SERVICE SPECIFICATION
FOR THE PURCHASE OF
KENT COMMUNITY INFANT FEEDING
SERVICE (excluding Medway)
1st October 2014 to 30th September 2017
This document defines the
COMMUNITY INFANT FEEDING SERVICES
purchased by Kent County Council
Copyright © The Kent County Council
2014
This material may not be copied or
published without the Kent County
Council’s permission in writing
1.
INTRODUCTION AND SCOPE
Breastfeeding performance, both initiation and continuation are targets in the Public Health
Outcomes Framework. Currently Kent is performing worse than local authorities in comparable
areas. Community services to support infant feeding have been in place across Kent, funded by
the former Eastern Coastal Kent and West Kent PCTs and through Children’s Centres funded by
Kent County Council.
Further funding has been made available to enable Kent County Council to tender for an
integrated service This will be both universal and targeted to areas of highest need in line with the
Marmot principle of proportionate universalism1. The scope is intended to widen with an
emphasis on working more in settings with schools, workplaces, town centres and with media to
promote the benefits of breastfeeding. This service must also cater for the needs of nonbreastfeeding mothers in a way that promotes the Marmot objective of achieving a healthier start
to life.
The new service is expected to start operating from 1st October 2014 and run for three
years. There will be a period of mobilisation and handover prior to the service starting.
This contract may be extended for a further year subject to agreement of both parties.
The indicative cost of this Service is a maximum of £475,000, we would welcome bids
that demonstrated how a quality service could be provided below this price.
The Service will cover the following local authority areas as follows:
Local Authority Area
Number of births 2012
6-8 week breastfeeding
prevalence (12/13)
Dartford Borough Council
1,560
34.0%
Gravesham Borough Council
1,472
38.4%
Sevenoaks District Council
1,383
48.2%
Tonbridge and Malling Borough
1,432
44.9%
Council
Tunbridge Wells Borough Council
1,326
56.9%
Maidstone Borough Council
2,040
41.5%
Canterbury City Council
1,419
42.7%
Swale District Council
1,777
28.1%
Ashford Borough Council
1,597
38.8%
Dover District Council
1,257
33.4%
Thanet District Council
1,654
32.5%
Shepway District Council
1,230
32.3%
Kent
18,147
43.2%
And the following Clinical Commissioning Groups:
Clinical Commissioning Groups
NHS Dartford Gravesham and Swanley
NHS West Kent
NHS South Kent Coast
NHS Canterbury and Coastal
NHS Swale
NHS Thanet
NHS Ashford
1
6-8 week breastfeeding prevalence (12/13)
36.4%
47.8%
34.6%
42.2%
24.8%
32.5%
38.8%
Marmot, M (2010) Fair Society, Healthy Lives: Strategic Review of Health Inequalities in England
2.
BACKGROUND
Successful infant feeding is important to the future health of the child. Breastfeeding specifically
confers a number of health benefits to both the baby and to the mother; a report commissioned
by UNICEF in 20112 described the economic benefits of breastfeeding. There is very strong
evidence that breastfeeding prevents:


four acute conditions in infants: gastrointestinal disease, respiratory disease, otitis media,
and necrotising enterocolitis (NEC)
breast cancer and other cancers in mothers.
In addition the UNICEF reports that there is good evidence that if the number of babies receiving
any breastmilk at all rose by 1% in the UK this could lead to a small increase in IQ. A very
modest increase in exclusive breastfeeding rates could national prevent at least three fewer
cases of Sudden Infant Death Syndrome annually.
Increasing breastfeeding rates could lead to around a 5% reduction in childhood obesity
Nationally the prevalence of breastfeeding is low compared to other European countries and this
is reflected in Kent. Kent is also poor compared to other similar areas.
Kent Breastfeeding Initiation 2010-11 (percentage of maternities where status is known) (Child and Maternal Health
Observatory, 2012)
The National Infant Feeding Survey 20103 found that the highest incidences of breastfeeding
were found among mothers aged 30 or over (87%), those from minority ethnic groups (97% for
Chinese or other ethnic group, 96% for Black and 95% for Asian ethnic group), those who left
education aged over 18 (91%), those in managerial and professional occupations (90%) and
those living in the least deprived areas (89%).
Whilst mothers of first babies were more likely to start breastfeeding than mothers of second or
later babies (84% compared with 78%), mothers who had previously breastfed a baby for at least
six weeks were more likely to start breastfeeding their latest baby than those who had breastfed a
previous child for less than six weeks or not at all (97% compared with 79% and 35%). These
variations were evident in all countries and were consistent with the patterns found in previous
2
UNICEF UK (2012) Preventing disease and saving resourses:the potential contribution of increasing breastfeeding in the UK
Information Centre for Health and Social Care (2011). Infant Feeding Survey 2010: Early Results. London: Information Centre.
