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					REPORT                                                                                  Board

                                                                          Agenda item No: 7(b)
HEALTH VISITOR TRANSFORMATION PROJECT

16 November 2010

Mandy Renton Executive Nurse, NHS Cambridgeshire (NHSC)

1.    Purpose

1.1   To give an update regarding the Health Visitor transformation project and recruitment to
      staff in Fenland

2.    Background

      Recruitment to Health Visitor posts has been problematic for some time in
2.1
      Cambridgeshire. Performance against contractual targets for Health Visiting has been
      slow to improve. NHS Cambridgeshire enforced performance levers with
      Cambridgeshire Community Services (CCS) in June 2010. A project to transform
      services has been developed with CCS and is on track to deliver improved performance
      by March 2011

3.    Supporting paragraphs


3.1   Health Visiting Transformation: Measures for Success - 1 Nov 2010

      In the business case the items below are specified as performance improvement
      measures and delivery information:
            Improvement in recruitment to known vacancies and retention
            Measurement of sickness and performance rates of staff
            Increased use of the Common Assessment Framework (CAF)
            Demonstration of links (increased / improved) with GPs
            Improved awareness of protocols and training procedures for safeguarding
            A service design model with skill mix mapped to need focussing on the agreed
              delivery targets as specified within the Healthy Child Programme

      Improvement in recruitment to known vacancies and retention
3.2
      The project has just moved to the implementation stage, so no impact on this measure
      yet. A recruitment plan is in place, alongside skill mix adjustment for improved delivery
      and succession planning (within workforce planning). Timeline should be from 1st
      quarter 2011/12.

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REPORT                                                                                Board

      Vacancy rate has reduced from 26% to 18%. Wisbech staff establishment has improved
      from 1.6 wte to 4 wte (whole time equivalent). March is at full complement. All 4
      students from last year are now employed, with another 2 completing in August 2011
      and a further 2 the following year.

      Measurement of sickness and performance rates of staff
3.3
      As above.

      Increased use of the Common Assessment Framework (CAF)
3.4
      Cambridgeshire County Council children’s services collect this data and have been
      requested through the CAF project board in October to break this down by the
      submitting professional, so we are able to track CAFs completed through Health Visiting.
      We have not yet had confirmed data, but anecdotally they have informed us that CAFs
      from health visiting have increased in number recently.

      Demonstration of links (increased / improved) with GPs
3.5
      All GPs have received a joint letter from CCS and NHSC, outlining the proposals. CCS
      are in discussion with GP leads from clusters and NHSC have made links with the
      account managers for GP clusters and will present the health visiting transformation
      project, in the context of the Healthy Child Programme, in November.

      Improved awareness of protocols and training procedures for safeguarding
3.6
      The project has had the input of the designated nurse for safeguarding from inception.
      Implementation of two-day CAF training has commenced. Links to increased use of
      CAF measure, above, and workforce planning.

      A service design model with skill mix mapped to need focussing on the agreed
3.7   delivery targets as specified within the Healthy Child Programme

      The model has been agreed through workstream 5 in the business case.

      Current metrics:
3.8
      New birth visit                    84% target 85% (Increased from 74% in April)
      2/3 year development assessment    84% target 85% (Increased from 79% in April)
      Breastfeeding coverage 6-8 wks 97% target 85% (Increased from 92% in April)

      (NB one year check not used as performance measure during transformation)


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REPORT                                                                                          Board

       Potential future metrics
3.9
       New birth visit
       I year review
       2-3 year development assessment
       Quality audit of visits to be developed.
       Emergency hospital admissions for children aged 0-5 years – need to explore viability of
       this as an outcome measure, could be CQUIN candidate in first year (2011/12), can data
       be collected for this age range, how much influence do CCS have on this measure etc

3.10


       The project delivery plan is on track to deliver targets as shown below –

        Level   Task                                         Owner              Start Date   Finish Date



                Key Milestones
        1        Agree project governance and management arrangements            Emma Morley      04-Oct-
        10       18-Oct-10
        2        Implement new HV management configuration                       John Peberdy     04-Oct-
        10       14-Jan-10
        3        Apply new HV team formations                 Sue Mills          19-Oct-10    10-Jan-11
        4        Commence recruitment programme               Steph Gavin        19-Oct-10    01-Feb-11
        5        Upskill worksforce to meet new service specification            Julia Mclean     02-Nov-
        10       01-Apr-11
        6        Design and implement an admin service/structure align to new HV service model John
        Lamb     04-Oct-10                                    01-Feb-11
        7        Design and implement model for service advice line              Jula May     04-Oct-10
                 01-Apr-11
        8        Agree and deliver an integrated service pathway for current group activities Charlotte
        Ella     18-Oct-10                                    01-Apr-11
        9        Agree system support/templates for clinical recording on systmone/Go Live on systmone
        roll out Bill Wilson                                  04-Oct-10          01-Apr-11
        10       Agree new service specification including contract measures     Noelene Harding 04-Oct-
        10       01-Apr-11
        11       Apply financial controls throughout projected delivery plan     Tim Glenn 04-Oct-10
                 01-Apr-11
        12       Implement Communication and Engagement plan                     Karen Mason      04-Oct-
        10       01-Apr-11
        13       Conduct Culture Change programme             Emma Morley        04-Oct-10    01-Apr-11




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REPORT                                                              Board




4.    Implications for partners

4.1   Partner agencies involved in change – e.g. children centres

5.    Views of Children, Young People, Parents and Carers

5.1   Not known.

6.    Decisions or recommendations required

6.1   The Trust is asked to note the report.

7.    Source documents and where they are held

7.1   Business case held by NHS C.




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