1. Health Visiting
and FNP services

2. National Policy Giving all children a healthy start in life
Improving the HV service
Improving chances for children with vulnerable mothers
Supporting mothers & children with mental health problems
Helping parents to keep their children healthy
Providing free school meals
Encouraging healthy living from an early age
Protecting children through immunisation
Improving maternity care
Current 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 4200
transform the Health Visitor service
increase the number of Family Nurse Partnership places to16,000

4. HV / FNP Programme key dates
2011
Health Visitor Implementation Plan : A Call to Action launched
Strategic 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.
2013
Public 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.
2015
Commissioning 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 child
is 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, etc
Health 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 school
LA resident populations from GP registered

9. Local provision

10. Two providers of CIOS Health Visiting
FNP
Cornwall Partnership Foundation Trust
Health Visitors in LAC Specialist Nursing Team
Royal Cornwall Hospital Trust

11. Three key aspects increase qualified Health Visiting workforce
Transform the Health Visitor service
increase the number of Family Nurse Partnership places

12. Increasing the workforce
May 2010
March 2015
Individualise 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’s
117fte qualified HV’s

13. Transform the Health Visiting service
Population uptake of core checks
Evidence based tools
Workforce development
Pathways of care
Supervision
Engagement of service users
Public Health & Prevention
Safeguarding

14. Population uptake of core checks
Antenatal
Newbirth
6-8 weeks *
3-4 months *
By 1 year
2-2.5 years
Aim 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 2014
53%
Q3 2013
70%
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
Solihull
Family Partnership Model
Motivational Interviewing
Baby Friendly
Ages & Stages 3 & SE
In 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 introduced
60% of reviews used ASQ
88% of staff trained by Q2

18. Workforce Development examples
Leadership of change training
Preceptorship programme
Communities of practice
Action Learning Set for CPT’s
NHS Employers
Clear workforce development plan supported by NHS Employers looking at HV recruitment and retention
Active communities of practice across area team geography including all HV leads and Public health representatives
Leadership 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 Scilly
HV in pre-birth assessment team
HV in MARU (multi-agency referral and assessment unit)
Multi-Agency Antenatal education
Migrant Workers Needs analysis
Doubled FNP capacity
Restorative Supervision
LAC Specialist Nursing Team

20. Family Nurse Partnership
Capacity increased from 4 to 8 nurses
Licenced model
Up to 200 places
Supporting vulnerable first time young parents
Evidence 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 investment
High quality consistent assessment
% reviews in time has increased from 34% to 90%+
Case management approach – nurse follows child
Specific support for adoptive parents to support placement

22. Developing clear pathways of care
Development of champion roles
Domestic Abuse
Perinatal Mental Health
Infant Feeding
Infant Feeding co-ordinator
BFI accreditation across Hospital & Community
Perinatal mental health & attachment
Currently use Woolley questions, GAD7 & PHQ9
Reviewing use of Promotional guides / MORS
Integrating two year reviews
Introduction of ASQ
Working with Early years to streamline delivery
Part of Social Marketing project
Initial focus upon the 6 early years high impact areas

23. Meridian Survey/Friends and family
Engaging families
Meridian Survey/Friends and family
Social marketing
Needs analysis

24. HV Challenges Increased accessibility & expectation
Achieving Population Uptake
Maintaining focus upon public health and prevention as well as safeguarding
Maintaining the workforce through change
Actively engaging service users and influencing change
Fit for purpose Information sharing and IT

25. FNP Challenges Decreasing teenage pregnancy rate
Staff turnover & sickness
Achieving fidelity of programme in a rural geography
Ensuring alignment to HV & Early Years services to provide a continuum of support

26. Any questions?