1. “Let’s talk about health visiting”
The Changing Context for Health Visiting
Kate Billingham
Deputy Chief Nursing Officer
Department of Health

2. Part One: The policy context for health Part Two: The policy context for children and families Part Three: Implications for health visiting

3. Future health challenges
Public expectations are changing – as patients and tax payers
Increasing and changing health needs
Scientific and technological change
HOW DO WE SUSTAIN A SERVICE THAT IS
TAX-FUNDED-FREE-AT-POINT-OF-USE?
Regardless of who is in charge
Facing the developed world
Period of rapid change
We all need to face up to these, understand why change is happening and work together to find solutions

4. Challenges for health visiting
Using new knowledge, new technologies and evidence of what works e.g. parenting and neurological development
Preparing for impact of unhealthy living and global health threats
Inequalities in health
Public expectations are changing - as patients and tax payers
Finding HV’s unique contribution in a more varied and diverse workforce
Making the case for preventive services to commissioners
HV is faced with some particular challenges that I am sure you are considering in your discussions.

5. Meeting changing needs, improving health and reducing inequalities
The policy jigsaw
Supporting
independence,
healthy choices,
Integrated services centred on the community
Meeting changing needs, improving health and reducing inequalities
Changing the system (funding, commissioning, IT, regulation, providers)
Adapting the
workforce

6. Modernising Nurse Careers: the strategic direction for nursing
Constancy of nursing values and practice
Quality care organised around people’s needs
A community centred health service
Better care for people with long term conditions (self-care)
Effective preventive interventions
Integration of services
Able to meet physical and mental health needs
Sufficient number with advanced skills
Leaders of mixed teams
Deliver high productivity and best value for money
MNC sets the strategic direction for nursing and the changes needed to equip the profession for the future
HV is an important part of the nursing family and these changes apply to HVs, in many ways HV is already well down this road

7. Health policies that impact on health visiting: ‘our health, our care, our say’
Public Health: obesity, inequalities, ‘fully engaged public’, pandemics
Primary care: ‘hospital to home’, long term conditions, choice, practice based commissioning, new providers, self- care and independence
Nursing: Modernising Nursing Careers, quality and reputation
System reform: Client/patient experience as the driver, active commissioning, better value for money/productivity, Connecting for Health, new providers, devolution

8. Part Two: The policy agenda for children and families

9. The policy agenda for children and families
Priorities: reducing poverty and social exclusion, best start in life, education
Prevention and early intervention
Progressive universalism
Balancing support with challenge
Integration of services in children’s centres
Health led during pregnancy to 3 years
Choice for parents from a range of different sources of support
Using what we know about risks and protective factors and what works

10. Key priorities for children and young people since 97
Tackling child poverty
introducing welfare reforms to make work pay and financial support for families with children. The Government’s goal is to eradicate child poverty by 2020, halving it by 2010
Ensuring every child has the best start in life
recognising the importance of the early years through Sure Start, Children’s Centres and expanded early years education. The Government has invested more than £17 billion in these areas since 1997
Education
raising standards across the board while giving priority to improving standards in schools in the most challenging circumstances.
Investment per pupil (including capital spending) has risen from £2,500 in to over £5,000 today and is expected to exceed £5,500 by
The government has created the opportunity for many more people from disadvantaged families to realise the aspirations they have for themselves and their families
Stable economy, investment and reform of public services

11. What is progressive universalism?
A universal preventive service that is systematically planned and delivered to give a continuum of support according to need at individual and population level in order to achieve ECM outcomes.
Those with greatest needs receiving more intensive support and those with lower levels of need a ‘lighter touch’
Why?
We know more about the impact of parenting and maternal health of outcomes for children
Inequalities (IMR 6x higher in Birmingham than Eastleigh)
It happens anyway but tends to be unplanned
The world is changing (expectations, technology, social relations)

