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Worcestershire Public Health Project Final Report - West Midlands


									Project Report June 2008 for Worcestershire PCT


As part of the West Midlands multi-disciplinary Workforce Deanery Plan
2007/2008 the West Midlands Teaching Public Health Network invited
expressions of interest from PCT‟ to participate in a six month public health
workforce development project using the Public Health Skills and Career
Framework (PHSCF) to help identify learning and development needs of staff
working on specific public health issues. The ultimate aim of the pilots is to
develop an approach to commissioning public health teaching which can be
adopted by PCTs and other commissioners in the West Midlands

Six pilots are currently working on themes from “ Choosing Health” areas with
the pilot being considered in this paper is supporting breast feeding as a
foundation to reduce childhood obesity. The approach looks at a woman‟s
journey from conception to postnatal care and personnel who can influence
her decision to breast feed.

Initially the Worcestershire project wanted to consider nutrition advice during
weaning, through to toddler diet and ongoing family nutrition with health
professional having the skills to deliver this information when having contact
with parents and children. The Infant Feeding Group within a revised format
will undertake this role and will be informed by using the Public Health Skills
and Career Framework. Progressing through the process of the project it has
become more realistic and achievable to look at (PHSCF) in relation to staff
and volunteers who support women with breast feeding and who may
influence decisions a woman may make.

The current Worcestershire PCT (WPCT) breast feeding policy has the
following principles
        WPCT believes the breast feeding is the healthiest way for a women
        to feed her baby and recognises the health benefits now known to
        exist for the mother and child
        WPCT believes that all mothers have the right to receive clear,
        impartial and timely information, to enable the to make fully informed
        decisions about feeding and caring for their babies
        WPCT believes in fully supporting mothers in their chosen method of
        infant feeding
        WPCT believes that breastfeeding can become the norm for infant
        feeding in Worcestershire. Breastfeeding is promoted by ensuring that
        all relevant health care staff undertake mandatory training appropriate
        to their role, and are equipped to offer regular and reliable support
        and encouragement to parents. Breastfeeding is further promoted b
        widespread awareness raising regarding the benefits of breastfeeding
        for parent and child.

The policy discusses training for health visitors, nursery nurses and reception
staff that will be audited by the Infant Feeding Group. There is mention of

encouraging Community Support for Breastfeeding, working with Children‟s
Centres and Worcester Acute Hospital Trust to meet UNICEF Baby Friendly
Status. The Seven Point Plan for community health care settings are:-
           1. Have a written breastfeeding policy that is routinely
              communicated to all healthcare staff
           2. Train all staff involved in the care of mothers and babies in the
              skills necessary to implement the policy
           3. Inform all pregnant women about the benefits and
              management of breastfeeding
           4. Support mothers to initiate and maintain breastfeeding
           5. Encourage exclusive and continued breastfeeding , with
              appropriately timed introduction of complementary foods
           6. Provide a welcoming atmosphere for breastfeeding families
           7. Promote co-operation between healthcare staff, breastfeeding
              support groups and the local community.

From experience of working with families, feedback within support groups and
recording of data there was some evidence and also some intuition that
exploring interprofessional working within a public health framework could
improve the consistency of messages to mothers within a mutually supportive
atmosphere wherever care was being delivered.

The project took several approaches in order to define
         Skills and competencies of professionals supporting breast
         feeding women.
             o Looking at roles
             o Examining job descriptions and levels of public health skills
             o Issues with other professionals e.g. GPs around prescribing

          Experiences from Volunteer support groups
             o Positive versus negative personal and rhetorical experiences
             o Value of Nursery Nurses in support role
             o Need for Breastfeeding information in their training
             o Influence of government policy & return to work
             o Removal of posters in some GP settings
             o Incentive for GPs to support breastfeeding
             o Lack of breastfeeding growth charts
             o Benefits of breastfeeding antenatal workshops
             o Request for sessions within school to promote breastfeeding
             o Possibility of accreditation for their training /work with
          Interprofessional workshop
             o Identification of PHSCF competencies relating to their role
             o Training needs of members of workshop identified
             o Training to help deliver correct messages about
             o Practice Nurses- key messages when advising women
             o School Nurses- core message from public health when
                 working with children

             o .Training on specific topics for HV students (Nutritional
               module at Wolverhampton)
             o Training in weaning advice for HVs, NNEBs practice nurses
             o Training and interpretation when weighing & measuring
             o Awareness raising for PCT , GPs and Children Centre
               administration staff.

