Viv Bennett

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					Improving health and wellbeing for
      children and families
   New approaches in England
                       Viv Bennett DCNO DH 2011
                                                       Improving child and family health –
                                                       new approaches in England
Child and Family Health & Health Visiting in England

                                                          Background – policy evidence families

                                                          Health visiting the vision and new family offer

                                                          Families who are vulnerable: Family Nurse Partnership

                                                          Older children: school nursing development programme

                                                          The national health visitor programme


                                                                  •Call to Action

                                                                  •Delivering the programme

                                                          What will success look like?

                                                       9 December, 2011                                           2
Child and Family Health & Health Visiting in England   Policy

                                                             •     Improving Public Health
                                                             •     Building a Big (strong) Society
                                                             •     Strengthening and supporting
                                                                   families and parenting

                                                             •     Cross Government Reviews
                                                                    – Frank Field MP (Poverty and
                                                                      life chances)
                                                                    – Graham Allen MP (Early
                                                                    – Claire Tickell ( Early Years
                                                                      Foundation Stage)
                                                                    – Eileen Munro
                                                                      (Safeguarding/child protection)

                                                                      Coalition agreement health visiting commitment 4200
                                                       9 December, 2011                                                     3
                                                       Evidence: The Healthy Child Programme (HCP)
Child and Family Health & Health Visiting in England

                                                        New evidence
                                                        •From Neuro-science
                                                        •What works in prevention/health promotion
                                                        •Impact of early years on adult health
                                                        •Impact of parenting in early years on life chances
                                                        •Early intervention – long term investment

                                                         Evidence based universal programme to improve health outcomes for
                                                                             children and young people                       4
                                                       Healthy Child Programme – an overview
Child and Family Health & Health Visiting in England

                                                        Universal                                    Universal plus                             Higher risk
                                                        • Health and development reviews             • Emotional and psychological problems     • High-intensity-based intervention
                                                        • Screening and physical examinations          addressed
                                                                                                     • Promotion and extra support with         • Intensive structured home visiting
                                                        • Immunisations                                                                           programmes by skilled practitioners
                                                        • Promotion of health and wellbeing, e.g.:     breastfeeding
                                                                                                     • Support with behaviour change            • Referral for specialist input
                                                             – smoking
                                                                                                       (smoking, diet, keeping safe, SIDS,      • Action to safeguard the child
                                                             – diet and physical activity              dental health)
                                                             – breastfeeding and healthy             • Parenting support programmes,            • Contribution to care package led by
                                                             weaning                                   including assessment and promotion of      specialist service
                                                             – keeping safe                            parent– baby interaction
                                                             – prevention of sudden infant           • Promoting child development, including
                                                             death                                     language
                                                             – maintaining infant health             • Additional support and monitoring for
                                                             – dental health                           infants with health or developmental
                                                        • Promotion of sensitive parenting and         problems
                                                          child development                          • Common Assessment Framework
                                                        • Involvement of fathers                       completed
                                                        • Mental health needs assessed               • Topic-based groups and learning
                                                        • Preparation and support with transition      opportunities
                                                          to parenthood and family relationships     • Help with accessing other services and
                                                        • Signposting to information and services      sources of information and advice

                                                               Be alert to risk factors and signs and symptoms of child abuse, and follow local
                                                                          safeguarding procedures where there is cause for concern.                                                     5
                                                       Families - What do parents tell us they need?
Child and Family Health & Health Visiting in England

                                                                                  A community that
                                                                                  supports children
                                                                                      and families
                                                                                                             Services that
                                                                                                         give our baby/child
                                                                                                             healthy start.
                                                                                                          Best advice on a
                                                                                                            being a parent
                                                                                                         To know our health
                                                                                                          visitor and how to
                                                                                                             contact them
                                                                                                  A quick response if we
                                                                                               have a problem and to be
                                                                                                 given expert advice and
                                                       To have the right people
                                                                                              support by the right person
                                                       to help over a longer
                                                       term when things are
                                                       really difficult
                                                       To know those people     To be able to care for our child who is ill
                                                       and that they will work  or has a disability at home within a normal
                                                       together and with us.    family life
                                                       Types of need and service response
Child and Family Health & Health Visiting in England

                                                                                      Types of Need

                                                            Predicted                   Assessed by HV              Expressed by
                                                        Population level e.g.          (or others involved             family
                                                             PREview                       with family)

