1. School Heath Workforce Rapid Roll-out Programme 14 th September 2006 Summary and Results Janis Stout Senior Workforce Advisor CSIP

2. School Heath Workforce Setting the Context Drivers – ‘Choosing Health’, ‘Every Child Matters’, National Service Framework, CNO Review Greater Focus on Outcomes and Public Health Obesity, diet and exercise Sexual Heath and teenage pregnancy Smoking cessation, substance abuse Mental and emotional health Greater Focus on Community Based Solutions School Health Service ideally placed to help deliver

3. Children’s Workforce Strategy Delivering improved outcomes will depend upon a combination of :- Service Re-design Improved workforce identification of and response to need But there is no one model Local solutions need to be found to local problems Recognising local priorities and local constraints

4. School Heath Workforce Rapid Roll-out Programme Focusing on the school health workforce and particularly on support roles to school health workforce and the wider team of school and health staff to systematically establish present practice to determine further models of working likely to benefit children and staff. to assist with development of a Career / Education framework for school health support workers in the context of the children’s workforce with particular reference to the role of School Nurses and the related school health workforce. To increase the capacity of the school health workforce with particular reference to school nurses by freeing them from tasks that could be undertaken by support workers and the wider healthcare team

5. Who did What ? Commissioned by Changing Workforce Programme then CSIP Hosted by Cumbria and Lancashire SHA working collaboratively with Cheshire and Merseyside and Greater Manchester SHAs Focus on the north of England SHAs Teams arranged into local clusters around Lead Team 31 teams in 8 clusters across north of England Sharing learning through networking Geographical Clusters around Lead Teams Project support costs Fast paced time limited programme All had agreed partnership agreement between Health and Local authority Regular reporting / impact measurement Reference Panel

6. Range of Roles Admin & Clerical (Basic admin duties – liaison with schools, filing etc) First Level Support Worker (Undertake basic level support, some admin, chaperoning, assist setting up workshops / demonstrations etc) Generic Support Worker (some aspects of screening – heights, weights, hearing, vision, simpler health promotion - particularly in primary schools, some admin) Advanced Support Worker (some autonomy in support work, screening, delivery of health promotion sessions, run group work, assist with immunisation, Teir 1 CAMHS, liaise with partner agencies, some admin.) Assistant Practitioner (greater autonomy in delivery of health promotion sessions, running group work, liaison with partner agencies, some admin Allowing Registered Professional to – undertake more health promotion, concentrate on child protection, establish new links across agencies

7. Results-Creating Increased Capacity Admin & Clerical roles eg - 45% reduction in School Nurse (SN) time spent on admin Screening / school entry assessments eg 34% reduction in SN time spent on screening Routine tasks – preparation / organisation eg time spent preparing health fairs by SN reduced from 95 to 35 hrs Sharing workload – team working increase in no. of schools receiving 5-a-day programme from 13 to 19 increase in time spent by on health promotion from 30 % to 44% (of total health promotion time) Organisational changes siting staff in place of service delivery staff

9. Results Using Increased Capacity Health Promotion Bolton – time for health promotion increased to 63 hrs in first month E Yorks – no. children reached at ‘Health Fairs’ increased from 586 2330 Work with vulnerable children Oldham – LAC review backlog reduced by 10% in first month – LAC nurse spends more time on targeted work Preparation E Yorks – time spent preparing health fairs Training / CPD Oldham – LAC nurse able to undertake M Sc

10. Other Impacts Children & Young Person Involvement Partnership working

11. Restructuring Staff uncertainty Financial constraints Data handling Key Challenges

12. Networking Raising profile Raising morale Finance Policy Clarification Key Successes

13. Clear benefits from developing support staff Admin is ‘quickest win’ Senior sign-up essential Consult widely – within and outside the team School Health Workforce doesn’t need to work in schools only Don’t try and solve every problem Lessons Learned

14. Evaluation Confirmation of the increase in workforce capacity resulting in delivery of increased services Improved access to services for children Improved ownership of work by teams with a particular emphasis of use of appropriate skills mix through service and role redesign The programme encouraged and enabled the delivery of multi agency working That the methodological approach to large scale workforce change was helpful in providing the necessary catalyst for change. The networking approach and support of key stakeholders were identified as particularly helpful. Staff are now skilled up to continue the spread of the work. It was too soon to evaluate impact on retention and recruitment but there is reported improved job satisfaction Clear roles have been delineated in the context of the Career Framework for Health Change is possible even at a time of major service reorganisation although there is concern about sustainability and funding

15. Further Evaluation Further work will need to be undertaken to establish the long term sustainability of the new roles and service innovations and their impact on outcomes. A small project to follow up sites is planned for later in the year by CSIP and the SHA’s themselves as the new North West SHA intend to revisit the programme in 6 months time.

16. Conclusion Future development of school health workforce will involve working in partnership with a range of organisations In developing a whole school health team it is important that development is undertaken as part of a whole team rather than individual roles and tasks A competency based skill mix to the team should be adopted when considering who should undertake the task ie those most appropriate not because of tradition Evidence based workforce redesign to get buy in

17. Contact Details Janis Stout Janis.stout@dh.gsi.gov.uk www.csipengland.org.uk/Childrenandfamilies Ann Gavin Daly or Juliette Swift @northwest.nhs.uk