Available at:
https://catalogue.ic.nhs.uk/publications/public-health/surveys/infa-feed-serv-2010-earl-resu/infa-seed-serv-2010-earl-resu-rep.pdf
3
surveys. The chart before shows the prevalence trend in the better and worst areas and the Kent
average.
A national problem which is replicated in Kent is drop-off rates. The Kent 2012/13 initiation rate
was 72.1% and by the 6-8 week check prevalence was only 40.8% (Public Health Outcomes
Framework). The following chart shows the reduction in prevalence over time in West Kent PCT.
Chart showing reduction in prevalence at each 'check' for each
Clinical Commissioning Group in west Kent area - 06/07-10/11
(pooled data)
100%
At delivery
At transfer/ discharge
At 10 day check
At 6-8 week check
Coverage Percentage
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Dartford Gravesham &
Swanley
Maidstone & Malling
WKW
Clinical Commissioning Group
West Kent
Across Kent there has been a general lack of investment and in latter years some funding
changes have resulted in further gaps in service. This has resulted in serious inequalities in
service provision. The main components of this service have been:
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specialist lactation services advising mothers and their families
specialist project management and training to professional groups (such as supporting
the Baby Friendly Initiative)
working in partnership with voluntary services such as the National Childbirth Trust, La
Leche League and independent organisations to promote to women and their families the
range of community service provision available and to promote to the voluntary sector
any funding opportunities or resources
media and publicity, for example promoting Breastfeeding Awareness Days, providing
media interviews, generating positive press, production of leaflets and information,
ekbaby website and social media
The aim of the new service is to increase the uptake of the initiation and continuance of
breastfeeding by facilitating service development and improvement. One identified barrier to
successful breastfeeding is tongue tie. It is intended that existing arrangements for referral into
this procedure will be reviewed with maternity commissioning with the aim of creating an
integrated programme to support infant feeding during the course of this contract.
3.
SERVICE CONDITIONS AND ENVIRONMENTAL FACTORS
A barrier that has been identified nationally and locally is attitudes and beliefs. These maybe from
the family culture, previous experiences and practices, or from the wider environment which is not
supportive of breastfeeding in public for example. A local example of family influences was
identified through a needs assessment which was undertaken in Swanley amongst teenage
mothers. The author discovered through the questionnaire that the teenage mother’s parents
had a huge part to play in their infant feeding decisions. A focus group was therefore held for
grandparents. The conclusion was that there also needs to be some education for them in order
to equip them to support the mother-to-be. The involvement of fathers is essential.
4.
ROLES RESPONSIBILITIES and RESOURCES
Provider: The provider will need to deliver all elements identified in this service specification and
be responsible for delivering the outputs and outcomes described. They will also need to
provide:
 All resources required for delivery
 Adhere to the service standards as outlined below
 Designated lead member of staff to liaise with the Commissioner for this contact
 Ability to be flexible, innovative and to ensure that any changes in good practice, guidance
and legislation are incorporated into the running of the service
 Attend any performance monitoring and evaluation meetings, training, seminars, and
other reasonable request
Commissioner: The commissioner will need to agree the format and delivery method of the
programme. They will also provide:

Pre-paid fees for Baby Friendly Initiative accreditation
Children’s Centres: are anticipated to carry out the following tasks:
 Co-ordination of peer supporter rotas (timetable of sessions to be run by peer supporters)
 Provision of premises for drop-ins, clinics and 1 to 1 interventions
 Resources for clinics and 1 to 1 interventions
 DBS vetting of all peer supporters
 Participate in Baby Friendly Initiative which includes training for all front line staff
Maternity Units: Maternity units will be supporting the breastfeeding pathway by:
 working towards Baby Friendly Initiative accreditation supported by the provider
 Hosting ward-based and ante-natal peer supporters
Health Visiting Teams: will be supporting the breastfeeding pathway:
 Working towards Baby Friendly Initiative accreditation
 To work collaboratively with the new service to achieve shared objectives
5.
SERVICE OUTCOMES
As a minimum this service will operate for 12 hours a day for 5 days a week. The service must
have a flexible approach and staff able to deliver evening and weekend working if desirable
based on identified need. Safeguards for any individuals working outside of these hours need to
be put in place, for example Lone Working policies and home visiting should not be in place
without rigorous safeguards and the agreement of a Home Visiting Policy with the commissioner.
They should also be in line with the policies of organisations with which visits have been agreed,
for example Children’s Centres.
The new service must work closely with maternity services, health visitors, children’s centres,
general practice, public health and communities. It must contribute to a seamless pathway and
intervene to increase initiation and decrease the drop-off rates from the handover from maternity
to health visiting that are evident.
The NICE Topic-specific Advisory Group suggested that commissioned services ensure multiple
access points through which women can be referred or contacted directly by peer supporters.
