brightThe following is an extract of JFHC board member Alison Wall's look at the key challenges faced do commissioners face to provide a children's service fit for children of today and tomorrow following the approval of the Health & Social Care Bill - to read the article in full, subscribe here

It's all change again next year following the recent approval of a revised Health and Social Care Bill. The Bill now awaits Royal Assent in May, despite a wave of opposition across nursing, public health and medical bodies. The main concern is the fact that a green light will be given for non NHS bodies to enter the field to compete for provision of services. The Bill is enabling GPs to hold a vast budget across England to commission services. As GPs are independent contractors and have a business approach we are likely to see a wide and diverse range of provider services in addition to qualified providers, including Community Interest Companies and social enterprises. So how will the Clinical Commissioning Groups, (CCGs) which will be clusters of GPs with one nurse member, make decisions on which services to commission and from whom? The CCGs are also required to find £20 billion savings over the next four years. This is a huge amount to return to the Government coffers, so how will this be achieved unless CCGs look at price margins as the key priority? 

Alongside CCGs there will be the creation of new Health and Wellbeing Boards (H & W Boards). They will be responsible for determining the public health priorities for their communities and will draw up local strategic health need assessment plans. They will link across to CCGs through a representative from the H & W Board sitting on CCG committees. It will be challenging to influence commissioning decisions as one public health member in a group of GPs, but the opportunity is there. However the way in which H & W Boards will link with the Local Children's Safeguarding Boards (LCSBs) is another issue that needs to be determined.

How will all this affect children's services? bright1

The previous Labour administration set up numerous projects for children and young people within the Department for Children, Schools and Families (DCSF). One of the key policies was "Healthy Lives, Brighter Futures" centering on the importance of the early years. The work of government ministers has also provided evidence that early interventions do deliver key outcomes. We know that babies' brains can be compromised during pregnancy from the research done in neuroscience. It is clear that children's services should focus on pregnancy as well as the early years, with midwives and health visiting teams working collaboratively. 

Commissioning disparities  

The main area of concern for children's services is the fact that a child's journey through the system will be disjointed, due to three or more commissioning bodies having responsibility for services at different life stages. Maternity services will be commissioned by the local CCGs, but specialist neonatal care will be commissioned through the National Commissioning Board (NCB). Commissioning transfers from CCGs to the NCB once the baby is delivered. The reason for this is that the Government is committed to the Health Visitor Implementation Plan. The plan is a time-limited project from 2011-2015. The objective is to recruit 4,200 extra health visitors over this period. 

How the Family Nurse Partnership (FNP) programme shapes up  

The FNP is a preventive programme for young first-time mothers. It offers intensive and structured home visiting, delivered by specially trained nurses (Family Nurses), from early pregnancy until the child is two. FNP has three aims: to improve pregnancy outcomes, child health and development and parents' economic self-sufficiency. The methods are based on theories of human ecology, self-efficacy and attachment, with much of the work focused on building strong relationships between the client and family nurse to facilitate behaviour change and tackle the emotional problems that prevent some mothers and fathers caring well for their child. 

The Government has committed to double the number of places on the FNP programme to 13,000 (at any one time) by 2015 Safeguarding needs clarity Child protection is a legal duty of all those working with children and families. Practitioners need clear standards and policies to guide practice. Eileen Munro has scrutinised the systems within social care and safeguarding and made succinct recommendations. One is that a new accountability framework should be drawn up by the Department of Education and Health. This task has been delegated to the Chief Nursing Officer and we await this with interest. Until its publication we have no clarity around who will commission specialist safeguarding services and where they will sit in the new structures. 

Training, mentoring and supervision  

Training to ensure a workforce is continually developing their services and delivers a quality service is never a cheap option. The training of children's workers consumes considerable financial resource. Many of the new providers take on staff who have been trained by the NHS, so have never had to put aside monies in their budgets in order to initially train staff. Training should be available for the children's workforce in order to maintain and enhance skills, knowledge and attitudes. Mentoring and preceptors are required, particularly for new and inexperienced staff. Working with children is demanding and specialised and is completely different from working with other age groups. Supervision is also essential, but resources need to be identified to undertake this function. 


We need to maintain a focus and adopt a positive approach to the changes in 2013 and beyond. Already there are over 226 shadow CCGs in place and staff are being appointed to the new NCB. The children's workforce needs to understand the different commissioning arrangements and look at ways to ensure that children's services are not adversely affected as a consequence. Not only should we be considering transitions between child and adult services, which have been a long-term issue, but now we need to consider transitions between different commissioners. We require collaboration across the network, a crossagency strategy and most importantly strong and decisive local leaders. The population of 0-10-year-olds is projected to rise by 15.6% between 2010 and 2020, so more practitioners will be required in the future. A cross-government strategy should be developed to provide a joint vision for improving the health and wellbeing of children and their families. We hope that in the future for the sake of our children and the next generation that we have a workforce to deliver services that is both fit for practice and fit for purpose.

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