During the booking visit, midwives assess how much support a pregnant person may need during their pregnancy, taking into account social circumstances, health status and age. Those who are identified as having a greater need than can be met by universal antenatal care alone are referred on to appropriate specialist services. For information on the number of referrals to specialist services, please see Local Data and Unmet Need section.

Since October 2015, local authorities have had responsibility for commissioning public health services for children under the age of five. This includes the Healthy Child Programme (‘Pregnancy and the First 5 Years of Life’ – see Box 2) and the Family Nurse Partnership (FNP) (see the Treatment, Care and Support section for more detail).

Box 2: The Healthy Child Programme

The Healthy Child Programme is a public health programme that begins in early pregnancy and ends it adulthood. It is led by Health Visitors in conjunction with an integrated services that joins together Children’s Centre staff, GPs, midwives and community nurses. Its core requirements are:

  • early identification of need and risk
  • screening and immunisation
  • promotion of social and emotional development
  • support for parenting
  • keeping the family in mind
  • effective promotion of health and behavioural change
  • prevention of obesity
  • promotion of breastfeeding
  • access to additional preventative programmes for children and families as appropriate to individual and local need.

Source: Department of Health, ‘Healthy Child Programme: Pregnancy and the First 5 Years of Life’ 2

City and Hackney health visiting services have recently been re-designed and re-commissioned, delivering through a new model since July 2016. The new service is provided by HUHFT, and delivers the five mandated health checks which form part of the Health Child Programme (new antenatal visit, new birth visit, six-eight week check, 3-4 month review and integrated health review at 27 months). In addition, the new service is delivering two extra health checks for our most vulnerable families (including first time parents and those with post-natal depression). There is a strengthened relationship with GPs (with a lead health visitor for each cluster of GPs and a named health visitor linked to each GP practice), as well as a lead health visitor for each early years setting. The new model also includes lead strategic health visitors for the five ‘high impact’ areas – obesity, domestic violence, mental health, substance misuse and disability.

Hackney and the City have been delivering a local FNP programme since 2014 for first time families where the mother is aged under 20 at conception (currently delivered by Whittington Health). Families are identified through a range of sources, including at booking, and are referred to the programme before 28 weeks of pregnancy where they are worked with intensively up until the child is two years old. The programme delivers the ‘Healthy Child Programme’ and also has a strong focus on increasing aspiration and outcomes for mothers and babies not only in terms of health, but also education and employment. See Box 3 in the Treatment, Care and Support section for more detail on the FNP programme.

Health visitors and family nurses also play a key role in identifying and supporting vulnerable children and families using the Common Assessment Framework (CAF). The CAF provides access to tailored, multi-agency support for eligible children and families – available to all children and young people up to 18 years, or up to 25 for young people with learning or other disabilities. Multi-agency teams based in Children’s Centres review CAFs for families with children under five years on a regular basis to identify where extra support is required, and aims to put these services in place in a timely manner before needs escalate. Where appropriate, this process provides a pathway to children’s social care.

References

  1. Department of Health, “Healthy Child Programme: Pregnancy and the First 5 Years of Life,” October 2009. [Online]. Available: https://www.gov.uk/government/publications/healthy-child-programme-pregnancy-and-the-first-5-years-of-life. [Accessed 15 November 2016].
  2. Department of Health, “Healthy Child Programme: Pregnancy and the First 5 Years of Life,” October 2009. [Online]. Available: https://www.gov.uk/government/publications/healthy-child-programme-pregnancy-and-the-first-5-years-of-life. [Accessed 15 November 2016].