Access points may include health centres, postnatal wards and community and hospital antenatal
clinics, (because women who are provided with appropriate breastfeeding information during the
antenatal period are more likely to initiate and continue breastfeeding), and drop-in centres or
baby cafes. Kent County Council requires that the majority of peer supporter drop-ins are held in
Children’s Centres. Where this is not the case alternative arrangements will need to be agreed by
the Commissioner.
Service models should focus on women who are least likely to breastfeed: young women, women
with low educational achievements and those from disadvantaged backgrounds.
The new provider will be challenged to achieve 45% partial or exclusive breastfeeding in all Kent
CCGs at 6-8 weeks. Given that the UNICEF model is based on 45% of mothers exclusively
breastfeeding at four months to achieve the projected savings, we expect the service to put in
place plans to extend exclusive breastfeeding rates at 4 months. This will require fundamental
changes in practice and in the cultural environment. Expected Service outcomes are:

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


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


Increased quarter on quarter initiation prevalence rates (Public Health Outcomes
Framework)
Increased quarter on quarter prevalence rates at 10-14 days recorded by Health Visitors
Increased quarter on quarter prevalence rates at 6-8 weeks (Public Health Outcomes
Framework) and better data recording
Demonstration of a universal service available to all women, with a more targeted
approach in areas of highest need.
An increased number of women reporting satisfaction at all stages of their journey until 26
weeks
Baby Friendly Initiative accreditation must be achieved in all services by the end of the
contract term
The Service must provide accredited peer support training, supervision and refresher
courses.
To increase Welcome signage and engage with local authorities Mind the Gap plans for
increasing breastfeeding
Evaluation of workplace, school, primary care and other community setting interventions
must be undertaken with the aim of making environments more conducive to
breastfeeding.
6.
THE RESPONSIBILITIES OF THE SERVICE
1. To work more closely with women in ways that women say they want in a way that
empowers them to take control over decisions about their health and the health of their
baby. Regular engagement work will be a key part of building understanding and should
include women who are unlikely to breastfeeding so we gain better understanding of what
may help them to do so. This may include working with the wider family of the women so
they can better support them; e.g. fathers, Grandparents etc.
2. To co-ordinate community breastfeeding support provision and ensure that there are good
relationships and excellent communication with and between partner organisations,
including the voluntary sector
3. To extend the provision of breastfeeding support into a complete infant feeding service
working with Kent Community Healthcare Trust to support weaning.
4. To ensure that all services provided have robust financial, clinical and managerial
governance
5.
To ensure services are provided universally but proportionately according to levels of
deprivation to contribute to the reduction in health inequalities.
6. To work closely with midwifery units, health visiting teams and Childrens Centre to
implement the national breastfeeding pathway
7. To ensure that signposting to other organisations/services which offer complimentary or
enhanced provision both ante-natally and post natally as agreed with the Commissioner.
(For example the National Breastfeeding Helpline and local La Leche League offer 24 hour
support)
8. To be responsible for the achievement of the 95% coverage target re: 6-8 week
breastfeeding data through liaison with the Child Health Information Service, General
Practice and Kent County Council Public Health and provide progress reports back to
general practice and children’s centres
9. To collect, analyse and interpret high quality data from a range of sources and provide
reports to Kent County Council, District Councils and to Clinical Commissioning Groups.
10. To provide Community based lactation clinics in all district and borough council areas.
Lactation Specialists should be registered and qualified to provide specialist advice to
mothers.
11. Lactation specialists should also be part of the Tongue Tie pathway
12. To recruit, develop and supervise an adequate number of peer supporters who will have
contact with mothers within 48 hours of birth in line with the NICE benchmarking tool, it is
estimated that the number will need to rise to 50 whole time equivalents over the course of
the contract
 To co-ordinate peer support networks (opportunities for sharing learning) in
Children’s Centres in Kent including support to young parents through YAPS
groups identifying areas where there are gaps in provision in order to ensure
services are equitable.
 To provide ante-natal and hospital based peer support
 To ensure that peer supporters are part of the multi-disciplinary team
 To ensure that all peer supporters understand the limits of their capabilities and
work within policy guidelines e.g. peer supports policy, Kent County Council
policies
 To recruit a diverse range of peer supporters
 To re-imburse peer supporters for travelling costs and to ensure that crèche
facilities are offered and made available when required.
