HC 1048-III Health CommitteeWritten evidence from Dr Fay Haffenden (PH 143)
There is a wealth of evidence from the Marmot Review and other research that the early years are crucial to children’s long term outcomes.
Children, young people and families want integrated, family-centred services.
The current proposals will fragment the commissioning of children’s services, making further integration much more difficult, if not impossible.
This will be a disaster for children and the future health and wellbeing of the population.
1. The commissioning of children’s services seems to me to be completely fragmented with (as I understand it!):
NHSCB responsible for primary care (so GPs +/- practice nurses for six–eight week check and GP visits +/- follow up from A&E) and Health Visitors and specialist commissioning
PHE responsible for the Healthy Child Programme (HCP) 0–five, child public health +/- screening and imms and vacs +/- child heath records (or do these go with the GP commissioners or NHSCB?)
LAs responsible for HCP five–19, children’s centres, schools, LA children’s info systems - and school nursing, I think
GP commissioners responsible for maternity services and most secondary care
2. We already know how difficult it is to get responsibility and accountability clear across complex pathways such as for children with disabilities or screening, Eg where will responsibility sit for say a child not getting a bloodspot? Who would pick it up? Who would be sued for a missed child who had one of the conditions they should have been screened for?
3. We have been struggling to make joint commissioning for children a reality between LA and the NHS which we know is essential to getting more integrated services focused on the child and family and getting services working out of their silos – but to try and get joint commissioning between all the new players functioning at different levels and geographies commissioning different bits of the pathway from different providers …..