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					Corporate Caseload Policy and Procedure

Provider Directorate

Health Visiting Corporate Caseload Policy

Version 1.0 Status: Approved Healthcare Governance Date: August 2007 Originating Author: Karen Holden, Acting Lead for Health Visiting Review Date: August 2008

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Corporate Caseload Policy and Procedure

Version History Document Version 0.1 0.2 0.3 0.4 0.5 0.6 1.0 Date of Issue 26/09/06 26/09/06 13/10/06 12/12/06 8/2/07 11/2/07 16/8/07 Status Draft Draft Draft Draft Draft Draft Approved Comments Initial version for review Includes changes by E McDonough Includes changes by E McDonough Includes changes from Policy Group workstream Includes changes from Policy Group workstream Includes format changes and amendments by Tracy Wood Healthcare Governance

Circulation: Health Visiting

Contents Version History ..................................................................................................................... 2 Contents ............................................................................................................................... 2 1.Introduction ........................................................................................................................ 3 2. Scope................................................................................................................................ 3 3. Accountability .................................................................................................................... 3 4 Principles of corporate working .......................................................................................... 4 5 Standard systems .............................................................................................................. 5 5.1 Allocation Book............................................................................................................ 5 5.2 Birth Book .................................................................................................................... 5 5.3 Generic Support Worker (GSW) Workbook ................................................................. 5 5.4 Team diary .................................................................................................................. 5 5.5 Filing system ............................................................................................................... 5 5.7 Team message book ................................................................................................... 5 6.Communication .................................................................................................................. 6 7 Named HV ......................................................................................................................... 6 8 Principles of Allocation ....................................................................................................... 7 9. System of Allocation ......................................................................................................... 7 10 Guidelines on home visiting ............................................................................................. 8 11 Monthly Team Meetings ................................................................................................... 8 12 Service Cover .................................................................................................................. 9 13 Filing system .................................................................................................................... 9 14 Duty Health Visitor Responsibilities ................................................................................. 9 15 Related policies and procedures .................................................................................... 10 16 References .................................................................................................................... 11

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1.Introduction 1.1 What is corporate working? Corporate working in Tameside and Glossop means two or more health visitors having responsibility to one geographically defined caseload whilst maintaining individual accountability for individual clients. It is an approach that aims to use skills within the team most effectively. 1.2 Why work corporately? A paper on corporate working within health visiting by Houston and Clifton (2001) concluded: “ We have demonstrated its usefulness to practitioners in developing practice, lowering stress, improving accountability, developing community work and showing strong health visiting outcomes. There is no doubt that it is a challenging model to set up, however, once practitioners have used this method, they are reluctant to return to individualised, single caseloads.” 1.3 Benefits of working Corporately  Improving service quality through sharing of knowledge and skills between practitioners, and improving clinical effectiveness.  Making workloads more equitable.  Promoting team work and staff support.  Provides a means of tackling operational difficulties. e.g. able to manage annual leave and sickness cover more effectively.  Responding to national policy drivers, e.g. enabling the development of community public health model.  More effective and focused planning, and evaluation of services. 1.4 It is acknowledged that corporate working can present challenges to teams. Attitudes of practitioners to the system and dynamics within the team, and robust communication systems are key to the success of corporate working. A period of time will be spent to facilitate team building and to work through any individual issues teams may have, to support the principles of effective corporate working. “Corporate working in health visiting and public health nursing teams.” CPHVA 2004.

2. Scope This policy applies to the health visiting service within the Provider Directorate of Tameside and Glossop Primary Care Trust.

3. Accountability The Nursing and Midwifery Council Code of professional Conduct discusses accountability in clause 1.3: "You are personally accountable for your practice. This means that you are answerable for your actions and omissions, regardless of advice or directions from another professional."

