Specialised Healthcare Tasks

Essex County Council, in partnership with the Integrated Care Boards covering Essex, are seeking to commission a Specialist Healthcare Tasks service that will provide competency-based training and support the delegation of certain healthcare tasks to support workers, working with children and young people up to the age of 19 in education and other support settings. The existing Specialist Healthcare Tasks Service was jointly commissioned in 2003 to ensure that children and young people with identified medical needs access the community and enjoy the same opportunities as their peers.

It is expected that the service will be provided to a range of staff working with these young people, including Special Educational Needs School transport providers, identified Essex Social Care staff, short break Foster Carers, Education staff supporting children with medical needs in local schools and settings; and workers supporting young people who access Essex short breaks. Commissioners are seeking to continue delivery of this service.

The Children & Families Act (2014) states that local authorities and health should jointly commission services to respond to needs of children with Special Educational Needs and/or Disabilities (SEND) and that health services are able to co-operate with schools supporting children with medical conditions. This service is an example of co-commissioning and good practice.

Please refer to the Indicative Activity Plan for detailed data relating to activity during the period April 2023- September 2024. The service should meet the priorities identified by service users, including short break providers, and schools.

These priorities are: • Robust, high quality, reliable service delivery; • Service delivery is responsive and enables children to access provision in a timely way, including attendance at school; • Competency based training and assessment leaves carers and staff confident in the delivery of health tasks for children and young people in their care; • Reminders to staff when their training and competency is due to be reviewed is important, to ensure the ongoing safety of the child. The Specialist Healthcare Tasks Service should deliver good quality competency-based healthcare training, assessment and delegation to support workers in order to meet the bespoke care needs of children and young people that will enable them to access and attend a range of settings and make progress in education.

Staff delivering the training must have the appropriate clinical competence to train, assess and delegate delivery of healthcare tasks to support workers. All training, assessment and delegation should be underpinned by an evidence-based methodology and process which complies with all relevant professional standards.

The provider of the service will also ensure there is a robust governance framework in which to deliver all aspects of this service. This service will be open to support workers, working with children and young people aged up to 19 who are resident within the administrative boundaries of Essex County Council and who are registered with a GP within the administrative boundaries of Essex County Council.

There may be exceptions to access, for example to allow an Essex resident child registered with a GP outside Essex but attending an Essex school to attend an Essex short break or travel to school; or to support an Essex resident child attending school at a neighboring local authority. These exceptions will be agreed on a case-by-case basis with commissioners.

There is a plan to introduce access to the Specialist Healthcare Tasks Service to Southend and Thurrock within the next couple of years, depending on the local government review this may be a request. The Specialist Healthcare Tasks Service should provide healthcare training, assessment and delegation to support workers in the following services: • social care services, including overnight respite staff supporting Essex County Council's two overnight respite centres, and Essex short break foster carers. • educational settings, where children and young people have a care plan detailing identified healthcare tasks.

This may be mainstream or specialist settings to include special schools, pupil referral units, alternative education providers, post 16 settings and colleges. This list is not exhaustive. • community short breaks provision commissioned by Essex County Council.

This includes short breaks clubs and activities providers, and their delivery partners, and packages of care providers who provide domiciliary and personal care to children with disabilities. • Transport providers commissioned by Essex County Council (both internal and external to Essex County Council) to provide home to school transport for eligible passengers across Essex and for out of county placements. The provider should deliver a training programme for support workers that includes both theoretical and practical aspects of the support worker's role.

This will include general training around complex health needs, as well as training around a specific child or young person and the procedures or care they require. General training courses should be offered throughout the year (according to demand) and via a variety of delivery methods/locations within Essex to maximise uptake.

Individualized competency-based training should be offered in as timely and flexible way as possible, to meet the individual needs of the child/young person and minimize any delay in accessing the community/education setting/short breaks/SEN transport. Training should be delivered to ensure support workers have the appropriate skills, knowledge, confidence and competence to undertake the role along with the appropriate delegation to deliver the task.

The training programme must include information on: • Providing care for a CYP based on set protocols and guidelines • Recognizing signs of the CYP becoming unwell • Following the individuals care plan, risk assessment, escalation and emergency procedures A list of the most common clinical tasks which require competency training will be provided upon full release of specification and it's appendixes. Training should be underpinned by an evidenced methodology and process which complies with professional standards.

Registered nurses have a duty of care and a legal liability with regard to the patient. If they have delegated an activity they must ensure that it has been appropriately delegated as outlined in 'The Nursing and Midwifery Council (NMC) Code (2018) section entitled 'Practise effectively' The provider will need to demonstrate flexibility around changes and updates to the list of tasks supported and take into account bespoke needs for each individual child or young person, as well as developments in the use of technology and in clinical practice within healthcare provision that may affect the range of healthcare tasks needed.

The healthcare tasks for which training will be delivered should be categorised according to clinical risk and the risk categorisation agreed with commissioners. The highest risk tasks should be considered by a panel convened by the provider, which may consist of: nurses within the service; senior managers within the service; local clinicians and other agencies involved in the child's care.

This panel should review whether training is appropriate. Should training be recommended, this recommendation must be sent for agreement by: the Director of Children's Services, Essex County Council and the Director of Commissioning, Essex County Council.

Training should not commence before agreement is received. Assessment must be undertaken by a suitably qualified registered professional with the appropriate skills and knowledge to delegate the task.

Opportunities must be provided for supervised practice before this assessment. Where relevant training, supervised practice and competency sign off should mirror any published guidance (i.e Pan London Guidance on CYP with Tracheostomy's and Ventilation).

At the time of assessment, feedback must be given to the individual and their employer, which clearly sets out whether the individual has been assessed as competent or not to deliver the identified healthcare task and the date by which annual reassessment will be required. All competency-based sign off should be put into writing and will be subject to regular review.

The provider will be responsible for proactively ensuring that all support workers who are assessed and have had skills delegated by them to deliver healthcare task are reassessed within one year. This will include maintaining training and delegation records and communicating with staff and employers with sufficient notice to book re-assessment.

Where support workers are assessed and not deemed competent to deliver healthcare tasks, they should be offered further training and re-assessment and consideration given to the continuation of training. Any risk mitigations during this time should be discussed with the employer and support worker.

The Provider will continue to work with commissioners to identify any gaps in service provision. We ask that organisations interested in this opportunity are able to meet the above requirements and evidence that they are/have completed services that are the same or similar before. As well as being able to deliver this to the Essex Area.