Derby City and Derbyshire Family Nurse Partnership David Stephenson Taking over delivery of services for young parent and their children 29th June 2012

Who we are Ripplez? An ex-NHS service that has operated since 2007 Social Enterprise since Jan 2011 – staff transferred out of the NHS 31 March Owned and run by staff for the benefit of young families in Derby and the surrounding areas Deliver Family Nursing Partnership in Derby, Derbyshire and Burton

What Ripplez do? Preventive, intensive, structured home visiting programme. Offered to first time mothers 19 and under Recruited in early pregnancy no later than 28weeks gestation and remain with the family nurse until child is 2. Licensed programme with fidelity measures to ensure replication of original research.

Objectives of the FNP Programme Improve pregnancy outcomes; Improve child health and development and future school readiness and achievement; Improve parents’ economic self- sufficiency.

Why we left? Creating a focussed organisation with less management layers and bureaucracy Empowering staff through direct control of the organisation; Enabling access to more funding streams not currently available to PCTs to increase sustainability and reduce overheads; Developing more services for existing service users such as volunteer programmes, housing support and greater access to employment or training; Expanding services to other geographical areas; Creating community ownership that has formal links with service users and key partners; Ensuring surpluses are reinvested into the communities we work to further develop and improve services.

History – Before leaving NHS Service setup as a national pilot in 2007; Right to Request process in late 2009; FNP became part of DoH Operating Framework – early 2010; Approved by the PCT Board in April 2010 and started working as a Shadow Organisation; Won contract to provide Family Nursing in Burton 5 Yr Contract & Transfer Agreement Agreed March 2011 (11 staff transferred); Commenced trading 1 April 2011

Actions required to leaving NHS Business Plan, due diligence and approvals; Agreeing contracts; Staff consultation and training; Setting up Company; Appointing board and organisational structure; Setting up bank account, tax status and accounting system; Setting up policies & procedures.

History – After leaving NHS June won contract to deliver FNP to Derbyshire; August 2011 – signed contract with Impetus Trust; Set up Footsteps – Young Families Group in Derby Won Big Venture Challenge 1 of 25 out 800 organisation; Strategic review – Nov 11 to May 12; Extention to Derby Contract – Jan 12 First year end completed March 2012 (25 staff). Extention to Derbyshire Contract – Jun 12

Our Plan to Scale Up Settling down in a new organisational form. Achieve a three/six months cash buffer. Maintain and develop our workforce. Be aware of competition. Secure additional funding to develop the business. Develop specifications for new services. Improve tendering and contractual skills (capability and capacity). Ensure young parent involvement in the running and development of the business. This was uncharted territory for the whole team!

Lessons learnt (1) Understanding the level of commitment, time and effort required to run a company; Creating an identity & ethos; Communication – keep staff involved; Staff are your greatest asset – knowledge & ideas; Recruiting is expensive in resources so it is important to get it right; Managing relatonships – commissioners, clients, funders and partnership organisations;

Lessons learnt (2) Get on top of your finances; Going for realistic funding opportunities; Managing multiple locations; Maintaining staff training; Managing the Board of Directors; There is still bureaucracy to manage; Get your self noticed in a good way; You can not wait for thing to happen for you.

Summary The experience has energised staff; Have increased our Family Nursing capacity from 130 to 390 clients; Ripplez has grown from 11 to 27 staff, maintaining financial stability. Staff are now more focussed on service and financial issues; Staff are empowered and feel more comfortable with service development and growth;

Family Nursing More About the Programme

Theoretical Basis Human ecology theory (client’s social and material context) Attachment theory (client as a ‘safe base’ from which her child can grow and learn). Self efficacy theory (ability to change behaviour by learning to draw on strengths and successes – building skills and confidence).

What do Parents Receive? Voluntary programme. Frequency of visits in pregnancy weekly first 4weeks then fortnightly. Infancy weekly first 6 weeks then fortnightly to 21 months. Monthly preparing for ending of programme. Each visit has structure and planned content.

The ‘6 domains’ Personal Health Environmental Health Life Course Development Maternal (and Paternal) role Family and Friends Health and Human Services

Guidelines for Nurses Pregnancy Infancy Toddlerhood Supported by PIPE, Ages and Stages and DANCE

Approach Therapeutic alliance Focus on bonding, attachment and emotional availability of caregivers Utilises client’s primary motivation Strength based, positive and hopeful Using motivational interviewing skills Respectful agenda Setting goals

Communication Styles Used to Engage Self Efficacy – “Well done, what a great achievement cutting down to 15 cigarettes per day” Guiding/MI – “Sounds like you already had a knowledge of risks of smoking in pregnancy” “What motivated you to cut down?” “It sounds like your baby’s health is very important to you”

Case Studies - Burton ‘Making a Positive Difference to the Lives of Young Families’ RippleZ Mission Statement

Case Study 1 Before FNP Involved with Social Care 20 a day smoking habit and cannabis Unemployed and homeless Poor diet Low self esteem Unplanned pregnancy No parental support With FNP Social Care no longer involved Smoking reduced and not using cannabis Living in rented accommodation Eating more healthy meals Aspires to entire education in future years Using contraceptives Improved relationships with family 21 26/10/2015

Case Study 2 Before FNP Involved with a “bad crowd”, social involved Abusive ex-partner Poor diet and smoker Father spent time in prison Low self esteem Unplanned pregnancy No parental support With FNP Social Care no longer involved Partner in prison Quit smoking and eating healthy meals Taking A-levels No GP visits Using contraceptives Supported by the family 22 26/10/2015

Financial outcomes and benefits Individual Stopping a 20 a day habit saves £ Breast feeding saves mothers £435 each year Mothers qualified to A-level standard can earn £3.07 per hour more than unqualified Public sector Obesity costs NHS £950 per person per year Costs saved of placing child into care £2500 per week Social care saving £400 per week Domestic Violence £240 per incident Council hostel £484 per week 23

Health & Social outcomes and benefits Individual Stronger family relationships More interaction with the fathers for mother and baby Healthier lifestyles Preventing of infections acquired by babies Increased self esteem Stable accommodation Public sector Reduced crime Reduced levels of obesity and smoking related illness Reduced demand on hostel accommodation 24

Public sector savings (Years 1 & 2) 25

Ripplez!

Ripplez CIC Derby City Family Nurse Partnership Revive Healthy Living Centre Roe Farm Lane Derby DE21 6ET T: E: a drop of inspiration