1. A Better Start: Enhanced HCP project
Learning so far…

2. BACKGROUND

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

4. 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”

5. 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

6. 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

7. 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
mins for this
Commissioning

8. 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

9. Learning about context

10. 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

11. 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?

12. 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

13. Needs analysis

14. 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.

15. current HCP delivery

16. 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

17. 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?