          Infant Feeding Group plan for future working
             o Support breastfeeding
             o Support healthy formula feeding
             o Health weaning
             o Toddler diet
             o Develop Terms of reference
             o Rewrite breastfeeding policy
             o Baby Friendly application to commence
             o Develop Infant Feeding Strategy.

          Consultation with Worcester University
            o Identification of course to support future work of the project
            o Offer to facilitate pathway focus group and transcribe
            o Software packages to support project lead
            o Packages for cookery work with ethnic groups, those on low

          Meeting with Local Authority
            o Working together to support breastfeeding women
            o Using PHSCF for developing job descriptions
            o Using PHSCF to identify competencies and training needs
            o Work in partnership to meet training needs.
            o Further meeting with key personnel from all agencies

Training Needs Assessment for Worcestershire PCT
The PHSCF competences for the defined area Health Improvement are set
out in column 2 of table 1. Topics relating to the breastfeeding project are
listed in column 1. Column 3 is headed „Choose the topics which your role
covers. Then choose the PHSCF level at which you can describe what you
do for each of those topics‟. When completing column 3 think broadly about
your role and include the less obvious things e.g. data that you have to collect
and possibly analyse; how you keep up to date and use evidence in your
work; if you take part in audits; the policies and procedures you work to and if
you have any part in developing them; who are the people you work in
collaboration with; are there people you teach and help to develop.

Table 1
Role -
                             Health Improvement
  Breastfeeding topics              PHSCF       Choose the topics which
                                 competences    your role covers. Then
                                                choose the PHSCF level
                                                at which you can describe
                                                what you do for each of
                                                those topics
These may include:           Level 1            Level 1
                             1.Offer accurate   Peer supporters
                             information on     Information on B/F at peer
      pre-conception         health and         support groups.
      advice e.g. healthy    wellbeing on       Sharing information at
      eating and drinking,   specific issues to promotional events e.g.
      smoking cessation      people             B/F awareness week and
      engaging women                            Baby Show
      on the benefits of
      breastfeeding on or                         School nursing team
      before the first                            HCAs involved in healthy
      ante-natal visit                            lunchbox initiatives
      promotion of
      breastfeeding                               Level 2
      including – at all     Level 2              Peer supporters
      ante-natal             1. Provide           Providing information at
      appointments;          information on how   Baby Bistro
      making the             to improve health    Being alert to formula
      decision; initiation   and wellbeing        feeding advertising
      and continuation                            General day to day
      encouraging                                 promotion of B/F
      breastfeeding at
      Children‟s Centres                          Community Nursery
      teaching various                            Nurses
      aspects of                                  Providing B/F support via
      breastfeeding                               poster campaigns and
      building the                                leaflets
      capacity of peer                            Promoting B/F e.g. child
      support for women                           health clinics, schools,
      postnatally e.g.                            shopping centres, B/F
      Bosom Buddies                               awareness week
      promotion of
      breastfeeding as a                          ( For NNEBs & peer
      public health issue    2. Signpost          supporters .Following my
                             individuals to       visit to Dorset & Bosom
                             people and           Friend being notified by
                             agencies that can    midwife of BF mum
      signposting to
                             help them improve    contact her 5-7 days 7
                             their health and     shows DVD on attaching
      seeking out „hard to   wellbeing            baby, give contact number
      reach‟ groups                               & details of support group)

developing a local                           Giving information about
network between                              promotional activities e.g.
services to increase                         antenatal groups
baby friendly
practices                                    Community Nursery
                                             Signposting B/F mothers
                                             towards helping other
                                             mothers i.e. undertaking
                                             training to become a peer

                                             Peer supporters
                                             Visiting women/families in
                       3. Undertake health   hospital to offer peer
                       improvement tasks     support and information re
                       and activities as     B/F
                                             Peer supporters
                                             Passing on information to
                       4. Listen to people‟s health professionals
                       views of and          regarding individuals‟
                       concerns about        worries
                       health and
                       wellbeing and pass
                       relevant information
                       to others as agreed Level 3
                                             Community Nursery
                       Level 3               Nurses
                       1. Engage             Running groups e.g.
                       efficiently with      „Taste for Tots‟ to improve
                       individuals and       knowledge of healthy
                       communities           eating for mothers