13. To ensure that Kent Community NHS Trust and all Hospital Trusts achieve UNICEF Baby
Friendly Initiative accreditation within the life of the contract (3 years). These Hospital Trusts
are Maidstone and Tunbridge Wells NHS Trust, Dartford and Gravesham NHS Trust, East
Kent Hospitals University Foundation NHS Trust. Medway Hospitals Trust provides services
for both Medway and Kent
This should include:
 Project management support for Baby Friendly Initiative programmes across Kent
 Comprehensive training sessions at an NHS venue for health visiting, paediatric
and any midwifery staff that have not completed the session previously, including
provision of all appropriate resources whilst providing updates as required to
ensure professional are kept up to date
 Comprehensive audit of community staff knowledge and interviews to assess
mother’s experience of care using BFI audit tool
 Achievement of Children’s Centre training programmes and GP eLearning
 Attending associated meetings with Community, Midwifery managers and GPs
 Updating the support information leaflets and websites and disseminate updates to
staff leads
14. To support Primary Care through provision of training and professional support to enhance
their role in promoting breastfeeding
15. To innovate and progress social marketing/community development approaches in areas
where rates remain low despite peer support being in place
16. To make the best use of technology including the use of applications to educate and inform
17. To maintain a strong communication presence in Kent and use a range of channels to
communicate with both the public and professional in an effective way. This may include a
Kent wide website, social media, written literature, content on KCC cooperate website,
campaigns etc. The organisation will need a strong communication plan that is agreed by
the commissioner and articulates clear and consistent messages around infant feeding. This
will need to set out any policy’s or safeguards for the use of social media and any
specifications that apply to any websites, such as being smart phone accessible and legally
compliant. Information about the service will to be available in a range of formats so that it is
accessible to all parties including those with additional needed and makes the service
appealing to those who may not traditionally access the service. The organisation will be
expected to update information on a regular basis and review the communication plan with
commissioners to reflect technological changes and up-grades. Consultation and
engagement will be key to ensure the service is communicated in an effective way.
18. To pro-actively engage with the media and have in place a comprehensive media strategy
and ensure there are links with KCC communications team
19. Lactation consultants should engage with GPs to support the Tongue Tie pathway.
20. To work with maternity and health visitor leads to promote Healthy Start
21. To work with Education services, schools, youth services and Kent Community Health Trust
to influence the school curriculum re: breastfeeding promotion to include relevant
information as required by young people to support breastfeeding later in life.
22. To work with local authorities to promote breastfeeding friendly communities including
Welcome mark development
23. To work with workplace health leads in local authorities to make it easier for breastfeeding
women to return to work
24. To have in place user satisfaction measures and regularly review and learn from user
feedback
25. To build an evidence base of effective practice in Kent
26. To undertake any additional work that is identified to support infant feeding in Kent as
agreed with the Commissioners
7.
SERVICE PROCESSES AND STANDARDS
Monitoring
The Service Provider will be required to report quarterly by the 31st of the following month
against all the Key Performance Indicators (attached). Reports will need to be prepared for the
following geographic areas:
 Kent
 Kent Borough and District Councils
 Clinical Commissioning Groups
Service User Review Process
The provider must demonstrate appropriate effective service user and public involvement in the
development, delivery and review of services by responding as appropriate to user
surveys/questionnaires (see KPIs for more information).
Quality Assurance
The Service must work to national guidance and standards including
 New Baby Friendly Initiative Standards (UNICEF, 2012)
 Public Health Outcomes Framework (Department of Health, 2012)
 Healthy Child Programme (Pregnancy and the first five years of life) (Department of
Health and Department for Children, Schools and Families, 2009)
 Healthy Child Programme: the two year review (Department of Health and Department for
Children, Schools and Families, 2009)
 NICE guidance on antenatal and postnatal care replaced by CG 62 Antenatal Care
Routine Care for the Healthy Pregnant Woman (NICE, 2003) and CG37 Postnatal care:
Routine postnatal care of women and their babies (NICE, 2006)
 Healthy Lives Healthy People (Department of Health, 2010)
 Healthy Lives, Brighter Futures (Department of Health and Department for Children,
Schools and Families, 2009)
 National Service Framework for Children, Young People and Maternity Services
(Department of Health and Department for Education and Skills, 2004)
 Maternal and child nutrition NICE guidance 11(NICE 2011)
 Midwifery 2020 Programme: the Core Role of the Midwife Work-stream (Department of
Health, 2010)
 Tackling health inequalities in infant and maternal health outcomes. Report of the Infant
Mortality National Support Team. (Department of Health, 2010)
 Marmot, M. (2010). Fair society, healthy lives: the Marmot Review: strategic review of
health inequalities in England post 2010.
 Maternity Matters: choice, access and continuity of care in a safe service (Department of
Health, 2007)
The Service must work to the principles of equal opportunities as detailed below.
The Service must have a designated Child Protection Officer and have a Child Protection Policy.
Staffing
1. This contract may be subject to TUPE arrangements
2. The provider will be responsible for sourcing and financing, where appropriate, suitable
premises for community services. Risk assessments and Equality Impact Assessments
should be undertaken to ensure that no individuals are discriminated against. For example
premises should be accessible for all, including women with disabilities and those without
transport. It would be expected that the majority of public facing services would be
Children’s Centre based, lactation clinics may be hospital based and training related to
the Baby Friendly Initiative would be local to the workforce.
3. Current Activity and Costs
£475,000 per annum for 3 years, see Key Performance Indicators
4. The Service must ensure that all recruitment and employment of staff shall be conducted
under the principles of equal opportunities in full compliance with the 2010 Equality Act.
