With 140 new nursery schemes in place, an extra 6,000 subsidised nursery places for NHS staff and more than 220 childcare co-ordinators in post to advise them, the 70m NHS childcare strategy looks on course to realise the targets set when it was launched in 2000. Yet doubts are looming about its continued success.
A recent impact analysis carried out by the Daycare Trust on behalf of the Department of Health found that more than 80 per cent of the parents surveyed said that the strategy had helped them.
Measuring its impact on recruitment and retention accurately has proved harder, but anecdotal evidence from case studies appears to show that it has helped Britain's biggest employer retain staff, enabled parents to return to work after maternity leave, reduced sickness and levels of absence and improved job satisfaction and morale.
The funding made available through the NHS workforce development confederations has provided on-site nurseries and new nursery places, financed childcare co-ordinators and supported a range of other initiatives to suit the flexible hours worked by NHS staff. The strategy has a target to create 150 extra on-site nurseries, providing an additional 7,500 places subsidised at an average 30 a week per place.
But clouds have appeared on the horizon. From April, funding for the strategy will no longer be ring-fenced and channelled through the workforce development confederations, but will be lumped into the general allocations made to Primary Care Trusts (PCTs).
The Daycare Trust report warns, 'There is a real danger that with the switch to the new funding regime, the NHS childcare strategy will lose much of its momentum.'
It adds that some of those surveyed 'felt that it was inevitable that in coming years, PCTs would divert monies away from childcare to service areas that they regarded as higher priority'. These concerns dominated the recent third annual conference on the strategy in York.
A lynchpin of the strategy has been the commitment to give every NHS employee access to a childcare co-ordinator to help them find affordable, accessible and good quality childcare - a requirement for an NHS organisation to achieve the Improving Working Lives (IWL) standard.
A national database has been created so that NHS staff can find out the name of their co-ordinator. But the report says that the creation of co-ordinator posts has been 'piecemeal' in some areas, while having unnecessary duplication in others.
Meeting standards
The Daycare Trust report says that the IWL requirement could prove a lifeline for co-ordinators as the funding arrangements change, 'although they suspected that they would not necessarily always be retained for the right reasons'.
Joanne Mockett, who manages the childcare co-ordinators in the Tees and North East Yorkshire NHS Trust, fears that IWL requirements could be putting trusts under additional pressure, because their imperative to help staff morale, retention and recruitment could have 'a knock-on effect' as the standard is needed if hospitals want to gain foundation status.
The health department says that Andrew Foster, its director of workforce, recently sent all PCT chief executives a letter reminding them that childcare will remain a crucial element in the IWL programme. A DoH spokeswoman says, 'NHS organisations will have to demonstrate that their childcare strategy feeds into the childcare strategy across the wider health economy and is one of the human resource activities that underpins their Local Delivery Plan.'
A spokeswoman for the NHS Alliance, which represents PCTs, says the new funding arrangements 'should not be a major problem', that 'most PCTs have an ideological investment in childcare' and that while 'different models and skill mixes may emerge', it was a positive step to move funds from the workforce development confederations, which were perceived to be remote.
However, the Daycare Trust report questions the commitment of many PCTs and acute trusts to the strategy. It says co-ordinators fear that senior management regard childcare as 'a perk for staff, rather than as a tool that can help them to meet their strategic objectives around service delivery and patient care'. They feel that PCTs, because they are still in their infancy, would be less committed to childcare than acute trusts.
Co-ordinators have also found it difficult to reach GPs and their staff - partly, the report says, because of opposition from some practice managers, but also because GPs are not NHS employees.
The report says the atmosphere among co-ordinators is 'very much one of anxiety and uncertainty'. Many fear their posts may be threatened under the devolved funding arrangements, which are consistent with the Government's aim to allow NHS organisations to determine local needs and priorities.
Joanne Mockett says the transition to funding from PCT allocations could prove problematic, as PCTs will have drawn up their most recent local delivery plans without factoring in childcare. 'So, we are going to have to go back to PCTs for more funding. This coming year could be particularly difficult,' she warns.
In one area, the report notes, a nursery was so worried that funding might be axed that it had decided not to take account of the 30 per place discount in calculating its budget, fearing that in future the discount 'might not be sustainable'.
Making a difference
Anna Johnson, childcare co-ordinator for the Birmingham and Solihull mental health trust, says, 'From April it's very unclear what exactly is going to happen. It looks as though we will have to go cap-in-hand to the PCT for funds to continue this work.
'If the plug was pulled, it would be such a shame, because I know from the feedback that I am getting from staff about recruitment and retention that it is making a difference. We did a jobs fair recently and I was able to meet lots of prospective employees who have family commitments, give them advice and signpost them in the right direction. We also support those returning from maternity leave.'
Carla Panter, who became a co-ordinator for the 7,000 staff at the St Bartholomew's and London NHS Trust two years ago, says she has seen a four-fold increase in enquiries about childcare. By May the nursery at St Bartholomew's will have grown from 25 to 43 places. Moves are afoot to register with Ofsted to take more under-twos, where the demand is highest.
She says the co-ordinator's role is a blend between a strategic and a hands-on approach, which has entailed producing a quarterly newsletter for 900 people giving advice on issues such as childhood illnesses and eating disorders.
Jane Attfield was manager of the nursery at the Royal Free Hospital acute trust in north London before becoming a co-ordinator. She is unequivocal in supporting the strategy, 'because it has raised the profile of childcare in the NHS and that can only be a good thing'. The nursery has been expanded to 70 places and holiday playschemes are in the pipeline, with an aim of developing links with local childminding networks.
Childminders' support
However, in some cases the viability of childminding networks themselves has been thrown into doubt by the changes in financing the NHS childcare strategy. A network in Doncaster, South Yorkshire, which previously had been run by the local early years partnership, was recently taken over by the local NHS and now faces an uncertain future.
Margaret Nye has set up childminding networks covering four key health areas in London, encompassing major hospitals such as Guy's, St Thomas's and the Maudsley. She says their future is 'one of the great imponderables'
as PCTs assume control of the purse strings next month.
The networks, which involve around 160 childminders, have been successful in showing that 'there are childminders out there very keen to support NHS staff to get back to work'. She says some had even offered to cover for Christmas Day.
She plans to meet with workforce development confederations' childcare leads to draw up a business case to put to PCTs for continuing the networks. 'If it all comes out of a central pot and you are looking at whether to finance an acute ward, a renal unit or a childminder, it will be harder to make the childcare case.' But she adds, 'We have to argue that without childminders, you may not have the staff to operate the renal unit or the acute ward.'
The Daycare Trust report provides co-ordinators with a guide to making a business case for childcare. A key element in this process could be the further evolution of the childcare co-ordinators' role to encompass all carers. But with co-ordinators still in the dark about the way the new funding arrangements will work and who will be the childcare leads in the PCTs, the next few weeks are likely to see some tough negotiations to ensure that the childcare strategy does not unravel and that it is made sustainable in the long term.