                                             Community Nursery
                                             Running postnatal groups
                                             e.g. health for mother and
                       2. Implement          baby
                       specific activities   Providing individual and
                       within health         group advice re weaning
                                             Community Nursery
                                             Supporting B/F mothers at
                       3. Communicate        home who are having
                       with people about     difficulties B/F and
                       their health and      signposting them to

wellbeing and the      relevant extra support
actions they may
take to achieve        Community Nursery
improvement            Nurses
                       Trying to reach and
                       support „hard to reach‟
4. Support             groups e.g. young
individuals to         mothers
communicate their
views of and
concerns about
health and
wellbeing and          Level 4
convey these to        Community Nursery
others                 Nurses
                       Supporting training via B/F
Level 4                training support groups
1. Contribute to the
planning and           School nursing
evaluation of health   Working with HVs,
improvement            teachers etc to support
projects and           B/F initiatives
                       Peer supporters (NCT)
                       Deliver antenatal classes
                       specifically for B/F for
2. Implement
specific aspects of    School nursing
health improvement     B/F as part of overall
projects and           obesity strategy
                       Peer supporters (NCT)
                       Providing support at B/F
                       drop-ins, telephone
3. Communicate         counselling, speaking to
with individuals,      mothers in hospital on
groups and             post natal wards
communities using
different methods to   School nursing
enable them to         Supporting initiatives as
improve their health   part of wider PH team
and wellbeing
                       School nursing
                       Delivering the key
                       messages and signposting
4. Support             to direct parents, teachers
individuals and        etc to the correct support
groups to make and
maintain informed

choices to improve
their health and      School nursing
wellbeing             Advocates for parents,
                      teachers, colleagues to
5. Communicate to     raise awareness
relevant people the
health concerns
and interests of
individuals and
communities           Level 5
                      1 Having discussions with
Level 5               pregnant women and
1. Listen to and      sometimes partners re
involve the public    benefits of B/F
and communities in    Using home visits as an
improving health      ideal opportunity to involve
and wellbeing and     others e.g. partner,
reducing              grandparents, other
inequalities          children, friends.
                      Giving information and
                      constant „drip drip‟ re
                      benefits of B/F e.g. during
                      community sessions
                      where local women are

                      Health Visitors
                      Targeting inequalities e.g.
                      housing, education, safer
                      communities, socio-
                      economic needs
                      Promote B/F during home
                      visits and group work ante
                      and postnatally and
                      identify health needs

                      Practice Nursing
                      Providing appropriate
                      environment for B/F
                      mothers, influencing the
                      planning of new surgeries
                      to include such

                      Using every visit as an
                      opportunity to talk re B/F
2 Identify and take   e.g. at ante-natal booking,
advantage of          each antenatal

opportunities to      appointment, postnatal
improve health and    clinics i.e. duration of
wellbeing and         pregnancy and afterwards
reduce inequalities   Preparing pregnant
                      women for the realities
                      and practicalities of B/F
                      via 1:1s
                      Educating the public re
                      B/F benefits from nursery
                      through schools to
                      colleges and universities

                      Health Visitors
                      Making use of any current
                      government agenda
                      through media
                      Signposting mothers to
                      relevant services

                      Practice Nursing
                      Giving pre conception
                      counselling – provide
                      support re life style
                      changes (could vary
                      between PHSCF levels 3
                      and 5 depending on

                      3 taking B/F as the norm
                      and not asking pregnant
3. Plan, implement    women if they intend to
and review specific   B/F.
aspects of health     Managing caseloads to
improvement           ensure adequate 1:1 time
projects              to support women with B/F
                      Undertaking constant
                      audit of B/F numbers
                      Ensure there is no visible
                      advertising of bottle
                      feeding in NHS premises
                      (Baby Friendly initiative
                      will help this (plus use of
                      dummies etc )

                      Health Visitors
                      Audit the use of peer

                     Running „Way Up‟ Club
                     (obesity work in children)
                     Auditing caseload
                     Practice nursing
                     Collecting B/F statistics at
                     childhood immunisation

                      Make sure appointment
                     cards have B/F benefits as
4. Develop           a prominent feature
resources for        Provide frequently
specific audiences   changed displays/posters
to support the       in waiting areas
improvement of       Develop and provide
health and           information re B/F for
wellbeing and the    those women who do not
reduction of         attend antenatal
inequalities         appointments or classes

                     Health Visitors
                     Make more use of the
                     Develop posters
                     advertising B/F peer
                     Develop Baby Friendly
                     leaflets and posters