The Service must ensure that all staff and volunteers, who deliver the services under this
agreement, even where they do not undertake the checks themselves (for example volunteers in
Children’s Centres) are:
(a)
Subject to an Enhanced Disclosure from the Disclosure and Barring Service (DBS)
And
(b)
Should a disclosure raise any past or current offences the Service Provider will
confidentially discuss such disclosures with the appropriate commissioner
During the period of this agreement offences committed by staff involved in the
delivery of this service and which become known to the Service Provider, will be
discussed in confidence with the lead commissioner
Workforce Development
Lactation Consultants must have the International Board Certified Lactation Consultant
accreditation. Peer support co-ordinators should be trained and accredited and all other staff and
volunteers will have an accredited qualification or be working towards accreditation.
All staff should have annual appraisal and CPD plans.
All volunteers must receive accredited training, supervision, Children’s Centre mandatory training
and updates.
Training provided for external staff e.g. health visitors, midwives, children’s centre and other staff
groups must follow current guidance, be accredited where possible and include robust evaluation.
Marketing and Communication
The Provider must adhere to the marketing and communication guidelines set by Kent County
Council and as agreed with the Commissioner including the use of relevant branding and logos.
Compliments and complaints
Service users should be consulted regularly about the quality and accessibility of services, to
ensure that the service meets their expectations. The quality and safety of services will be
assured through the use of the governance framework. This will include analysis of critical
incidents, complaints and compliments, risk assessment, internal audits, continuing professional
development identified through staff reviews and both monitoring of sickness and absenteeism
and actions to mitigate against service disruption. The commissioner should immediately be
informed of any critical incidents and action planned/taken.
Equal opportunities
In carrying out the Services the Service Provider will be “exercising public functions” for the
purposes of section 149(2) of the Equality Act 2010. As such, the Service Provider is required to
pay regard to the Public Sector Equality Duty under section 149(1) of that Act and to deliver
Services accordingly. The Equality Act 2010 relates to service users and employees. The Service
Provider has responsibilities’ as a provider to service users and as an employer to its employees.
Services will respond positively to the needs of all groups who have a protected characteristic
within the Equality Act 2010. These characteristics are race, religion or belief, sexual orientation,
pregnancy and maternity, age, disability, gender and gender identity. The Service is expected to
engage with these groups through all necessary means to ensure inclusion is in a positive and
meaningful way.
In delivery of any services commissioned on behalf of Kent County Council Providers must
demonstrate awareness and be responsive to the accessibility and needs of groups described
above either in or attempting to access services.
Accessibility relates to (but is not limited to); physical and mental impairment, communication
needs, those with either a hearing or sight impairment, translation/interpretation if English is not a
first language, the expectation with regards to acceptance of individuals defined under gender
identification, respect of faith and beliefs.
The Equality Act 2010 replaces the Disability Discrimination Act 1995 (reviewed 2005). Proof of
compliance will be required in the form of a current and up to date Access Audit with an action
plan outlining any needs and how these will be addressed.
An Equality Impact Assessment (EIA) is a requirement that the Service Provider will complete
annually. The EIA will cover these characteristics: age, disability, gender, gender identity, race,
religion or belief, pregnancy and maternity and sexual orientation, which need to be assessed
against delivery. This should be submitted annually as part of the performance management
programme.
Health Inequalities
Health inequalities are avoidable variations in health status of groups and individuals and are a
complex issue. There is evidence that populations in areas with high deprivation experience
higher morbidity and mortality than those areas with low deprivation (Marmot strategic review,
2010).
Health inequalities are ultimately measured by Life Expectancy at Birth and All Age All-Cause
Mortality rates and a range of shorter-term performance indicators set by the Public Health
Outcome Framework. One of the success factors for improving public’s health for local
authorities and Clinical Commissioning Groups will be assessed on how well they are reducing
health inequalities in their area.
Kent County Council Public Health have developed a screening tool (HIWIA) to enable all
commissioning to be assessed in terms of the potential for increasing or decreasing Health
Inequalities and it is required that all providers utilise this screening tool to evaluate the
programmes they deliver and identify a targeted action plan to address to improve Health
Inequalities outcomes.
Six Ways to Wellbeing
Six Ways to Wellbeing are actions that are shown by research to improve people’s wellbeing.
They can’t change our circumstances but building them into our daily lives can help us feel better,
no matter what our starting point. The list was drawn up by an independent think tank, The New
Economics Foundation, which was commissioned by the government’s Foresight Project on
Mental Capital and Wellbeing to review evidence on improving wellbeing in research studies from
around the world.
The Six Ways to Wellbeing and the Wheel of Wellbeing have been developed by the South
London and Maudsley NHS Trust.
The Six Ways – connect, give, take notice, keep learning, be active and grow your world – can
improve your mood, strengthen your relationships and help you to cope when life doesn’t go to
plan.