                                                                                         Health Visitor

                                                           Provide               Delegate to          Signpost to
                                                                                                                          Refer on
                                                           Service              Team member           elsewhere

                                                                                      Service Response
Child and Family Health & Health Visiting in England
                                                       Health visiting services ‘a new family offer…’

                                                                             Your community
                                                        has a range of services Sure Start services and the services      S
                                                            Families and communities provide for themselves.
                                                         Health visitors work to develop these and make sure you          E
                                                                             know about them.
                                                                               Universal services                         R
                                                       Your health visitor and team provide the healthy child programme   D
                                                           to ensure a healthy start for your baby/children and family    I
                                                        (for example immunisations, health and development checks),       N
                                                                       support for parents and access to a                G
                                                                    range of community services/resources.

Child and Family Health & Health Visiting in England   Family offer contd…

                                                                               Universal plus
                                                        gives you a rapid response from your HV team when you need
                                                                             specific expert help,                    F
                                                          For example with postnatal depression, a sleepless baby,    E
                                                             weaning or answering any concerns about parenting.
                                                                       Universal partnership plus                     A
                                                                provides ongoing support from your HV team            D
                                                               plus a range of local services working together        I
                                                              and with you, to deal with more complex issues          N
                                                                           over a period of time.
                                                         These include services from Sure Start Children’s Centres,
                                                          other community services including charities and, where
                                                                  appropriate, the family nurse partnership.
                                                       Additional services for young and vulnerable families
                                                       Family Nurse Partnership
Child and Family Health & Health Visiting in England

                                                            FNP is an evidence based, preventive
                                                            programme for vulnerable first time teenage
                                                            It offers intensive and structured home
                                                            visiting, delivered by specially trained nurses,
                                                            from early pregnancy until the child is two.
                                                            FNP uses in-depth methods to work with
                                                            young parents, on attachment, relationships
                                                            and psychological preparation for parenthood.
                                                            Family nurses build supportive relationships
                                                            with families and guide first time teenage
                                                            parents so they can adopt healthier lifestyles
                                                            for themselves and their babies, provide good
                                                            care for their babies and plan their own

                                                       FNP has consistent results in outcomes across 3 scientific
                                                       trials in USA
Child and Family Health & Health Visiting in England

                                                          •   Improvements in women’s antenatal health and behaviours
                                                          •   Reductions in children’s injuries, child abuse and neglect
                                                          •   Fewer subsequent pregnancies
                                                          •   Greater intervals between births
                                                          •   Increases in fathers’ involvement
                                                          •   Increases in maternal employment
                                                          •   Reductions in welfare dependency
                                                          •   Better parenting
                                                          •   Improves children’s cognitive development, school readiness and academic
                                                          •   Improves children’s emotional and behavioural development
                                                          •   Reduces children’s involvement in crime and anti-social behaviour later in life
                                                          •   Reduced substance use initiation
                                                          •   Substantial cost savings – up to $5 for every $1 invested by age 15

Child and Family Health & Health Visiting in England   Services for older children and young people
                                                       School Nursing development programme
                                                       Raising profile and potential of school nursing
                                                         and HCP 5-19
                                                       • Producing a clear vision for school nursing
                                                       • Produce a clear vision for school nurse role
                                                       • In public health
                                                       • In supporting children and young people with
                                                         illness and disability to access education
                                                       • Preparing for new commissioning
                                                         arrangements by providing much more clarity
                                                         re service and contribution to PH outcomes for
                                                         families and young people
                                                       • Working with children, young people and
                                                         families to shape the vision
                                                       • Building on the evidence base
                                                       • Working closely with partners (LA)
     Child and Family Health & Health Visiting in England

                       Delivering the national health visiting

                                                       Current challenges: health visiting capacity and vision
Child and Family Health & Health Visiting in England