                     Lobby for government
                     incentives to force a
                     change to attitudes,
5. Provide           behaviour and entrenched
information and      bottle feeding culture
advice on specific   Ensure that all staff are
measures and         trained to give the same
approaches to        B/F messages in a way
improve health and   that is relevant to their role
wellbeing            Take part in training peer
                     supporters for B/F
                     mothers so they are
                     available in every
                     Provide a DVD re B/F for
                     each woman instead of
                     leaflets( as earlier point)
                     Treat every week as
                     breastfeeding awareness

                       week e.g. info re B/F e.g.
                       leaflets written to appeal
                       to the general public,
                       prominent displays in GP
                       surgeries, ads on buses,
                       encouraging more media
                       cover in TV soaps, local
                       More leaflets on B/F that
                       are explained to mothers
                       1:1 and not just handed
                       out, as incomprehensible
                       leaflets are cold comfort in
                       the middle of the night

                       Health Visitors
                       Ensuring all staff are Baby
                       Friendly trained
                       Advise mothers re B/F
                       positioning and

                       Practice nursing
                       Providing ongoing
                       support, information and
                       advice on the benefits of

6. Articulate the      Promote the availability
health interests and   and use of electric breast
concerns of            pumps and feeding cups
individuals and        to all HVs and MWs and
communities to         have them as stock items
other relevant         in Children‟s Centres etc
people                 Visit local pharmacies to
                       check the visibility of
                       formula feeds and bottles

                       Health Visitors
                       Visiting „hard to reach‟
                       groups e.g. young
                       parents, travellers, ethnic
                       Acting as an advocate for
                       such groups

                       School Nurses
                       Should be advocates for

                        members of communities
                        – parents, teachers,
                        colleagues to raise
                        concerns and views

                        Practice nursing
                        Acting as advocates for
                        B/F mothers to influence
                        policy change on B/F in
                        GP practices and public

Level 6                 Level 6
1.Involve               Midwives
communities and         Initiate Mother‟s Forums to
the public in           inform re benefits of B/F
assessing their
health and              Health visitors
wellbeing and           Through caseload
needs, and              analysis, special interest
identifying             groups
approaches to
address these

2.Involve               Supporting peer
communities and         supporters/volunteers
the public in the       Running weekly drop in
planning,               groups
implementation and      Providing telephone
evaluation of health    support
improvement             B/F awareness initiatives
programmes and
3 Plan, implement       Introduce referral form for
and review health       community MWs to refer
improvement             hard to reach women for
programmes and          1:1 B/F sessions
projects in different
settings                Health Visitors
                        Increase use of IT e.g.

                        Practice nursing
                        PPF involved in service
                        redesign and planning
                        health improvement


                       School Nurses
                       PPF for school nursing
                       should be engaged with
                       other PPFs/PH to
                       influence Health
                       Improvement programmes
                       and projects in different
                       settings. PPF able to
                       identify school nursing role
                       in all aspects of service

4. Develop             Midwives
resources to           Provide DVDs in different
support health         languages e.g. Urdu,
improvement and        Bengali for free loan
the reduction of       Produce promotional
inequalities for a     material e.g. leaflet re
range of audiences     available telephone
                       support on B/F, how to
                       contact Peer Supporters

5. Support             Co-ordinate B/F
communities and        Awareness Week
the public in the      activities
articulation of, and   Train and support Peer
advocating for,        Supporters and Family
health and             Support Workers in
wellbeing and their    Children‟s Centres
health concerns

Level 7                Level 7

1.Lead on the          DPH
implementation and     Promote B/F as a PH
review of health       issue
improvement            Mount media campaigns
programmes across      and celebrate successes
partnerships and

2.Manage health

improvement            Programme management
programmes across      of MEND programmes
agencies and

3.Advocate for
communities‟ health    Advocate and develop
and wellbeing and      opportunities within local
their concerns         communities/districts via
                       Local Strategic
                       Partnerships and County
Level 8                Partnerships
                       Level 8

1.Plan and             DPH
commission             Review, plan, redesign
programmes to          and commission Early
improve population     Years Services (HVs,
health and             NNs)
wellbeing and          Review, plan, redesign
reduce inequalities    and commission School
                       Health Services (School
                       Nurses, HCAs)
                       Incentivise providers re
2.Lead on the          B/F targets
implementation and     Lead for implementation of
evaluation of health   Childhood Obesity
improvement            Strategy and BFI
programmes across      accreditation
agencies,              Commission Infant
partnerships and       Feeding Advisors within
communities            WAHT (B/F Initiation
3.Build sustainable
capacity and
resources for health
improvement and
the reduction of       PH lead on MSLC and
inequalities           County Infant Feeding
                       Group TOR etc being
                       Lead for BFI accreditation
                       (including training across
                       PCT, GPs and Children‟s
                       Ensure B/F is promoted at
                       every opportunity – LAA,
4.Ensure               LSP, CPYPP, PH
infrastructures and    Business Plan

processes are in
place to enable and
support                 Ensure that verifiable data
communities in the      and intelligence is
articulation of their   available to monitor
views and concerns      prevalence of B/F and B/F
about health and        skills
wellbeing               Sit on District Local
                        Strategic Partnership
                        Board and prioritise