It is a requirement that all programmes commissioned by Public Health actively contribute to the
Six Ways to Wellbeing.
Sustainability
The concepts of ‘well-being’ and ‘sustainability’ are inextricably linked. The central purpose of
Local Government Act 2000 was to give local authorities the ability, via enabling powers and
community strategies to “improve the economic, social and environmental well-being of each
area in its inhabitants and contribute to the achievement of sustainable development in the UK.”
Since the Planning Act 2004, sustainable development has also been established as the statutory
purpose of the planning system in which local authorities play a critical role. As it is now a
statutory rather than a theoretical concept, a working definition of sustainability is required which
can be found in the UK Sustainable Development Strategy 2005. This defines five principles of
sustainability:
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Environmental enhancement: respecting the limits of the planet’s environment by
protecting and enhancing it, its natural resources and biodiversity;
Social justice: meeting the diverse needs of all people in existing and future
communities, promoting personal well-being, social cohesion and inclusion, and
creating equal opportunity for all;
Sustainable economy: building a strong, stable and sustainable economy which
provides prosperity and opportunities for all, and in which environmental and social
costs fall on those who impose them and efficient resource use is incentivised;
Sound evidence: ensuring policy is developed and implemented on the basis of
strong scientific evidence, whilst taking into account scientific uncertainty as well
as public attitudes and values;
Community engagement: actively promoting effective, participative systems of
governance in all levels of society.
The provider must ensure that the above sustainability objectives and outcomes are fully
addressed within their programmes.
7.
POLICIES AND PROCEDURES
In providing this service the following policies and procedures must be in place, implemented and
adhered to along with any new policies that are put in place during the course of the contract:
a)
Quality assurance
b)
Complaints
c)
Equalities and diversity
d)
Health and Safety
e)
Recruitment and selection
f)
Induction and training
g)
Supervision and appraisal
h)
Adult/Child protection
i)
Environmental Management Systems
j)
Positive Disclosure
k)
Information Governance
l)
Clinical Governance
m)
n)
o)
p)
q)
r)
s)
Data Protection
Lone working policy
Serious Incident Policy
Risk Assessment Framework
Privacy Impact Assessment
Business Continuity Policy
Social Media Policy
8. PERFORMANCE MONITORING
Baseline Performance Targets – Quality, Performance & Productivity
Performance
Indicator Heading
Media Strategy
6-8 week data
collection
Indicator
Undertake campaigns, media and
advertising to include Start4Life and
evidence of working with C4L Team
including Kent wide website and use of
technology i.e. applications
95% coverage achieved
Method of Measurement
Evidence that there is a
communication plan in place
with all local Borough and
Districts in line with Mind the
Gap and other local plans,
portfolio of press
releases/press coverage to
demonstrate reach. Number of
hits
Published data
Frequency of Monitoring
Consequence of Breach
Quarterly progress report to
Public Health
Commissioners
N/A
Quarterly
Performance
Indicator Heading
Indicator
Method of Measurement
Frequency of Monitoring
Quarter on quarter improvement in
Kent and all local authority areas.
Across Kent we would expect to see a
1% rise in prevalence annually. In
addition the greatest improvements will
be evidenced in areas with the lowest
rates.
Published data
Quarterly
Follow up of women
to track longer term
outcomes
1% random audit of outcome for each
clinic by phone contact at four months
of age spread across the year
Audit Report
Quarterly as above
Baby Friendly
Initiative
Progress Kent Community NHS Trust to
BFI full accreditation by end of March
2016. (Assessment fees pre- paid by
Public Health)A staged plan for
achieving this will be required by the 6
month review.
6-8 week
prevalence
Progress Report and evidence
of stages achieved
Quarterly to Public Health
Commissioners
Consequence of Breach
Performance
Indicator Heading
Indicator
Method of Measurement
Frequency of Monitoring
Quarterly as above
Progress to Maternity BFI accreditation
in all Kent hospital NHS Trusts by March
2016. (Assessment fees pre- paid by
Public Health)A staged plan for
achieving this will be required by the 6
month review.
Progress Report and evidence
of stages achieved
Document and present evidence to
locality managers that participants have
achieved training outcomes through:
completed workbooks, e-learning
certificates, competency sign-off and
BFI audit
Training Records
Quarterly as above
50 audit days per year.
