The EPDS - A universal screening tool

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					  Facing the future: a review of the
       role of health visitors
        What do you think?

Community Practitioners’ and Health Visitors’ Association
  Professional Team




                                    http://www.amicus-
                                    cphva.org/pdf/Facing%20the%20Futur
                                    e%20-%20HV%20report.pdf
The presentation will cover:

 Why the review was commissioned
 The process
 The main recommendations
 The implications for health visiting if these
  are endorsed
 Issues CPHVA think are critical for a
  professional view
Why the review was commissioned

  As a result of lobbying of Patricia Hewitt by
  Unite/CPHVA
 To respond the CPHVA concerns re the
  crises in health visiting
 To provide a road map for the future of the
  profession
 To consider the unique role health visitors
  can offer the NHS
The process:

 10 Lets talk about health visiting
  workshops, one in each strategic health
  authority area
 High level steering group – met 4 times
 Electronic feedback invited by Chris
  Beasley, Chief Nurse
 Survey of commissioners – PCT and
  practice based
What was it asked to do?

Provide a new role for health visitors which:
 Delivers measurable health outcomes
 Provides a rewarding and enjoyable job
 Has the support of families and communities
 Delivers government policy for children and
  families, reducing inequalities
 Fits new commissioning systems of choice and
  contestability through new providers
 Can adapt to changing needs and aspirations
 Attracts a new generation to the profession
CPHVA View

 Concern that the current service has been
  imposed and isn’t the service health visitors
  would chose to deliver.
 Feel health visiting has been subjected to
  many service and educational philosophies
  over the past 15 years and isn’t responsible
  for its current situation
 With improved professional leadership the
  review should never have been necessary
Recommendation 1
1.   The core elements of health visiting should be:
    Public health and nursing
    Working with the whole family
    Early intervention and prevention
    The value of knowing the community and being
     ‘local’
    Pro-active in promoting health and preventing ill
     health
    Progressive universalism
Recommendation 1 cont…
 Safeguarding children
 The value of working across organisational
  boundaries
 Team work and partnership
 Readiness to provide a health protection
  service
 Home visiting
Recommendation 2
Focus:

 The focus of health visitors should be early
 intervention, prevention and heath
 promotion for young children and families as
 this is where their nursing and public health
 skills and knowledge can have the greatest
 inpact.
Recommendation 3
Priorities:
 Preventing social exclusion
 Reducing inequalities
 Tackling the key public health priorities,
  particularly obesity, smoking, drugs and accident
  prevention
 Promoting infant, child and family mental health
 Supporting the capacity for better parenting by
  improving pregnancy outcomes, child health and
  development, parents’ self-sufficiency,
  safeguarding children, addressing domestic
  violence etc
Recommendation 4
Commissioning:
 Commissioners should commission
 early intervention, prevention, and
 health promotion services for all
 young children and families
Recommendation 5
Level of practice:
Responsible for the difficult things:

 Managing risk/decision making in conditions of uncertainty
 Building therapeutic relationships and addressing difficult
  issues in families with complex needs
 Leading multi-skilled teams
 Working across sectors and putting health into multi-
  agency work
 Delivering population level outcomes
 Assessment and identification of existing and future
  vulnerability
 Engaging hard to reach groups and individuals
 Translating evidence into practice
Recommendation 6
 The primary role of the heath visitor should
 be either:

 Leading and delivering the child health
  promotion programme using a family
  focused public health approach
 Delivering intensive programmes for the
  most vulnerable children and families
Recommendation 7
Additional areas of practice:
  There are 2 further packages of services
  that health visitors or other nurses can
  provide:
 Wider public health packages
 Primary care nursing service for children
  and families
Recommendation 8
Organisational options:

 Key part of integrated children’s services
 whether located within children’s centres or
 the primary care team should be determined
 locally
Recommendation 9
National policy should support the
  implementation by:
 Issuing national guidance which strengthens
  and updates the NSF std on the Child
  Health Promotion programme, bringing
  together screening, early detection, health
  promotion, health protection and parenting
  support into one programme
Recommendation 9 cont…
 Assembling the relevant research findings to
  support a 21st century child and family health
  promotion service
 Strengthening the commissioning of early
  intervention and preventative services for children
 Leading the development of the workforce through
  Modernising Nursing Careers to support current
  and future HVs to undertake the roles
 Clarifying and promoting the contribution of health
  in the government’s policy on parenting
What are your first
  impressions?
 A possible implications for health visiting
 if intense visiting pilots are
 mainstreamed
 Focusing on 2% most vulnerable using
  intensive visiting would leave little resource
  for remainder of families – could take half of
  workforce using model currently being
  piloted

 Question: If this would reduce social
  exclusion is it a price worth paying?
Areas we need your feedback on:
General:
1. Do you support these recommendations if
   not, which and why not?
2. Areas requiring additional work?
3. What should CPHVA be lobbying for?
4. How could health visiting training be
   improved?
Areas we need your feedback on:
General:

5. What shape should progressive universal
   services be?
6. What are the career development
   implications
7. Could these proposals lead to a
   fragmented service?
Specific issues CPHVA think are
critical for a professional view

A. Are multi-skilled teams working? If not
   why not? What needs to happen to
   make them work?
B. Should health visitors only focus on
   the first 2 years of life?
C. Are the ‘Principles of Health Visiting’
   still important as a framework for
   health visiting practice?
D. Should health visitors chose a specific role
   either working with the socially excluded or
   leading the delivery of the child health
   programme as suggested by the review?
E. Where should health visitors be based?
   What works and why (advantages and
   disadvantages)
F. Who should employ health visitors: health,
   local authority, other?
Other comments you
 would like to make:
Don’t forget the review and many more
key practice issues of concern to you
will be discussed and debated at
CPHVA Annual Conference in
Torquay, October 31st to November 2nd

For more details look at the CPHVA
website – www.amicus-cphva.org