Rachel McNickle, Children’s Health Commissioner, Kelley Webbmartin (Head of School Health) Caroline Bloch (Strategic HR Business Manager), May 2017
Background and Context
Following agreement from the Mayor, Newham in-sourced school nursing services in early 2016. The process took about a year. The Council wanted to move towards a model of neighbourhood integrated working, with a focus on improving outcomes using a multi-disciplinary approach. At the same time, the Council recognised that rationalising the schools offer was important - existing relationships with schools were good and taking this route made sense.
In relation to rationalising 0-5 services, both the council and CCG wanted to establish an integrated service with a joint outcomes framework. It was agreed that a good option to help meet their requirements would be for the council to in-source the health visiting service. This aligned well with the move to providing a seamless 0-19 service and meant more control. The council is currently going through this process, with the new transfer arrangements due to go live July 2017. The transfer will still allow integration with other CCG Services for this age group.
IT
IT has been difficult to resolve. The system that is used by the existing provider is RIO. The council has had to commission from this to meet its IT requirements - RIO is not currently used within the Council. Commissioning to keep existing IT arrangements in place will allow health visiting staff to have access to necessary data and information from day one. Longer term arrangements will then be agreed. Changes to the operation of the Child Health Information System adds an additional layer of complexity.
HR & Pensions
Existing health visiting staff will be transferred under TUPE arrangements whilst any health visitors appointed post transfer will be employed on council contractual terms and conditions. HR colleagues do not foresee any issues being caused by this, as the Council has attractive terms and conditions which align well with NHS contracts.
In relation to continuing service, it is noted that national guidance requires regarding the definition of continuous NHS service. As there are currently diverse providers in the market and staff mobility across different organisations; (NHS, Local Authority, Social Enterprise etc.) there should now be a consideration/requirement for the definition of continuous service, to be based on ‘Health provision’ as opposed to organisation status.
Pensions were protected as per TUPE arrangements. Officers did need to pursue a closed direction order for pensions (to ensure that contributions are passed on as they should be post transfer). The council can now use these to protect pensions for school nurses and the order will also protect health visitor pensions once they transfer. (Initially the Council did seek external support to manage NHS pensions but this was difficult to find with not many organisations providing such a service. The internal pension’s team following discussions agreed to take on this responsibility).
Post transfer, HR will support professional revalidation and clinical supervision of health visitors (they are already doing this for the 5-19 service).
CQC & NHS Provider licence registration
The council pursued CQC registration for the transfer of the school nursing service (which took approximately 3 months) and will be doing the same for health visiting. The CQC advisor was very helpful.
The council sought advice on whether an NHS provider licence was needed from different partners including NHSE and were advised that they did not require a licence.
Other observations
All providers have to engage in supporting placements for student health visitors/school nurses as part of the wider HEE framework to ensure there is enough capacity in the system to provide all students with the training they need. HEE have been extremely supportive in helping the council to put these arrangements in place. Councils are able to apply for tax relief for these students as they are on a lower wage. Initially HRMC advised that the council was not entitled to do. They are currently in the process of resolving this issue.
The support arrangements needed to provide staff with NHS pensions needs consideration; councils need to make adjustments to account for this as usually it is only one pension scheme for all staff.
The health visitor transfer is proving to be much more complex given the size of and scope of the service (i.e. universal reach) than transferring school nursing services.
Thought needs to be given to maintaining the provider/commissioner split. (In Newham there is no central public health team, commissioners sit within service departments).