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If delegating care to another registrant, health care support staff, carer or relative, clause 4.6 of the Code explains that: "You remain accountable for the appropriateness of the delegation, for ensuring that the person who does the work is able to do it and that adequate supervision or support is provided." Accountability is an integral part of provision to practice, as, in the course of practice, registrants have to make judgments in a wide variety of circumstances. Professional accountability is fundamentally concerned with weighing up the interests of patients and clients in complex situations, whilst using professional knowledge, judgment and skills to make a decision. This enables registrants to account for any decisions they make. All health visitors (HVs) in the corporate team are responsible for managing the corporate caseload and individually maintain accountability. Working as a team, co-working cases, peer reviewing cases, supporting and advising colleagues is good practice when managing a corporate caseload. Accountability does not change in these cases and the named health visitor remains accountable. When the team discusses how to manage a case, there must be a named HV. The accountability for decisions and actions taken cannot lie with the team. Examples from practice As an unallocated case comes into the team, it is the duty HV responsibility to be the named health visitor for that case during assessment and to take to allocation. If another health visitor then takes the case from allocation, accountability for that case transfers to the new named health visitor. Child protection cases and co- working - the case must have named health visitor who is accountable for that case, even though another health visitor may have mentored and advised.

4 Principles of corporate working  There should be a shared approach to the workload; however, a named Health visitor must be accountable for decisions and actions made on any given case.  Teams should work to develop consistency of practice, to ensure all families receive a service based on need supported by a sound evidence base.  Individual members of the team must acknowledge their commitment to the team, and be a team player.  All team members must adhere to Tameside & Glossop PCT Policies and Procedures.  Team building is instrumental to good working practices and all teams will be given time out to develop and maintain team working, as this is integral to delivering a highly effective service.  Teams must develop an open and honest relationship with all team members, and allow for healthy challenge and a high level of support.  All team members must be recognised for the contribution they make to the team.

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5 Standard systems 5.1 Allocation Book. A cashbook is ideal for this purpose. This is discussed in the allocation section of this document. The allocation book should be stored in the allocation drawer of the filing system. The book needs to contain the following information:  Date put into allocation.  Name of child and date of birth (this applies even when the client is another family member, e.g. the mother)  Brief description of need, e.g. new birth, Edinburgh Postnatal Depression Score etc.  Date allocated and to whom. 5.2 Birth Book Every team should operate a birth book where all births are entered for a given month and year. Every team needs to operate a robust system to ensure entries are made as soon as a new birth or removal in comes into the team. Similarly, removal out children need to be clearly removed from the book with date of removal and new address (where known) stated clearly 5.3 Generic Support Worker (GSW) Workbook Work should be listed in the GSW book. Their named supervisor should monitor the workload and guide the GSW with prioritising their workload. This can also be reviewed during allocation meetings. Work should be entered into the book as it comes in. 5.4 Team diary This diary is to be used by all members of the team to record duty; clinics, groups, other sessions and who is covering them and should also record annual leave, flexi, sickness and training. 5.5 Filing system  Lockable filing cabinets.  Drawer(s) for allocation and duty.  Records filed alphabetically unless specific local circumstances exist.  All records must be stored in the filing system. No records are to be kept in desk drawers, individual active drawers or left on desktops overnight.  The exception to this is unallocated antenatal and new birth visits and removal in records, which should be kept in the allocation drawer. 5.6 Duty box file A box file should be used for correspondence, A&E forms, and letters that the duty Health Visitor will manage. The box file should be stored in the lockable filing system in the allocation and duty drawer. 5.7 Team message book Teams will need to agree other systems such as telephone calls outside of contact/duty times Telephone message pads can be used. The team message book can be kept in the health visitor office or with the clinic administrator depending on the system developed by each team.

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6.Communication Communication is essential to the effective functioning and management of the corporate caseload, and in maintaining professional relationships with other professionals. 6.1 Standard communication There must be a number of standard means of communication that exist in all teams. These are:  Allocation meetings. These will take place weekly. They are detailed further in the allocation section of this policy.  Team meetings: These will take place every 4-6 weeks. This meeting should be scheduled for all members of the team to attend whenever possible, and to accommodate part time staff, there should be flexibility for attendance. All staff are expected to have attended at least one team meeting every three months. The focus of these meetings is team building, reviewing management of caseload, reviewing active families, planning workload and writing and reviewing team objectives and action planning.  All teams must use the standard systems outlined above. 6.2 Link Health Visitor Each GP Practice and midwifery team will have a link health visitor. The roles and responsibilities of this are found within the Link Health Visitor Procedure.

