2 National Policy Giving all children a healthy start in life Improving the HV serviceImproving chances for children with vulnerable mothersSupporting mothers & children with mental health problemsHelping parents to keep their children healthyProviding free school mealsEncouraging healthy living from an early ageProtecting children through immunisationImproving maternity careCurrent government policy to Give all children a Healthy Start in Life specifically includes improving the HV and FNP service but in doing so this also has significance on many of the other outcomes identified within this policy bundle.Delivery of the Health Visiting (HV) Programme represents a major Government priority. The target of ensuring that an extra 4,200 HVs are in post by April 2015 is set out in the Coalition agreement (HM Government, May 2010 )
3 Policy deliverables by 2015 increase qualified Health Visiting workforce by 4200transform the Health Visitor serviceincrease the number of Family Nurse Partnership places to16,000
4 HV / FNP Programme key dates 2011Health Visitor Implementation Plan : A Call to Action launchedStrategic Health Authorities worked with Primary Care Trusts to identify how many Health Visitors would be needed in localities to meet identified population needs. Business cases and Investment profiles agreed.2013Public Health transferred to the Local Authority in 2013, however the commissioning of Health Visiting & FNP Services moved to NHS England for a period of two years to complete the investment and transformation programme.2015Commissioning responsibility for Health Visiting and Family Nurse Partnership services will transfer from NHS England to Local Authorities on 1st October to complete the transfer of public health functions.
5 Why the focus on Health Visiting? Public Health - The foundations for virtually every aspect of human development – physical, intellectual and emotional – are set in place during pregnancy and in early childhood.Economic - Successive academic and economic reviews have demonstrated the economic and social value of prevention and early intervention programmes in pregnancy and the early years.Competency - Health Visitors, specialist community public health nurses, have a unique role in identifying need and supporting the development and wellbeing of every child in England up to the age of 5.80% of brain development takes place during pregnancy and in the first 2 years of life setting the neurological pathways for adult life – what happens during this period is crucial and a key determinant of intellectual, social and emotional health and wellbeing.What happens during these early years has lifelong effects on many aspects of health and wellbeing, educational achievement and economic status.
6 The Health Visiting Service… provides expert information, advice, guidance and interventions to help parents become the best parent they can be and give their children the best start in life.has a central role in improving the health outcomes of populations, reducing inequalities, protecting children from harm and identifying additional needs at the earliest opportunity.leads the delivery of the national Healthy Child Programme 0-5 for every childis the only service that comprehensively assesses the health, wellbeing and social needs of every child at crucial stages of their development between pregnancy and the age of 3, often in the home environment.
7 Healthy Child Programme An universal schedule of evidence based assessments, screening, immunisations and contacts aimed at promoting and protecting the health and wellbeing of all children as well as identifying needs early and taking appropriate additional action.NB The Healthy Child programme provides the evidence based schedule of assessments, screening, contacts available for every child. Health Visitors are responsible for leading this across their population group.Detail examples of screening, etcHealth visitors lead the Healthy Child Programme for families with children up to the age of 5, offering a universal service to families, with more targeted and tailored support for those who need it.
8 National Core Service Specification NB….ASQ – PH readiness for schoolLA resident populations from GP registered
10 Two providers of CIOS Health Visiting FNPCornwall Partnership Foundation TrustHealth Visitors in LAC Specialist Nursing TeamRoyal Cornwall Hospital Trust
11 Three key aspects increase qualified Health Visiting workforce Transform the Health Visitor serviceincrease the number of Family Nurse Partnership places
12 Increasing the workforce May 2010March 2015Individualise by area according on audience – example of Cornwall shown above using baseline position and most recent UNIFY position. By March 2015 the provider is expected to achieve its full trajectory of fte. This number includes a team of 8 Family Nurse Partnership Nurses who provide intensive family support for fist time young parents under the age of 19. In addition there are 3.2fte Health Visitors working within the Looked After Children specialist nursing team based within the Roya Cornwall Hospital, Truro.Important to note that this is not the whole workforce – there are skill mix nurses and nursery nurses in addition to these numbers who support the delivery of the Health Visiting ofer.81fte qualified HV’s117fte qualified HV’s
13 Transform the Health Visiting service Population uptake of core checksEvidence based toolsWorkforce developmentPathways of careSupervisionEngagement of service usersPublic Health & PreventionSafeguarding
14 Population uptake of core checks AntenatalNewbirth6-8 weeks *3-4 months *By 1 year2-2.5 yearsAim that all achieve minimum of 90% by March 2015 with 95% in 2015/16.Important to ensure as many children as possible engage so that the service can screen those who need more support.Those in yellow are mandated from October 2015, service currently delivers a 3-4 month check owing to importance timing wise around maternal mental health, weaning, accident prevention – moving from a nonmobile to mobile baby.
15 Increasing universal uptake - 1 year review Q2 201453%Q3 201370%This check focuses upon infant development including speech and language, motor skills, behaviour and attachment.With the introduction of Ages and Stages assessment tool (ASQ3) at the two year check we are currently exploring intorducing its use at the 0ne year check as a way of tracking individual development and progress.
16 Evidence based tools examples SolihullFamily Partnership ModelMotivational InterviewingBaby FriendlyAges & Stages 3 & SEIn line with NICE guidance and the evidence base
17 Evidence Based Assessments of Need Check uptake increase from 67% to 74%ASQ to be nationally introduced60% of reviews used ASQ88% of staff trained by Q2
18 Workforce Development examples Leadership of change trainingPreceptorship programmeCommunities of practiceAction Learning Set for CPT’sNHS EmployersClear workforce development plan supported by NHS Employers looking at HV recruitment and retentionActive communities of practice across area team geography including all HV leads and Public health representativesLeadership of change – frontline HV’s 6 week course looking at how to lead change through projects
19 Snapshot of local developments Equitable practice on the Isles of ScillyHV in pre-birth assessment teamHV in MARU (multi-agency referral and assessment unit)Multi-Agency Antenatal educationMigrant Workers Needs analysisDoubled FNP capacityRestorative SupervisionLAC Specialist Nursing Team
20 Family Nurse Partnership Capacity increased from 4 to 8 nursesLicenced modelUp to 200 placesSupporting vulnerable first time young parentsEvidence based model for use with vulnerable first time young parents. Capacity was doubled using HV investment profile now has space for up to 200 young families.
21 Looked After Children’s Team 3.4wte New nurses from HV investmentHigh quality consistent assessment% reviews in time has increased from 34% to 90%+Case management approach – nurse follows childSpecific support for adoptive parents to support placement
22 Developing clear pathways of care Development of champion rolesDomestic AbusePerinatal Mental HealthInfant FeedingInfant Feeding co-ordinatorBFI accreditation across Hospital & CommunityPerinatal mental health & attachmentCurrently use Woolley questions, GAD7 & PHQ9Reviewing use of Promotional guides / MORSIntegrating two year reviewsIntroduction of ASQWorking with Early years to streamline deliveryPart of Social Marketing projectInitial focus upon the 6 early years high impact areas
23 Meridian Survey/Friends and family Engaging familiesMeridian Survey/Friends and familySocial marketingNeeds analysis
24 HV Challenges Increased accessibility & expectation Achieving Population UptakeMaintaining focus upon public health and prevention as well as safeguardingMaintaining the workforce through changeActively engaging service users and influencing changeFit for purpose Information sharing and IT
25 FNP Challenges Decreasing teenage pregnancy rate Staff turnover & sicknessAchieving fidelity of programme in a rural geographyEnsuring alignment to HV & Early Years services to provide a continuum of support