12. Progressive impacts – but concerns about the tail
Faster income growth for poorer families since 1997 – particularly compared to
This is an important slide. It tells us that incomes have increased for a huge swathe of families who were living in poverty – tended to be those in work on low pay.
What is of concern is the families who have been left behind, for some of whom things have got worse
poorer families
richer families
Source: Institute for Fiscal Studies

13. Reaching Out: An Action Plan on Social Exclusion
Considerable progress made in tackling poverty and social exclusion since 1997
Need to do more to achieve the goal of progressive universalism and help those with the most entrenched and complex problems
Importance of support from the start – breaking intergenerational transmission of disadvantage
Research on risk and protective factors offers us considerable opportunities for early identification and more effective prevention
Key points in the SEAP

14. Life chances are influenced by opportunities and constraints operating at different levels – at the heart of this model is the individual child and family
Economic, fiscal and social policy
Current well-being
Choices Actions
Be healthy; stay safe; enjoy and achieve; make a positive contribution; economic well-being
Opportunities & Constraints
Family
Community
Region
Nation
Future well-becoming
Global
Prospects and social mobility (inter- and intra-generational)
There is a significant association between parental income and children’s education, and subsequent earnings. Children growing up in low income households are likely to earn lower wages as adults
24% of children getting Free School Meals gain 5 or more GCSEs at A*-C, compared with 55% of all children 9 (2003 data).
The daughter of a teenage mother is twice as likely to become a teenage mother herself as the daughter of an older mother; the children of women who have spent time in care are 2½ times more likely to go into care than their peers.
An estimated one- to two-thirds of children who live with parents who have a mental health problem will experience mental health difficulties themselves.
Only 15% of young people from unskilled social backgrounds begin higher education by the age of 21, compared with 79% of young people from a professional background.
‘Proximal’ factors (e.g. parenting and cultural capital): ‘distal’ factors (e.g. social class, income, assets)
Social capital; peers; concentrations of deprivation; discrimination
Environment; housing; regional economy

15. A ‘magic moment’ of opportunity
“Like it or not, the most important mental and behavioural patterns, once established, are difficult to change once children enter school”
Nobel Laureate James Heckman (2005)
Pregnancy and the first 3 years are vital to child development, life chances and future achievement
Birth of a child is a ‘magic moment’ of opportunity when parents are uniquely receptive to support
Universal midwifery and health visiting services are ideally placed to identify children and families at risk
Embedding the principle of ‘progressive universalism’ into maternal services should be a priority to ensure that additional support is provided to those children and families at greatest risk
This is obvious but needs restating
We never have a time like this to make a difference

16. What might this look like for a 16 year old single mother with her first child?
Has chosen which HV she wants by seeing video clips of the team’s particular skills at the local children’s centre
The HV keeps in touch with the practice and all other services using the new IT systems that are in place, with all aware of progress
The mother has a collection of video clips of her baby’s development on her own Health Space which mum and the HV look at on the digital TV
Feels that she is benefiting from the intensive parenting support programme
She has a volunteer support worker who helps her with some of the practical day to day needs
Job centre staff at the children’s centre have helped her find a job and she has made new friends
Daily SMS messages sent via the HV’s PC are helping mum to keep off cigarettes

17. Implications for health visiting
Part Three
Implications for health visiting

18. National developments
The establishment of 10 health-led parenting support demonstration projects from pre-birth to age 2
Working group to look at the future of health visiting
Modernising Nursing Careers
These workshops
Commissioning for health well being guidance

19. What does this mean for health visiting?
Health visiting role within a service rather than a ‘HV service’?
Focus on improving the well being of children through progressive universalism, health-led prevention and early intervention
Evidence based interventions with known outcomes
Integration of child and family services
Changing landscape of primary health care
New career paths and educational preparation (level and content)
More ‘players on the field’ - public health role of the public
New roles in a new world – leading and delivering
Influencing commissioning and delivering a contract
Local decision making
New providers (general practice and children’s centres)

20. The real social revolution we are living through is from a life that is largely organised for us
To a world where we have to be in charge of our own destiny

21. The Blue Book, Trevor Bradley Greive

22. The Blue Day Book – Trevor Bradley Grieve