A Better Start: Enhanced HCP project Learning so far…

BACKGROUND

Includes contributions from a wide range of practitioners and services In project we have not been lookng at imms and screening

Principle of Progressive Universalism A universal service that is offered to all families, with additional services for those with specific needs and risks. “…offers a range of preventive and early intervention services for different levels of risk, need and protective factors”

HCP is commissioned nationally and locally… Nationally commissioned through NHS England: Immunisation programme Screening programmes (eg antenatal and newborn hearing) Child health information system 6-8 week GP check of child (aka child health surveillance) Locally through Local Authorities includes: Many elements of HCP (including HV and School nurses) Family Nurse Partnership (FNP) programme Child measurement programme Sexual health services; Stop smoking services Locally through Clinical Commissioning Groups: Maternity and newborn services Children’s health care eg for long term conditions Community Health eg Speech & Language Services for people with learning difficulty

Expected outcomes of the HCP Healthy nutrition, increased breastfeeding and increased physical activity Early recognition of growth disorders and risk factors for obesity Care which promotes health and safety Strong attachment and positive parenting leading to better social and emotional wellbeing Readiness for school and improved learning Identification of factors that could influence health and well being in families The outcomes identified in the dark green boxes (left) map directly with ABS key outcomes (centre). Those outcomes in the light green boxes (right) are more indirectly related but the activities have an important contributory impact on realising ABS outcomes Prevention of communicable diseases Early detection of /action to address developmental delay, abnormalities, ill health and safety concerns Better short and long term outcomes for children at risk of social exclusion

HCP within a context Ideal Situation 15 - 20 mins for this National Policy context Local context Ideal Situation Common Agenda Continuous communication Shared, specific measurement of results Mutually reinforcing activities of all stakeholders Dedicated staff to co-ordinate participating organisations Competency in programme delivery Organisational Ability HCP Needs 15 - 20 mins for this Commissioning

Real world example National Policy context Local context Continuous communication Common Agenda Competency in programme delivery Organisational Ability HCP Needs Shared, specific measurement of results Mutually reinforcing activities of all stakeholders Commissioning Dedicated staff to co-ordinate participating organisations

Learning about context

Emerging learning Cuts in funding & uncertainty for future Difficult to maintain current provision Difficult to innovate when context shifting Moves in commissioning still embedding Uncertainty and anxiety Variations in alignments (esp role of PH) Strong integration agenda Early years/ primary prevention/ HCP/ early intervention pathways Within commissioning and service provision

Emerging learning LA services – content and volume - very varied, health less so Everyone has plans! Process of coming together, sharing and understanding each others contexts very important Helping each other through the challenges How to keep it up?

Challenges for improving HCP within this context HCP not well understood and ‘health’ terminology resisted in some (LA) contexts Complexity of commissioning and provider arrangements HCP broader than ABS Scope Population Commissioning

Needs analysis

Emerging learning to date There is a large amount quantitative data available Over 100 data items Data describe population level: Demographics Risk factors Outcomes Do not routinely bring together information on individual families to identify combination of risk factors or capacity to benefit from services. Therefore, difficult to determine the right kind of services to commission and the capacity required.

current HCP delivery

Local Community Context Local Organisational Context Meets Needs National Context Good Practice Selection, training, coaching Key Organisational ability WHO and WHAT Local Organisational Context Common Agenda Mutually reinforcing activities Shared measurement system Continuous communication Dedicated coordinating team HOW Commissioning process Feedback Implementation Collective Impact

Given this , what should be done? Issues Challenges HCP branding Not seen as a programme Commissioning and provider complexities Complex range of activities being undertaken by a range of practitioners Quality of delivery uncertain Funding under threat Strengths Integrated care pathways being designed Passionate and committed practitioners Complex range of activities being undertaken by a range of practitioners Commitment to doing this as well as possible Given this , what should be done?