Level 9

1.Influence and
shape the multi-        Level 9
agency political and
policy agenda to        DPH
maximise                Author and lead for
opportunities for       Childhood Obesity
improving               Strategy
population health       Author and lead for
and wellbeing and       Breastfeeding and Healthy
reducing                Weaning Strategy
inequalities            Partner sitting on PCT
                        Board, Care Planning
                        Partnership, Joint
2.Engage with           Commissioning Board,
strategic partners in   CYP Strategic Partnership
all sectors and the
public to determine
goals, priorities,      Lead for CYP from PCT
strategies and          and sitting on CYP
success criteria for    partnership
improving               Responsible for PCT PH
population health       targets e.g. B/F at 6-8
and wellbeing and       weeks, reduction of
reducing                childhood obesity
inequalities            New CYPP 08-11 includes
                        as a priority “Ensure
                        children have a good start
3.Lead on               to life” (Pre-conception to
commissioning for       age 2)
population health       Lead commissioner for
and wellbeing and       HVs NNs and School
reducing                Nurses
inequalities            Commission Maternity
                        Services from WAHT

                                                     Budget holder for
                                                     “Choosing Health” monies
                                                     for Early Years,
                                                     Breastfeeding and
                                                     Childhood Obesity in
                                                     school setting

Identifying training needs using the PHSCF

Having a clear idea of the service which the team wishes to deliver guides the
way to the competences staff will need to possess.
Once the competences of individual team members and the whole team have
been mapped to the PHSCF it is possible to see if there are any gaps and to
consider if those gaps could be filled by people outside the immediate team.

The advantage of using the PHSCF in planning and developing training
packages is that the competences are constant and become the „shows how‟
of any programme while the underpinning knowledge, the „knows how‟ has
the correct weight and can be related to any public health topic.

Training needs perceived by the team
It was acknowledged that the training offered through Baby Friendly Initiative
will cover most of the training needs of the team. Other training needs were
divided into two main areas.

1. The need for the development of training that helps people to deliver the
correct messages about breastfeeding
       for Practice Nurses a few key messages are needed that could be
       included in pre-conception& post natal advice
       School Nurses also need core messages from public health

It was reported that public health are currently looking at the issues of
effective ways of getting messages out and signposting to services.

2. The need for training on specific topics
       it was identified that Wolverhampton University have a nutritional
       module which covers breastfeeding for BSc students on Public Health
       nursing course (HV & SN)
       training in weaning advice was needed by HVs ,NNEBs practice nurses
       to signpost to HVs ,offer DH advice
       training and interpretation re weighing/measuring (this could be
       addressed in-house) Supporting documents
NICE guidance on maternal & Child nutrition, CHPP, Report from Infant &
Toddler Forum study days 2007
       faltering growth
    Supporting documents as before

3. Awareness raising for PCT, GP and Children Centre admin staff may
fall out of BFI

4. Pilot of a school “whole systems approach” by Health Schools
Coordinator (Worcestershire County Council)
To promote & enable breast feeding in schools from early years to young
people .First meeting 26/06/08 I am on leave but have asked HV members
of Infant feeding group to attend.

Action Plan

Baby Friendly application
Worcester Hospital Acute Trust              Stage 1 accreditation Sept 08
                                            Training for HVs (champions)
                                            10 places Oct/Dec
Worcester University                        Stage 1 accreditation Sept.08

Planning visit BF I                         9th September 2008

BFI Audit                                   Commence Oct 08

Breastfeeding status data                   Introduction of CHIS for HVs/
                                            NNEBs to record activity
                                            Commence Sept 2008

Infant Feeding Group                        Next meeting 12th June 08
(Breast feeding policy rewrite
Audit training
County wide peer support)
Identify ways to reach hardest groups
Rewriting breast feeding policy in line
With BFI.Distribution to all areas of PCT   September 2008

Map current breastfeeding pathways          End June 08

Map current breastfeeding training          End June 08
Skills & practices map against

Develop Infant Feeding Action Plan          Dec 08

Education & Training Plan
Funds for training                          April 08/09


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