1. Delivering health visiting service transformation Denise Thiruchelvam, NHS England Contact:
Webinar
14th November 2013
NHS | Presentation to [XXXX Company] | [Type Date]

2. Aim of Webinar 1 Define service transformation and the new model of health visiting
0-5 Commissioning responsibilities of ATs (HCP, HV, FNP, CHIS), CCGs (maternity services, adult and child mental health services, acute and community services) and of local authorities including delivering school readiness.
Transition of responsibilities for PH of 0-5s to local authorities from 2015
Expectations on Area Teams in terms of delivery of service transformation: the spec, AT dashboard and provider performance framework
Commissioning intentions
How the service transformation funding is intended to support Area Teams, Local Authorities, and provider organisations in delivery of the new model of health visiting in the context of new and future commissioning strategies – a systems approach.

3. Service transformation deliverables
Full delivery of new model of health visiting including universal elements of healthy child programme
Ensure that commissioning of public health services for 0-5s is effective and embedded with commissioning of other early years services
Improvement in defined public health outcomes
As set out in the National Health Visitor plan, supported by the draft A agreement on NHS provision of public health services, service transformation deliverables are:
Full delivery of new model of health visiting including universal elements of healthy child programme
Ensure that commissioning of public health services for 0-5s is effective and embedded with commissioning of other early years services
Improvement in defined public health outcomes
Service transformation requires delivery of the new model of health visiting, including community, universal and targeted levels of delivery.
It must deliver the new model sustainably in the context of the new and future commissioning landscape for public health of the 0-5 years. This will require partnership between Area Teams and Health and Wellbeing Boards (HWB boards); including local authorities as current commissioners of early years services and CCGs as commissioners of maternity, mental health and acute and community children’s services.

4. Delivery of the new model of health visiting
Community: health visitors have a broad knowledge of community needs and resources available
Universal: health visiting teams lead delivery of the Healthy Child Programme.
Universal Plus: families can access timely, expert advice from a health visitor when they need it
• Universal Partnership Plus: health visitors provide on-going support, playing a key role in bringing together relevant local services, to help families with continuing complex needs
Community: health visitors have a broad
knowledge of community needs and
resources available e.g. Children’s
Centres and self-help groups, and work
to develop these and make sure families
know about them.
• Universal: health visiting teams lead
delivery of the Healthy Child Programme.
They ensure that every new mother and
child have access to a health visitor,
receive development checks and receive
good information about healthy start
issues such as parenting and
immunisation.
• Universal Plus: families can access
timely, expert advice from a health visitor
when they need it on specific issues
such as postnatal depression, weaning
or sleepless children.
• Universal Partnership Plus: health visitors
provide ongoing support, playing a key
role in bringing together relevant local
services, to help families with continuing
complex needs for example where a
child has a long term condition.

5. Delivery of the Healthy Child Programme
Universal, progressive, preventive
Led by HVs but delivered in partnership
Focus on outcomes
Address inequalities ]

6. Current commissioning system
New Commissioning Landscape
Current commissioning system
Department of Health (DH)
The DH is the lead organisation for policy development.
It will continue to set out the Secretary of State’s expectations and requirements of the NHS and reflect them in the annual mandate provided to NHS England
It will also set out the resources allocated by government to the NHS
NHS England
NHS England is responsible for the direct commissioning of a range of public health services as set out in a section 7a Agreement and accompanying Specification 275 with the Secretary of State
The universal elements of the Healthy Child Programme 0-5 years.
Health Visitors, including the Health Visitor Implementation Plan.
Family Nurse Partnership, including the planned expansion of services to 16,000 places.
Clinical Commissioning Groups (CCG)
CCGs are responsible for commissioning acute and community health services for children aged 0-5 years, excluding the universal elements of Healthy Child Programme 0-5 years, national screening and immunisation programmes and specialised care.
They are also responsible for commissioning maternity and mental health services for parents and children.
Local Authorities (LA)
LAs are responsible for commissioning many of public health services for people in their area, including the Healthy Child Programme 5-19 years and school nursing.
The direct commissioning responsibility for public health services for children aged 0-5 (other than the national immunisation and screening programmes) will transfer to local government from 2015.
NHS | Presentation to [XXXX Company] | [Type Date]

7. Interdependencies and ensuring a ensuring a seamless pathway
Interdependencies and ensuring a seamless pathway
It is essential that the Healthy Child Programme 0-5 years is not commissioned or provided in isolation of other healthcare services. It is also crucial that operational relationships with colleagues in local government, such as Children’s Centres, are maintained and strengthened. The new commissioning arrangement split responsibility for the commissioning of the children’s pathway between three responsible commissioners. In addition to the Healthy Child Programme 0-5 years, NHS England will commission other important services used by children including primary care services and specialised services. CCG’s will commission Maternity Services, children’s community services and most secondary care
services, and local authorities will commission a wide range of services for children, including Healthy Child Programme 5-19 years, children social services, and many education related services. All commissioners share a responsibility for safeguarding. Some of the high level interdependencies are represented in the figure.
This splitting of responsibility may lead to the possibility of fragmentation of the pathway, or duplication of effort, cost or time, or, most importantly, gaps in safeguarding provision. NHS England’s commissioning arrangements will minimise these risks by working closely with local partners through the Health and Wellbeing Board (HWB) and Children’s Partnerships. Where appropriate they will make use of joint commissioning arrangements, single pathway specifications and shared information/monitoring systems.