7 Named HV 7.1 The following families will retain a named Health Visitor:  Children on the Child Protection register.  Looked after children  Children on the PCT Family of Concern System.  Children with additional needs currently in the child and family process.  Children with additional needs requiring health visiting support, e.g. health visitors are key workers for the family, or have a specific role in supporting the family.  All families with a child up to the age of 12months.  Allocated families.  A family member requiring additional support, e.g. a mother with postnatal depression. 7.2 The Health Visitor will determine when the family returns to the corporate caseload or if a change of Health Visitor is needed. 7.3 Continuity between a named Health Visitor and the client/family should be considered where appropriate when allocating families and supporting families over a period of time. However, this must be accompanied by objectivity and transparency in justifying the extended contact to other members of the team. 7.4 Systems need to be in place to ensure everyone knows who the named health visitor is to prevent problems arising and duplication. Each month a list of active families must be updated by the team which includes names of children, their named health visitor, and including brief reason for contact, using active caseload sheets.)

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8 Principles of Allocation 8.1 Allocation meetings must be held weekly and prioritised by all members of the team. 8.2 Attendance at the meeting should be recorded in the allocation book. Efforts should be made to arrange the meeting at the most convenient time to include the majority of the team. Team members are expected to attend as a minimum two allocations a month, unless in exceptional circumstances that needs agreement with your line manager. 8.3 As a referral comes into the office it must be date stamped on the day of receipt, and signed by the duty health visitor This includes any A&E form, domestic violence incident form, and written and telephone referrals. This is the responsibility of the duty health visitor. 8.4 The allocation system is a needs based priority system for the allocation of cases. 8.5 Team members are expected to leave one free slot in their diary every week to allow for urgent priorities to be allocated. 8.6 Allocation of families to a Health Visitor or Nursery Nurse is based on the week following the allocation meeting and the capacity space for visits in an individual’s diary. All team members have a responsibility to share the week’s workload with their colleagues, taking into account active caseload. Open communication is essential to ensure that there is a consistency and transparency in the way all team members are operating within the corporate policy. 8.7 When a member of staff is on annual leave it is expected that their first day back be left clear for them to manage their current active families. However, some work can be allocated to them within the week, taking into account their diary for that week

9. System of Allocation 9.1 Families that must be allocated a named Health Visitor immediately at the allocation meeting are:  Children on the Child Protection Register  Children with additional needs already within the child and family process  Looked after Children  Any other vulnerable family that in the health visitors’ professional judgement needs to be allocated immediately. 9.2 All the families awaiting allocation must be assessed prior to determining which families are to be allocated a health visitor. Families in allocation should be assessed to see if they meet the criteria to be delegated to a nursery nurse, or require referral to another agency without the need to be seen by the health visiting team. Teams should also consider where a letter or telephone call might be an appropriate course of action. 9.3 When it is assessed that a family require health visiting intervention within allocation they must be prioritised according to need, based on professional judgement. If not all families can be allocated at the time then those families unallocated will be managed on the waiting list. Each month teams will be expected to provide waiting list numbers to management as per Tameside and Glossop PCT Policy on Performance Management of Waiting Times.

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9.4 Visits required through the child health promotion programme should be dealt with as follows: Once an antenatal contact has been allocated a named health visitor, that health visitor will remain the named health visitor for the new birth assessment, and for all contacts during the first year. New birth records and 8-12 month assessments can therefore be given directly to the named health visitor without going through allocation. It is the responsibility of the named health visitor to manage those visits within their diary. Health Visitors are expected to deliver the standard for service delivery as cited within the Child Health Promotion Programme 9.5 Removal in visits from outside the area are a high priority, and must be visited in accordance with the lone worker policy. Those moving from within Tameside & Glossop can be assessed on an individual basis, and may not necessarily require a home visit, although a letter must be sent informing the family of the new health visiting team.

10 Guidelines on home visiting 10.1 As a guide, four to five visits a day is manageable to allow for record keeping, any immediate liaison and work required with the active caseload and to aim for quality rather than quantity. This could be exceeded if the nature of the visits allows and time has been allowed the day after for record keeping and management of the cases. Less than four visits will be dependent upon an individual’s diary commitments and the nature of the visits being planned. This guidance does not replace professional judgement and professional responsibility for managing ones workload.

10.2 If a visit is cancelled then the team member is expected to replace that visit by taking a new case within the allocation book, ensuring they make a note of their name and date taken.

11 Monthly Team Meetings 11.1 Planning team activities including partnership working and public health activities, allocation of duty, clinics and groups or any other session should be completed at a monthly team meeting, usually following on from allocation meeting, and should be pro-rata. This ensures fairness and equity. 11.3 Flexibility, trust, rotation and a view of the individual’s total workload and commitments are needed. 11.4 Teams must also plan to have annual review of priorities, setting team objectives and working towards key performance indicators. This will include other workers within Sure Start Children’s Centres as required, to plan postnatal groups, parenting and other local initiatives which respond to needs of an area.

