Specialist Public Health Nursing Service

Somerset Public Health provide community care, delivered by health visitors, school nurses and across the county of Somerset.

We rated the service as good because:

• Staff understood how to protect children and young people from abuse, and managed safety well. For example, during our visit, staff members identified safeguarding concerns. They appropriately escalated and shared information. There was a fast multi-agency response in line with their safeguarding policy. The service was aware of the recommendations of national reviews like the recent Star and Arthur review in relation to children being harmed in their homes. Staff members received training in being extra vigilant.
• The service controlled infection risk well. Staff assessed risks to children and young people, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them. For example, in March 2022, following a national and local review into non accidental injuries the service introduced the duty system so that all notifications about pregnancy, domestic abuse, accidents and emergency notifications went to a central duty line. Staff members were positive about the impact the duty system had made to their work in protecting patients.
• Staff provided good care and treatment. Care records showed clear strategies and interventions in place for each child open to the service. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of children and young people, 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.
• Staff treated children and young people with compassion and kindness, respected their privacy and dignity and took account of their individual needs. They provided emotional support to children and young people, families and carers. Parents told us staff were very attentive and would give them as much time as they needed. During observed interaction we saw they helped, comforted, supported and provided reassurance.
• The service planned care to meet the needs of local people, took account of children and young people’s individual needs, and made it easy for people to give feedback. The service was constantly looking for ways to improve and ensure services met existing and emerging needs. Managers looked at public health and demographic data to plan staffing, skills mix and services. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. The service introduced new models of care to look at skill mix and work in different ways like practise teachers in localities following requests from staff. The service was currently looking at ways they could coproduce service developments with children and young people and families.
• Staff felt respected, supported and valued. They were focused on the needs of children and young people receiving care. Staff were clear about their roles and accountabilities. The service engaged well with children, young people and the community to plan and manage services and all staff were committed to improving services continually.

However:

• Facilities were not all clean and did not all have a suitable furnishings which were clean and well-maintained. The carpets in the health visitors’ room in the temporary building in Bridgwater were stained and bins in toilet areas did not all have lids.
• The service did not always have enough nursing and support staff.
• The service did not always have suitable facilities to meet the needs of children and young people's families. Patients entering the Bridgewater site had unrestricted access to stairs leading to staffing areas and staff kitchen. There was no reception area so patients were unclear how to alert staff in the waiting area. There was not sufficient signage outside the temporary building in Bridgwater to ensure patients can easily access it.
• The voice of the child was not evident in all files reviewed.