Solutions 4 Health - Barnet

Updated 14 February 2024

We undertook this unannounced, comprehensive inspection of Solutions 4 Health- Barnet to follow up on the actions taken by the service to address the breaches of regulation as a result of the section 29 warning notices served following our focused inspection in April 2023.

At the April 2023 inspection, we found that there were insufficiently robust safeguarding systems and processes in place to ensure children, young people and their families were appropriately assessed, reviewed and identified risks were managed in a timely manner. We also found that the service did not have a robust governance and assurance systems in place to oversee and monitor the quality and safety of care.

The warning notices required the provider to make improvements by 24 November 2023.

Solutions 4 Health - Barnet provides an integrated health visiting and school nursing service that supports children and young people aged 0 to 19 and their families. The service covers the London Borough of Barnet. The health visiting team is comprised of three locality teams: South, East Central and West. The school nursing team are not split into localities. The registered provider of the service is Solutions 4 Health Limited. The delivery model for the health visiting team is based on the nationally mandated Healthy Child Programme (HCP). The health visiting team delivers the part of the HCP that is for children aged 0 to 5. The programme requires children and families to receive five mandatory checks: an antenatal contact at 28 weeks pregnancy, a new birth visits within 14 days of birth, 6 to 8 week reviews, 1 year development reviews, and 2 to two-and-a-half-year development reviews. The school nursing team delivers the part of the HCP that is for children and young people aged 5 to 19. The Healthy Weight Nursing team are part of the wider school nursing team and deliver the mandated National Childhood Measurement Programme. The service also has an oral health team and an infant feeding support team. The service supports children and families in their homes, children’s centres, clinics, health centres, GP premises and schools. The regulated activities attached to this service are diagnostic and screening procedures, family planning and treatment of disease, disorder or injury. There is a registered manager in post. At the inspection in November 2022, we rated the service as requires improvement overall. Safe was rated as inadequate, effective, responsive and well-led as requires improvement, caring was rated as good.

What people who use the service say

We spoke with 14 families that had used the service and 11 of these famlies reported wholly positive experiences from direct communication with staff. Families told us that the health professional they spoke with provided advice when they needed it and made them feel comfortable.

Eight parents/carers told us of their difficulties getting appointments when they were worried about their child’s development. Three parents/carers said that if they did not contact health visitors, they would not have any contact from them including for mandated checks.

Updated 14 February 2024

Our rating of this location went down. We rated it as inadequate because:

• Five out of 14 parents and carers we spoke with during the inspection site visit, and 5 people who contacted CQC independently during the inspection process expressed concerns about difficulties getting in touch with staff, and long waits to be seen leaving them feeling unsupported to manage health concerns about their babies/children.
• Despite significant improvements in safeguarding and governance systems at the service, as required in the warning notices issued in June 2023, further work was needed to fully address the breaches of regulation and to ensure that improvements were embedded and sustained. We found some on-going concerns with the management and oversight of children and families transferring into the service, and those with safeguarding concerns. This meant that children and families who were potentially vulnerable or high risk might not be identified or supported in a timely manner.
• We found that a small number of children and family safeguarding concerns were not managed appropriately when children transferred in and out of the service. Some families were not being seen and reviewed in accordance with the timescales expected in the provider's own policy, placing them at risk of avoidable harm.
• Despite improvements, the service leaders had not ensured that the assurance systems in place were robust enough to monitor, identify and address risks that impacted on patient safety, and staffing decisions did not impact negatively on families within the local population.
• Despite a requirement made at the inspection in November 2022, between April and June 2023, the service had only been able to provide a 6 to 8 week review for 21% of infants. The 6 to 8 week check is a vital part of the Healthy Child Programme and missing this might mean that families’ needs would not be identified, including any mental health needs. Over this 3 month period, only 28% of babies received a 12 month review, and 30% received a 2 to 2.5 year review by the age of 3 years.
• Following recent reductions in staffing just prior to the current inspection, the service was proposing a further reduced model particularly impacting on the universal pathway. If accepted this would include no psychosocial contact, reductions in breastfeeding support, continuing non-provision of 6 to 8-week visits for families unless they were identified as high risk, and virtual 1 year reviews for babies assessed as lower risk. This model had not been accepted by the service commissioners and staff we spoke with were concerned about the ramifications of this on vulnerable families in the borough.
• Whilst client records had improved as required at the inspection in November 2022, there were some gaps in the information recorded in some of the cases we reviewed.
• As required at the inspection in November 2022, the provider had worked hard to improve staff morale. However, following recent changes to the staffing of the service, staff reported low levels of morale and concerns about their job security.
• There had been improvements in provision of supervision to staff members as required at the inspection in November 2022, although further work was need to increase attendance at clinical supervision sessions.
• Most parents and carers we spoke with were not clear about how to complain and give feedback to the service.

However:

• As required at the inspection in November 2022, staff had received mandatory training in key skills, and understood how to protect children and young people from abuse. The service controlled infection risk well, and the service was notifying CQC of incidents as appropriate. The service managed safety incidents well and learned lessons from them.
• As required at the inspection in November 2022 staff had undertaken level 3 safeguarding training for adults and children and were receiving regular safeguarding supervision.
• The service had appointed a specialist education needs and disability (SEND) lead and was working to improve the offer for children in the area. Staff had completed training in Autism and SEND.
• When staff did see families, staff treated children and young people with compassion and kindness. Parents and carers spoke highly of individual staff who had supported them. Staff advised them and their families on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.

As a result of the concerns we identified we issued the provider with 2 Warning Notices under Section 29 of the Health and Social Care Act 2008. The provider had failed to comply with the relevant requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We require the provider to make the necessary improvements and be compliant with the regulation by 24 November 2023. You can see full details of the regulations not being met at the end of this report.

Updated 14 February 2024

see section above