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12 Service Cover 12.1 When a team is fully staffed the service should be covered Monday to Friday. There are limited exceptions to this in the smallest clinics, agreed within the Health Visitor Service Directory. In this case, those teams must ensure there is telephone cover arranged with another clinic. 12.2 The service contact times are generally 9-10am and 4-5pm Monday – Friday but will be dependent on local working arrangements (availability of hot desks etc.) Contact times should be well publicised locally. In normal circumstances with a fully staffed team, only half the team should be on annual leave, flexi leave or training at the same time. Flexitime policy must be strictly adhered to. 12.3 It is recognised that occasionally even when fully staffed there will be situations that arise where this expectation of service cover cannot be met. This will need to be agreed with your line manager. 12.4 When a team is not fully staffed service cover and meeting the needs of the service will be reviewed and agreed with your line manager.

13 Filing system 13.1 The filing system will be in filing cabinets that are lockable. The caseload must be held as ONE corporate caseload, with cases/records for allocation kept in an allocation drawer. This should be a filing cabinet drawer that can be locked. 13.2 The records for families must be filed strictly alphabetically, according to the family surname or youngest child’s surname if different. Double-barrelled surnames should be filed by first letter of surname, e.g. Taylor-Smith must be filed under T. Local circumstances may override this arrangement e.g. where families are required to be filed by street name, in areas of high BME proportion. . Where this is the case a notice to this effect should be visible on the outside of the filing cabinet drawer. 13.3 Tracer cards must be used when a record is removed from the corporate drawer, stating the date and person the record is with. All records must be replaced in the corporate file once written up. 13.4 Individuals must not have their own active drawers. 13.5 Records must not be left on desk tops overnight, and are not be kept in desk drawers or anywhere else other than the filing cabinet system.

14 Duty Health Visitor Responsibilities 14.1 The duty Health Visitor is an essential role in ensuring the effective management and functioning of the corporate caseload. Every team must operate a duty system.

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14.2 All health Visitors in the team must participate in the duty rota. Allocation of the duty role should be done so on a pro-rata basis. It must be planned as a priority when planning and allocating other sessions. 14.3 The duty health visitor must be available at the service contact times: 9-10am and 45pm Monday to Friday, there may be agreed exceptions to this in the smallest teams where telephone cover from other teams may be arranged. 14.4 The length of the duty period is dependent upon the size of the caseload and team size. However, some teams will need to allocate more time to ensure effective management of the caseload. 14.5 Role of Duty Health Visitor  General telephone contacts.  Reviewing and action of messages  Assessment of Domestic Incident notifications (Tameside only). Please follow the Health Visiting Domestic Abuse Guidelines Tameside & Glossop PCT 2006  Any referrals, A&E Slips and Domestic Abuse Incidents received for active families should be given to the named Health Visitor to assess.  Any A&E slips coming into duty without a named health visitor should be assessed by the duty health visitor for allocation, or be recorded and filed.  Sort the post, and review any post received with regard to internal memos, faxes and letters to establish urgency for other team members to read. Non urgent memos should be circulated, initialled and dated.  Read any client correspondence such as hospital letters received.  Any client correspondence for active families should be given to the named Health Visitor.  Review waiting list. Clients who have waited for 1 month should be sent a letter/contacted.  Duty must be recorded in the team diary. 14.6 Please note: There is not an expectation for the duty health visitor each day to cover every component of the role above and finish everything that they may be faced with. The role is one that will have changing priorities on a daily basis. The team will therefore need to ensure they find the balance that meets the needs of their caseload and ensures the duty role is fulfilled over a weekly period.

15 Related policies and procedures      Link Health Visitor Procedure. Tameside and Glossop PCT Policy on Performance Management of Waiting Times. Lone worker policy Flexitime policy Health Visiting Domestic Abuse Guidelines Tameside & Glossop PCT 2006

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16 References 1. 2. 3. 4. Houston and Clifton (2001) cited in Corporate Working. CPHVA 2005 Corporate working in health visiting and public health nursing teams. CPHVA 2004. Nursing and Midwifery Council Code of Professional Conduct NMC (2005) Child Health Promotion Programme Tameside & Glossop Primary Care Trust 2006

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