8. Challenges Opportunities
Fractured commissioning
Understanding organisational boundaries
Changing the current model of work
Short timeline
Change fatigue
Anxiety for the future
Establish a local vision
Using the Health and Wellbeing Board, JSNA and Health and Wellbeing Strategy to develop an integrated approach to commissioning
Improved pathway development
Increased user engagement

9. Transition of responsibilities for PH of 0-5s to local authorities
The direct commissioning responsibility for public health services for children aged 0-5 (other than the national immunisation and screening programmes) will transfer to local government from 2015.
This offers considerable potential for developing more integrated approaches to commissioning for 0-5s in and
Although NHS England Area Teams will not be required to develop transition plans until 2014, the local arrangements they put in place for the commissioning of these services should be developed in light of the knowledge that commissioning responsibility for them will transfer to local government from September 2015.

10. Role of area teams in term of delivery of service transformation
Potential Use of Health Visiting Transformation Funding
Role of area teams in term of delivery of service transformation
Bring together commissioners and define the role of health visiting within the context of:
Local needs
Resources
Priorities

11. Potential Use of Health Visiting Transformation Funding
Bring together commissioners and providers and engage with them to deliver the new model of health visiting implemented locally:
In the context of 0-5 strategies
Providing leadership across the system for improving outcomes for 0-5s
Leading delivery of the Healthy Child Programme
Delivering the full new model of health visiting by April 2015
What are their support needs?

12. What is the system approach to service transformation
Using the funding to deliver a system-wide approach to service transformation
What is the system approach to service transformation
To deliver high quality care and improved outcomes for children and families for example through:
Commissioner development, for example supporting partners in developing and/or commissioning integrated 0-5 years strategies
Provider development for example professional development to support the delivery of evidence-based early attachment and parenting programmes to deliver the integrated strategy
This is a time of significant change for healthcare and social care services in the UK. The funding is to support provider and commissioner development to deliver health visitor service transformation. Examples of how the money might be used would include:
Commissioner development, for example supporting partners in developing and/or commissioning integrated 0-5 years strategies
Provider development for example professional development to support the delivery of evidence-based early attachment and parenting programmes

13. Webinar 1-Questions and Answers panel
Sabrina Fuller- Health of Health Improvement, NHS England
Denise Thiruchelvam- Public Health Project Manager, NHS England
Victor Francis- Health Visiting Programme Commissioning Support, NHS England
Samantha Ramanah- Adviser – Community Wellbeing, Children and Young People, Local Government Association 

14. The requirements of NHS England in terms of assurance that the proposals received will deliver the required outputs and outcomes and value for money Presented by Lois Shield FCIPS NHS England
Seminar
14th November 2013

15. Topics covered:
What a bid will be expected to cover– what are the expectations in terms of meeting the criteria set out in Appendix 4
Supporting Area Teams who do not meet the criteria
Once the bid has been funded: NHS England procurement rules

16. Successful Proposal Criteria
Each bid will be evaluated based on the criteria in this table
Name and contact details of Area Team Health Visiting lead
Yes No
Is the proposal in not more than 500 words?
Does the proposal give full details of how funding will be used to support provider and commissioner development and represents value for money?
Are there milestones for the programme? (Key deliverables and dates).
Does the proposal support delivery of the new model of health visiting as set out in the core national health visiting service specification and the health visitor implementation plan?
Does the proposal support an integrated approach to commissioning and provision of services for 0-5 years?
Does the proposal specify the outputs expected?
Will the outputs improve public health outcomes for young children and their families?
Does the proposal indicate availability of a report on programme implementation, achievements, outputs and outcomes at the end of the project, and an intermediate report in March 2014?
Is there evidence of support for the proposal from each of the following or their representatives:
Chair of health and wellbeing board/Children’s partnership/Children’s Trust.
Constituent Local Authority Directors of Children’s Services/ Director of Public Health
Commissioned Health Visitor Provider Directors of Nursing
CCG children’s/maternity commissioners
Is there any information in the proposal in respect of further funding and how it would support delivery of the service specification and the new model of health visiting?

