1. Public Health Skills in Nursing Audit Report for Plymouth “Building public health through Nursing” Kevin Elliston: Public Health Specialist Hon Snr Lecturer, University of Plymouth and June Wilkinson: Snr Lecturer Hon Public Health Specialist, Plymouth tPCT

2. Project Aim & Objectives  Project Aim:  To undertake a public health skills audit of Health Visitors and School Nurses working in Plymouth PCT based on the Health Development Agency’s ‘Skills Audit’ tool (HDA 2001).  Objectives:  Map the current level and extent of skills, knowledge and public health practice as identified by practitioners (Health Visitors and School Nurses)  Identify strengths in skills, and gaps in local training provision against the public health competencies for practitioners  Produce report with recommendations for public health practice development for Health Visitors and School Nurses  To review the current post registration curriculum for public health nursing in partnership with the Public Health Development Unit and the University of Plymouth, Faculty of Health & Social Work  Present the findings to the tPCT Executive Board, Workforce Development Confederation, and relevant practitioner councils

3. The Policy Context public health agenda Action on Inequalities Our Healthier Nation Wanless Review National Service Frameworks NHS Plan Sure Start Uk Fuel Poverty Strategy The Teaching PCT Local Strategic Partnership University curricula Our City’s Health Workforce Development Public Health competencies

4. Targeting the participants  CMO identified 3 broad categories for the public health workforce Wider public health = Managers, teachers, local businesses etc Wider public health = Managers, teachers, local businesses etc Public health practitioners = health visitors, school nurses, environmental health etc Public health practitioners = health visitors, school nurses, environmental health etc Public Health specialists = leading strategic public health programmes etc Public Health specialists = leading strategic public health programmes etc

5. Preparing the ground  Funding from the PHDU  Meetings with the professional leads for Health Visiting & School Nursing  Half-day workshop designed (repeated x6, 90 places available)  Invitations sent to all health visitors and school nurses in Plymouth tPCT & Sth Hams W.Devon PCT 42 nurses attended 42 nurses attended

6. The Audit Process  Used the validated skills audit tool from the Health Development Agency 7 Skill clusters & 67 competency areas 7 Skill clusters & 67 competency areas Personal Skills, Leadership, Policy & Strategy, Management – Implementation, Workplace Management, Underpinning Principles, Professional/TechnicalPersonal Skills, Leadership, Policy & Strategy, Management – Implementation, Workplace Management, Underpinning Principles, Professional/Technical  Two separate exercises Participants assessed skills in professional groups, rating skills they perceived to be essential to not essential Participants assessed skills in professional groups, rating skills they perceived to be essential to not essential Repeated the assessment as a self-assessment exercise Repeated the assessment as a self-assessment exercise

7. Skills Strengths  The majority of the 67 skills were rated as highly required (pp 14-30)  Strengths were shown to be in: Communication Communication Interpersonal skills Interpersonal skills Multi-disciplinary teams Multi-disciplinary teams Understanding inequality issues Understanding inequality issues Understanding influences on behaviour Understanding influences on behaviour Understanding own contribution to health/well-being Understanding own contribution to health/well-being

8. Self assessed gaps  The Nurses self assessment showed gaps in: General awareness and understanding of public health. General awareness and understanding of public health. Community development. Community development. Health needs assessment and the range of skills required to undertake this work. Health needs assessment and the range of skills required to undertake this work. Using IT for public health work. Using IT for public health work. Organisational/planning skills (project management, prioritising, decision making, using evidence, evaluation). Organisational/planning skills (project management, prioritising, decision making, using evidence, evaluation). Knowledge of, and how to influence, policy. Knowledge of, and how to influence, policy. How to work in partnership with other agencies, in particular on regeneration. How to work in partnership with other agencies, in particular on regeneration. Managerial/leadership skills (negotiation, leadership, change management, influencing policy). Managerial/leadership skills (negotiation, leadership, change management, influencing policy).  The Plymouth Audit study reflect the national findings

9. Qualitative findings  Two questions posed to participants (pp 31-36) What changes had there been in role over the last 2 years? What changes had there been in role over the last 2 years? Individual focus vs Community wideIndividual focus vs Community wide Caseload vs neighbourhood workingCaseload vs neighbourhood working Child focus vs broader health promotion roleChild focus vs broader health promotion role What would help you fill the identified gaps, or use your skills better at individual, organisational, inter- organisational, regional levels? What would help you fill the identified gaps, or use your skills better at individual, organisational, inter- organisational, regional levels? Skill development (individual)Skill development (individual) Management support (organisational)Management support (organisational) Joint planning (inter-organisational)Joint planning (inter-organisational) Policy influence (regional)Policy influence (regional)

10. Recommendations 1-4  Professional development and practice for health visitors and school nurses needs to be supported through an accredited rolling programme of continuing professional development in public health, focusing initially on modules in Leadership for Public Health, Professional and Technical Skills in Public Health and Policy development in practice.  Plymouth’s Public Health Development Unit and the University of Plymouth, (Faculty of Health and Social Work) should jointly review the current post-registration curriculum of the BSc (Hons) in Public Health Nursing at the University of Plymouth.  A ‘Professional Practice in Public Health Nursing’ steering group for Plymouth and the Peninsula (affiliated to the Expert Advisory Groups for curriculum development at the University of Plymouth) should be established, with terms of reference, to include the development of a CPD programme, monitoring and evaluation of the programme.  The development of a post-graduate education programme in public health nursing at certificate, diploma and masters level should be explored and scoped for viability at the University of Plymouth.

11. Recommendations 5-7  Capacity building and skills development needs to be supported through the development of a training and education programme for post-registered health visitors and school nurses, (linked into current provision of training departments and other providers), to strengthen current skills and meet deficiencies in skills, knowledge and practice.  Support for CPD funding and programme development, and its management, should be sought from the Workforce Development Confederation, the Health Development Agency and other sources.  Public health community practice and role demands should be reviewed by the professional leads in health visiting and school nursing to ensure that the CPD programme development is supportive of the needs of the profession.

12. The way forward  An innovative CPD programme has been devised  Opens the way for further professional development Bid submitted to LWDG Bid submitted to LWDG Focus initially on HV & SNs for Leadership skills in Public HealthFocus initially on HV & SNs for Leadership skills in Public Health potential to extend into multi-disciplinary public health potential to extend into multi-disciplinary public health Working in partnership with the Royal College of Nursing national exec committee for the Health Visitors and Public Health ForumWorking in partnership with the Royal College of Nursing national exec committee for the Health Visitors and Public Health Forum Using the evidenced based tool - the Birkman Method for skills development toolUsing the evidenced based tool - the Birkman Method for skills development tool Academic accreditation via the University of Plymouth, professional accreditation via the RCNAcademic accreditation via the University of Plymouth, professional accreditation via the RCN