Audit Report
Quarterly as above
Provide BFI RAG progress report to
Public Health
Progress report
Quarterly as above
Consequence of Breach
Performance
Indicator Heading
Specialist Lactation
Support
Indicator
Method of Measurement
Frequency of Monitoring
Anonymised report showing
activity through the period by
CCG of mother
Quarterly to Public Health
Commissioners
Provide qualitative data: anonymised
non identifiable personal stories on
mothers experience of using service
A minimum of 4 Case Studies
supported by interviews with
women
Quarterly as above
Customer satisfaction at point of service
offered for all mothers, minimum 10%
coverage. Log of complaints and
compliments with actions taken
User Satisfaction Survey
summary report
Log
Lactation Clinic records of number,
presenting problem and treatment of
mothers/babies attending
clinics/referrals made (as a minimum 2
weekly specialist clinics to be held in
each district authority area, spaced out
over weekdays to enable women to
access a clinic on any day of the week
within reasonable travelling distance)
Quarterly as above
Consequence of Breach
Performance
Indicator Heading
Peer Support
Indicator
Method of Measurement
Frequency of Monitoring
A 3 year plan to be put in place and
monitored to ensure that peer
supporters annually provide support
and advice to 11,000 post-natal women
within 48 hours of leaving hospital or of
time of home birth(based on NICE peer
support bench marking tool)
Children Centre and other
clinic records analysed Kent
wide, local authority and CCG
areas
All peer supporters attending accredited
Peer Support training courses
Training Records
Quarterly to Public Health &
Child Health Commissioners
Evidence participant outcomes-80%
participants to pass course
Evaluation reports
Quarterly as above
Evident enrichment for volunteersnumbers at each supervision session
recorded
Peer supporter records
Quarterly as above
Evidence partnership working in every
District authority area (Mind the Gap
health inequality plans)-minutes of
meetings/action plans
available as requested
Quarterly as above
Quarterly
Consequence of Breach
Performance
Indicator Heading
Indicator
Method of Measurement
Frequency of Monitoring
Quarter on quarter increase in the
number of mothers who are contacted
ante-natally from Q2 2014/15 baseline
Summarised contact logs by
Kent/local authority area/CCG
areas
Quarterly
Evidence that peer supporters are full
volunteers with Children’s Centres and
have had the necessary checks, where
peer supporters also support hospitals
these checks need to have been
undertaken/ transferable
Peer supporter records
Quarterly as above
Year on year increase in number of
volunteers supporting groups, with
evidence that the majority are working
in areas of deprivation defined by local
Mind the Gap plans
Peer supporter records
Quarterly as above
Consequence of Breach
Performance
Indicator Heading
Indicator
Method of Measurement
Frequency of Monitoring
Evidence of qualitative data; Personal
stories
A Case study provided in each
local authority district
including interviews with
mothers
Quarterly as above
Randomised audit of 10% mothers
satisfaction with attendance at support
groups
Summary report
Supporting primary
care in their role for
supporting
Community BFI
5% of practices undertake training per
annum
Training log, certificates,
evidence of e-learning
Quarterly as above
Supporting
children’s centres in
their role of
supporting
Community BFI
All children’s centres to have received
training over a 24 month period then a
rolling programme of updates
Training log, certificates
Quarterly as above
There will be challenges in each
geographical area, the service will need
to evidence plans as part of Mind the
Gap local processes that show how they
will address the inequality related to
infant feeding.
Evidence in Mind the Gap
locality plans
Quarterly
Tackling Inequalities
Quarterly as above
Consequence of Breach
Performance
Indicator Heading
Indicator
Method of Measurement
Frequency of Monitoring
To work with local
authorities to
promote
breastfeeding
friendly
environments
Welcome scheme for Kent County
Council implemented in all districts and
boroughs as part of Mind the Gap
within 18 months
Publication of scheme,
evidence of support resources
and log of all participating
venues who are accredited
Quarterly as above
To provide social
marketing
approaches in areas
of low take-up
Identify and work in partnership with 3
areas per annum (Using Bentley
Christmas Tree model or similar
methodology)
Evaluation report
Quarterly as above
Consequence of Breach
Performance
Indicator Heading
To work with
Education, schools
the KCHT C&YP
Team to promote
breastfeeding
education as part of
the curriculum
To work with
informal youth
groups to promote
infant feeding
Indicator
Method of Measurement
Frequency of Monitoring
Curricula
Increase year on year the number of
schools who include breastfeeding as
part of the curriculum
To work with youth services to
determine the most effective way of
introducing this education informally
Quarterly as above
Evidence of planning and
evaluation
Quarterly
Consequence of Breach
Performance
Indicator Heading
Indicator
Method of Measurement
Frequency of Monitoring
To work with
workforce leads in
local authorities to
enable
breastfeeding
mothers to return
to work
Breastfeeding Friendly scheme for
inclusion in workplace health
improvement plans. Quarter on quarter
increase in number of workplaces with
schemes in place
Number of workplaces with
verified schemes in place
Quarterly as above
The service has
plans in place to
measure uptake of
services from
groups that might
be negatively
impacted
The service needs to ensure that use of
services by the following groups are
measured and included in performance
reports:
Age
Disability
Gender
Race
Beliefs/Religion
Sexual orientation
Pregnancy and maternity
Marriage and civil partnerships
Carers responsibilities
Women living in deprived areas
Women with low educational
attainment
Service monitoring
Equity Audits
Quarterly as above
Consequence of Breach
9. Activity
9.1 Activity
The provider will provide robust information during the life of the contract in relation to their activity, as detailed in section 8. Monthly exception reporting if
not on track
9.2 Activity Plan / Activity Management Plan
Not used for this contract
9.3 Capacity Review
Not used for this contract
REPORTING
Reports must be submitted quarterly, by the 31ST working day of September, December and April for the duration of the contract. It may be necessary on
occasion to request data and reports earlier, as breastfeeding is a Public Health Outcome Framework indicator. An annual report will be required by the end of
April of each contractual year.