                                                       • NHS and local authorities financial pressures
                                                       • The SR settlement for the uplift totalled £577m (£88m/127/190/172)
                                                       Scale of expansion
                                                       • The number of health visitors has been in decline for 5 years and is an aging workforce. A
                                                          decline in numbers has led to variable coverage of service across England.
                                                       • To do nothing would lead to continued decline (estimated 450 leaving profession each year) and
                                                          thus we need 6,000 more HVs to meet the target
                                                       • The required growth of 4,200 FTE will be need to be achieved by (estimated) 85% training and
                                                          15% Return to Practice and improved retention.
                                                       • Training of huge increase in students requires more and different clinical education and
                                                          supervision -1828 commissions for 2011/12 (compared with 500 previous year)
                                                       A changing system
                                                       • Managing changing incentives and levers for increasing the workforce in a new and devolved
                                                       • New commissioners and providers
                                                       The current workforce
                                                       • Achieving high morale motivation and mobilization in the current workforce
                                                       • Implementing a new service vision whilst managing current service pressures
                                                       • Demonstrating progress and good practice and achieving some early wins
Child and Family Health & Health Visiting in England   ‘What we are doing nationally and locally… A Call to Action’

                                                         ‘A Call to Action’ sets out what we need to
                                                         do nationally and locally to overcome the
                                                         challenges, rapidly grow capacity and
                                                         embrace innovation to transform services
                                                       Health visitor programme performance management and
                                                       demand side actions
Child and Family Health & Health Visiting in England

                                                       Policy/Performance management

                                                       •   Maximise Public Health White Paper and early years policy opportunities for HV and
                                                           School Nursing to improve outcomes
                                                       •   Build and promote improved partnerships at national level (e.g. cross government)
                                                       •   Performance manage progress towards delivery of the new service
                                                       •   Monitor progress and move to more real time data and mix data and ‘soft

                                                       Demand side actions and commissioning

                                                       •   Promote ‘prevention’ and provide evidence for benefits to support growth in posts and
                                                           transformed services
                                                       •   Develop and promote the new service vision and embed a new offer for families
                                                       •   Support local services to work together
                                                       •   Improve commissioning of HCP (up to 19)
                                                       •   Develop outcome measures/metrics and pricing
                                                       •   Demonstrate and share success and early wins

Child and Family Health & Health Visiting in England   Growing the workforce – ‘supply side actions’
                                                       Attract sufficient numbers of nurses to the health visiting profession
                                                       • Exploring linking training places (bursaries provided) with guaranteed posts to
                                                          encourage nurses to train as health visitors.
                                                       • Recruitment campaigns re value of HV role and advertising local availability of
                                                          training/post packages.

                                                       Get the training right: expansion and new service model requires
                                                       • Ensure commissions for HV training for national target are filled
                                                       • Training more students and providing more and different clinical education and
                                                       • Work with the CoD/HEIs to ensure the framework for curricula is right for the new
                                                         model of service
                                                       • Work with NMC as part of its review of Part 3 of the register (standards relating to
                                                         health visiting) later this year.

                                                       Increase the numbers of clinical practice teachers
                                                       • CPTs) to meet the needs of training and supervision of the substantially increased
                                                          number of new HVs. NMC has amended its guidance, re more flexible use of the
                                                          existing CPTs together with mentors. Need to explore other system levers to
                                                          encouraging take-up and commissioning of CPTs.

                                                       Increase number of returners to practice and improve retention
                                                       Actions professional development and mobilization
Child and Family Health & Health Visiting in England

                                                       Use technology
                                                       • explore options and good practice which help health visitors use mobile technologies
                                                         to maximise reach and accessibility of service and improve productivity

                                                       Develop skills/confidence/leadership in current workforce –
                                                       • ‘mobilization’ and good practice/early wins
                                                       • support through post graduate learning opportunities
                                                       • Implement Early Implementers Programme (EIS)

                                                                                      EIS still pioneers?!

                                                                             Early implementation sites x 20
                                                             Deliver the new model of service and family offer by April 2012:
                                                            Requires significant national and local development and support                18
                                                       What would success look like ?
Child and Family Health & Health Visiting in England

                                                                                All communities have access to a full range of
                                                                                services from universal to support for vulnerable
                                                                                families to care for children with illness/disability
                                                                                at home and in local communities
                                                                                Evidence based services and practice are
                                                                                provided by mobilized and supported
                                                                                Strong partnerships are built between local
                                                                                organisations and with families using services
                                                                                Families receive joined up services to meet their
                                                                                needs and choices and express high levels of
                                                                                Needs/problems are identified early and the right
                                                                                service response provided
                                                                                Children are ‘ready for school’
                                                                                Local health outcomes improve and inequalities
                                                                                reduce                                                  19

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