Health Visiting and FNP services

National Policy Giving all children a healthy start in life Improving the HV service Improving chances for children with vulnerable mothers Supporting mothers & children with mental health problems Helping parents to keep their children healthy Providing free school meals Encouraging healthy living from an early age Protecting children through immunisation Improving maternity care Current government policy to Give all children a Healthy Start in Life specifically includes improving the HV and FNP service but in doing so this also has significance on many of the other outcomes identified within this policy bundle. Delivery of the Health Visiting (HV) Programme represents a major Government priority. The target of ensuring that an extra 4,200 HVs are in post by April 2015 is set out in the Coalition agreement (HM Government, May 2010 )

Policy deliverables by 2015 increase qualified Health Visiting workforce by 4200 transform the Health Visitor service increase the number of Family Nurse Partnership places to16,000

HV / FNP Programme key dates 2011 Health Visitor Implementation Plan 2011-15: A Call to Action launched Strategic Health Authorities worked with Primary Care Trusts to identify how many Health Visitors would be needed in localities to meet identified population needs. Business cases and Investment profiles agreed. 2013 Public Health transferred to the Local Authority in 2013, however the commissioning of Health Visiting & FNP Services moved to NHS England for a period of two years to complete the investment and transformation programme. 2015 Commissioning responsibility for Health Visiting and Family Nurse Partnership services will transfer from NHS England to Local Authorities on 1st October to complete the transfer of public health functions.

Why the focus on Health Visiting? Public Health - The foundations for virtually every aspect of human development – physical, intellectual and emotional – are set in place during pregnancy and in early childhood. Economic - Successive academic and economic reviews have demonstrated the economic and social value of prevention and early intervention programmes in pregnancy and the early years. Competency - Health Visitors, specialist community public health nurses, have a unique role in identifying need and supporting the development and wellbeing of every child in England up to the age of 5. 80% of brain development takes place during pregnancy and in the first 2 years of life setting the neurological pathways for adult life – what happens during this period is crucial and a key determinant of intellectual, social and emotional health and wellbeing. What happens during these early years has lifelong effects on many aspects of health and wellbeing, educational achievement and economic status.

The Health Visiting Service… provides expert information, advice, guidance and interventions to help parents become the best parent they can be and give their children the best start in life. has a central role in improving the health outcomes of populations, reducing inequalities, protecting children from harm and identifying additional needs at the earliest opportunity. leads the delivery of the national Healthy Child Programme 0-5 for every child is the only service that comprehensively assesses the health, wellbeing and social needs of every child at crucial stages of their development between pregnancy and the age of 3, often in the home environment.

Healthy Child Programme An universal schedule of evidence based assessments, screening, immunisations and contacts aimed at promoting and protecting the health and wellbeing of all children as well as identifying needs early and taking appropriate additional action. NB The Healthy Child programme provides the evidence based schedule of assessments, screening, contacts available for every child. Health Visitors are responsible for leading this across their population group. Detail examples of screening, etc Health visitors lead the Healthy Child Programme for families with children up to the age of 5, offering a universal service to families, with more targeted and tailored support for those who need it.

National Core Service Specification NB…. ASQ – PH readiness for school LA resident populations from GP registered

Local provision

Two providers of CIOS Health Visiting FNP Cornwall Partnership Foundation Trust Health Visitors in LAC Specialist Nursing Team Royal Cornwall Hospital Trust

Three key aspects increase qualified Health Visiting workforce Transform the Health Visitor service increase the number of Family Nurse Partnership places

Increasing the workforce May 2010 March 2015 Individualise by area according on audience – example of Cornwall shown above using baseline position and most recent UNIFY position. By March 2015 the provider is expected to achieve its full trajectory of 117.66fte. This number includes a team of 8 Family Nurse Partnership Nurses who provide intensive family support for fist time young parents under the age of 19. In addition there are 3.2fte Health Visitors working within the Looked After Children specialist nursing team based within the Roya Cornwall Hospital, Truro. Important to note that this is not the whole workforce – there are skill mix nurses and nursery nurses in addition to these numbers who support the delivery of the Health Visiting ofer. 81fte qualified HV’s 117fte qualified HV’s

Transform the Health Visiting service Population uptake of core checks Evidence based tools Workforce development Pathways of care Supervision Engagement of service users Public Health & Prevention Safeguarding

Population uptake of core checks Antenatal Newbirth 6-8 weeks * 3-4 months * By 1 year 2-2.5 years Aim that all achieve minimum of 90% by March 2015 with 95% in 2015/16. Important to ensure as many children as possible engage so that the service can screen those who need more support. Those in yellow are mandated from October 2015, service currently delivers a 3-4 month check owing to importance timing wise around maternal mental health, weaning, accident prevention – moving from a nonmobile to mobile baby.

Increasing universal uptake - 1 year review Q2 2014 53% Q3 2013 70% This check focuses upon infant development including speech and language, motor skills, behaviour and attachment. With the introduction of Ages and Stages assessment tool (ASQ3) at the two year check we are currently exploring intorducing its use at the 0ne year check as a way of tracking individual development and progress.

Evidence based tools examples Solihull Family Partnership Model Motivational Interviewing Baby Friendly Ages & Stages 3 & SE In line with NICE guidance and the evidence base

Evidence Based Assessments of Need Check uptake increase from 67% to 74% ASQ to be nationally introduced 60% of reviews used ASQ 88% of staff trained by Q2

Workforce Development examples Leadership of change training Preceptorship programme Communities of practice Action Learning Set for CPT’s NHS Employers Clear workforce development plan supported by NHS Employers looking at HV recruitment and retention Active communities of practice across area team geography including all HV leads and Public health representatives Leadership of change – frontline HV’s 6 week course looking at how to lead change through projects

Snapshot of local developments Equitable practice on the Isles of Scilly HV in pre-birth assessment team HV in MARU (multi-agency referral and assessment unit) Multi-Agency Antenatal education Migrant Workers Needs analysis Doubled FNP capacity Restorative Supervision LAC Specialist Nursing Team

Family Nurse Partnership Capacity increased from 4 to 8 nurses Licenced model Up to 200 places Supporting vulnerable first time young parents Evidence based model for use with vulnerable first time young parents. Capacity was doubled using HV investment profile now has space for up to 200 young families.

Looked After Children’s Team 3.4wte New nurses from HV investment High quality consistent assessment % reviews in time has increased from 34% to 90%+ Case management approach – nurse follows child Specific support for adoptive parents to support placement

Developing clear pathways of care Development of champion roles Domestic Abuse Perinatal Mental Health Infant Feeding Infant Feeding co-ordinator BFI accreditation across Hospital & Community Perinatal mental health & attachment Currently use Woolley questions, GAD7 & PHQ9 Reviewing use of Promotional guides / MORS Integrating two year reviews Introduction of ASQ Working with Early years to streamline delivery Part of Social Marketing project Initial focus upon the 6 early years high impact areas

Meridian Survey/Friends and family Engaging families Meridian Survey/Friends and family Social marketing Needs analysis

HV Challenges Increased accessibility & expectation Achieving Population Uptake Maintaining focus upon public health and prevention as well as safeguarding Maintaining the workforce through change Actively engaging service users and influencing change Fit for purpose Information sharing and IT

FNP Challenges Decreasing teenage pregnancy rate Staff turnover & sickness Achieving fidelity of programme in a rural geography Ensuring alignment to HV & Early Years services to provide a continuum of support

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