmOne support.
They worked hard to keep staff on board, selling the benefits and opportunities of a fully integrated service for families with existing council services. There was an issue around retaining pensions and lease cars – several staff were using the NHS lease car scheme which was heavily subsidised and now people had to source their own vehicles. Overall, people managed; the previous employer paid for any penalties for early release of lease car. The local authority had to apply for a pension direction order. This took a long time to obtain but does allow staff to remain in the NHS pension.
Transfer of Undertaking (TUPE) was straightforward. There were staff development sessions with both existing and future provider organisations and staff felt supported throughout.
In general, staff were reluctant to transfer to council contracts and lose their NHS terms and conditions. However, following transfer there have been a significant number of staff who have opted to transfer onto council terms and conditions. The main incentive for this has been that they will now be entitled to a cost of living pay increase should the council award one. For staff remaining on NHS terms and conditions they will not be eligible for any cost of living pay increases awarded by the NHS.
There was an issue with Health Education North East – initially advised that they could not fund a non NHS organisation for health visitor and school nurse training. They have agreed to do it this year but this needs wider discussion.
The council is still developing the internal commissioner/provider relationship. The services are based within the children and families service to fully integrate with other children and families services.
Aligning policies, procedures and standard operating procedures required a lot of dedicated resource.
The service manager who manages both health visiting and school nursing services reports into an assistant director who does not have a health background. Opportunities for external clinical supervision are being considered. She is part of an integrated children and families senior leadership team.
Safeguarding and CQC registration
The safeguarding supervision and training is provided by South Tees Hospitals Foundation Trust. They explored employing their own safeguarding nurse but there would then be a sole reliance issue – it seemed more effective to commission the service.
Registration with Care Quality Commission (CQC) was an ‘interesting part of the journey’. They tried to navigate through guidance and telephoned the helpline on an number of occasions. The system is not set up for health visiting and school nursing. Redcar and Cleveland have now registered following a CQC inspector assessment. Frances Anderson thought the CQC is not set up to accommodate health visiting and school nursing as stand-alone services. There was no requirement for the local authority to obtain an NHS provider license
Following transfer of services from the NHS to the local authority a CQC inspection of school nursing and health visiting services was conducted. The outcome of the inspection was extremely positive with no recommendations and two areas of outstanding practice one of which was regarding the smooth transfer. The following quote from the inspection report reflects this:
Main tips for success
- Set up a partnership board of people with the right expertise to support you. Developing the relationships at an early stage was critical to our success as everyone involved was unanimously clear about what we needed to achieve and committed to delivering the transfer.
- Be realistic about the time it takes to transfer the services and make sure you have dedicated resources to support
- Keep staff on board – it is useful to have a project leader with a health background who already has established respect - someone who knows what the School Nurse/Health Visitor role entails.