17. Successful Proposal Criteria
A "yes“ decision will take due account of NHS England's responsibility to ensure that this funding delivers the required outputs and value for money.
If its a "no" then feedback will be given to the area team to ensure they are clear on our expectations
Bids that have yes as specified in the table will go forward to a reference group for further review and endorsement of decision.
Those not meeting the evaluation criteria will get full written and verbal suggestions for improvement and invited to resubmit their proposal within 2 weeks.

18. NHS England Procurement Rules
Applies to all employees of NHS England and also to the Commissioning Support Units (CSUs) and other Hosted Bodies.
The Public Contracts Regulations 2006 (as amended) (the “Regulations”) divides services into two types, Part A and Part B services.
Examples of Part A services include telecommunication services, financial services, computer and related services, advertising services and property management services.
Examples of Part B services include health and social services, education and vocational health services, legal services and recreational, cultural and supporting services. Clinical services fall under health services and will be categorised as Part B services.

19. NHS England Procurement Rules
When awarding contracts for services, it is important to determine whether the service to be procured is a Part A or Part B service as different obligations under the Regulations will then apply to the procurement process.
Part A services are subject to the Regulations in their entirety while Part B services are only subject to certain limited parts of the Regulations including obligations to treat bidders equally, to act in a transparent way, to act in a non- discriminatory way, the use of technical specifications and the requirement to submit a contract award notice.
All procurement activity is underpinned by the EU Treaty Principles.

20. EU Thresholds The current thresholds are as follows:-
Supplies & Part A Services (except R & D, and certain telecom services)
Schedule 1 bodies (including NHS bodies) £113, 057
Part B Services & R & D, and certain telecom services and subsidised services (Regulation 34)
All bodies £173, 934
Determining the contract value – total life or whole life costing approach. Values exclude VAT
These thresholds will be updated on 31 December 2013.

21. Above the EU Threshold
For expenditure over the EU threshold the EU Procurement Directives may apply.
There are a number of procurement routes under the Regulations – Open, Restricted, Negotiated and Competitive Dialogue procedures
The procedure to be followed in each case will largely depend on the type of goods and/or services being procured and the complexity of the procurement.
Use of Frameworks should be considered by the ATs for direct placements or further competitions from EU compliantly procured frameworks.

22. Lower Thresholds
Should the value of the services being procured fall below the EU threshold above then the following procurement routes should be applied:-
Under £50,000
must obtain three written quotes from potential suppliers.
Above £50,000 but below the relevant EU Threshold
must obtain five written tenders from potential suppliers

23. Considerations in Service Procurement
When procuring services, NHS England must also comply with the Public Services (Social Value) Act 2012.
This set out requirements for public authorities to comply with prior to the commencement of their procurement processes for services (so before the OJEU notice/tender documents are published). NHS England will need to consider:
how the service that is being procured might improve the economic, social and environmental wellbeing of the local area;
how that improvement might be secured through the procurement process; and
whether to hold a consultation on the potential improvements themselves.

24. Healthcare Services Procurement
When procuring health care services for the purposes of the NHS, NHS England must comply with the National Health Service (Procurement, Patient Choice and Competition) (No.2) Regulations 2013 (the "2013 Regulations").
The 2013 Regulations provide that when procuring health care services for the purposes of the NHS ("Health Care Contracts") whatever the value, NHS England must act with a view to:
securing the needs of the people who use the services;
improving the quality of the services; and
improving efficiency in the provision of the services.

25. Healthcare Services Procurement
both regulations include wording to ensure that when procuring Health Care Contracts, NHS England must act in a transparent and proportionate way and treat providers equally and not discriminate.
treating providers equally and in a non-discriminatory way, will include not treating one provider, or type of provider, more favourably than any other provider, in particular on the basis of their ownership.

26. Exemptions
It may be possible for the ATs to award a contract for services to another public body without running a procurement process in accordance with the Regulations. This is referred to as the Teckal exemption.
to satisfy the exemption the recipient of the funding would have to ensure that the entity or entities contracting with NHS England carried out the principal part of its activities with NHS England;
is controlled in a similar way to that which NHS England exercises control over its own internal departments;
is funded wholly or mainly by NHS England; and
has no private sector participation or financing

27. Webinar 3-Questions and Answers panel
Lois Shield, FCIPS, NHS England
Sabrina Fuller- Health of Health Improvement, NHS England
Denise Thiruchelvam- Public Health Project Manager, NHS England
Victor Francis- Health Visiting Programme Commissioning Support, NHS England

28. Supporting health visitor service transformation
Seminar
14th November 2013

29. Topics covered:
Developing a system-wide approach to service transformation and the new model of health visiting
Bringing together commissioners and providers – managers and clinical leaders
Developing or building on 0-5s strategies with a clearly articulated role for health visitors
Supporting the process
What will be the development needs of health visitors
What are the current resources available to support those development needs
How can they be accessed

30. Key stakeholders Commissioners Providers Area Teams Local authorities
CCGs
Providers
Providers of health visitor services
Health visitor clinical leads and front line staff
Providers of early years services
Primary care etc.