Address for reports:
PHperformance@kent.gov.uk
Data will be gathered, analysed and displayed by provider. Reports should be submitted by the following areas
Kent County Council
Clinical Commissioning Groups
Mind the Gap reports for Districts and Boroughs
Any changes to the format of the report can be discussed between Provider and Commissioner to ensure it is useful to both sides throughout the contract
term.
Reports must cover Performance and Activity and indicators from the table above.
PERFORMANCE MEETINGS
Performance Meetings will be held quarterly or as requested by Kent County Council or the provider. The Service will be reviewed at 6 months and then
annually during the life of the contract.
Appendix 1
Glossary of Terms
Community Infant Feeding Service
Covering feeding during the first six months of life, a key aim is to increase breastfeeding rates
because of the health benefits this results in for babies and mothers but it also includes
supporting any woman who is experiencing difficulties feeding her baby by any method.
Lactation Consultant
A person qualified to advice on infant feeding, who has an International Board Certified Lactation
Consultant (IBCLC). Work in partnership with health professionals they would help mothers with
babies with latching difficulties, painful nursing, low milk production, or inadequate weight gain
Lactation Specialist
A person qualified to advise on infant feeding, the minimum qualification would be National
Childbirth Counsellor or Association of Breastfeeding Mothers counsellor.
Peer Supporter
A person who has experience of breastfeeding her baby who volunteers to provide peer support
to women who are experiencing difficulties breastfeeding. The peer supporter would have
received training and attend regular updates and supervision from a Lactation Specialist.
Baby Friendly Initiative (www.unicef.org.uk/babyfriendly )
BFI is an accredited programme of service improvement which is open to Maternity Units & NHS
Community Trusts who provide midwifery and health visiting services. It is based on a set of
standards which include policy development, adherence to the WHO code on infant formula,
rigorous prescribed training and audit
UNICEF (UNICEF.org.uk)
United Nations Childrens Fund advocates for measures to give children the best start in life,
because proper care at the youngest age forms the strongest foundation for a person’s future.
UNICEF UK is responsible for The Baby Friendly Initiative.
Public Health Outcomes Framework (www.phoutcomes.info)
Public Health will be measured against a framework which sets out 66 health measures so
councils and the Government are able to see real improvements being made and take any action
needed
Tongue Tie
Tongue-tie is a problem that occurs in babies who have a tight piece of skin between the
underside of their tongue and the floor of their mouth. It can sometimes affect the baby's feeding,
making it hard for them to attach properly to their mother's breast. There is a procedure that can
be undertaken to cut the skin to help feeding.
Appendix 2
The location and number of breastfeeding groups and peer supporters will be agreed in partnership with the KCC Infant feeding programme management service.
Lead Provider Childrens
Centre Core
service
Peer support programmes per locality.
These should be seen as a locality provision and shared across the centres of the locality.
Recruitment of volunteer peer supporters from the local community who are mothers who have breastfed for at least 6
weeks. Aim for two new courses per year.
Provision of volunteer status with up to date DBS, safeguarding and other necessary volunteer training. Estimate 20 new
recruits per year
Provision of a peer support coordinator/”breastfeeding champion” . This is a clerical role. JD available. 0.6 WTE per
locality
Provision of a training room for the ps training and for quarterly supervision of the breastfeeding volunteers.
Deliver two peer support accredited courses per year for up to 12 mothers
Quarterly ps training update/enrichment
Fee for ps trainees to Greenwich
UNICEF Baby Friendly Initiative for CCs
One-off Fee to BFI for all CCs
Training and audit for all staff (with HV service)
Venues for training
Resources for training
Enable all staff to attend BFI training programme
Manage requirements of BFI within the CC eg WHO Code compliance.
Performance reporting
Provide volume and reach data for the breastfeeding groups from data collated and inputted on estart
Provide qualitative feedback of the peer support service from mothers.
.
KCC
commissioned
Infant feeding
programme
team
Direct
payment from
Public Health
Provide qualitative feedback of the peer support service from peer supporters
Lactation Clinics-one per locality alongside peer supporters
Provide lactation specialist LC or bfc with established organisations (NCT,LLL etc)
Provide premises for group with lactation clinic
Provide play worker at breastfeeding groups to support peer supporters with children
This does not include any bf services funded by KCC that are not linked to CCs eg community BFI, data recovery , lactation services alongside