31. Commissioner and provider partnership
Benefits to commissioners
Builds successful implementation in to the strategy
Wins hearts and minds
Tackles potential barriers to implementation
Benefits to providers
Understanding and influencing the agenda
Building relationships
Benefits to children and families: services better meeting needs and improving outcomes
Examples of good practice

32. Local resources – JSNA and Health and Wellbeing Strategy
A statutory duty for LAs and relevant CCGs to prepare and publish JSNA.
Requirement to involve district councils, Local Healthwatch and people who live or work in area.
Cornerstone document in identifying local priorities in joint health and wellbeing strategy and in commissioning health and care services for the 0-5s.
An inclusive process, with outputs, for determining the health and wellbeing needs of the community in the short, medium and long-term.
Some area teams have more than (up to 10) HWB boards and in London presumably more. Some areas such as London have a regional health and wellbeing strategy.

33. Defining the role of health visitors in a wider 0-5s strategy
Relatively skilled and highly paid professionals in early years.
Early years experts – delivery of evidence-based interventions
Leading delivery of healthy child programme
Supporting good parenting and early attachment as the foundation for happy, healthy, achieving families and communities
New model of health visiting – leading through universal, targeted and safeguarding.

34. Relating strategy to health visiting development needs
Shared understanding of priority needs for 0-5s across commissioners and providers
Shared understanding of what the evidence and policy guidance tells us is effective
What are we doing well now and where are the gaps?
What is the role of the different providers in delivery and how do they work together?
What are the development needs of health visitors to delivery this strategy.
Is integrated or uni-professional workforce development required?

35. Web links
Association of Directors of Public Health
Department of Education
Healthwatch
NHS England  
Public Health England health-england
RCN (Royal College of Nursing)
Local Government Association
SOLACE
N | Presentation to [XXXX Company] | [Type Date]

36. Institute of Health Visiting (iHV)
Its focus is on supporting the development of high quality and consistent health visiting practice.
It was established with support from the Royal Society for Public Health and works with many educational, statutory and third sector partners.
The iHV aims to become a Centre of Excellence for health visitors and health visiting
Contact Dr Cheryll Adams, Director:
Website
The Institute was established with government funding in 2012.
Although relatively young the iHV already has over 1000 health visitor members, some joining individually, but increasing numbers of providers are taking advantage of corporate membership to make the resources of the iHV available to all their health visitors and students. It developed the recently published DH Preceptor's Charter for health visiting and also the DH SAFER update. It has also recently delivered training in perinatal mental health to health visitors across England and in so doing created 299 Perinatal Mental Health Champions who will be local resources, and who will disseminate the training to colleagues.
The iHV can support commissioner provider development in a range of ways, but particularly in the areas of education, leadership, research/evaluation and practice development. Its professional team are all national policy and academic leaders in the field, many also having specialist expertise in different areas of practice.
For further information please contact Dr Cheryll Adams, Director:

37. CPHVA
Working at a strategic level with policy makers, we are in the unique position of being the conduit with the profession throughout the UK to listen, engage, advocate, understand and develop evidenced based best practice.
Develop professional standards and uphold and defend the services that our members deliver.
Provide extensive resources to members and the wider health sector to support them in their practice and to enable them to develop and deliver safe and effective services.
Contacts:
The Community Practitioners' & Health Visitors' Association (CPHVA) represents the majority of health visitors, school nurses and community nursery nurses in the UK and has done so since 1896.
For example, through years of campaigning we were instrumental in achieving and implementing the commitments in the HV implementation plan.
We provide extensive resources to our members and the wider health sector to support them in their practice and to enable them to develop and deliver safe and effective services. We produce the monthly Community Practitioner journal which is a benefit of membership and has over 20,000 individual subscribers. We also produce a range of written and online resources including continuing personal and professional development resources.
NHS | Presentation to [XXXX Company] | [Type Date]

38. Future support for health visitor transformation
December 2014-March weekly webinar surgeries
Monthly talks from experts- any topic requests?
One to one support for area teams from the national team
NHS | Presentation to [XXXX Company] | [Type Date]

39. Webinar 3-Questions and Answers panel
Sabrina Fuller- Health of Health Improvement, NHS England
Denise Thiruchelvam- Public Health Project Manager, NHS England
Victor Francis- Health Visiting Programme Commissioning Support, NHS England
NHS | Presentation to [XXXX Company] | [Type Date]