Opportunities for Safeguarding Children in the New NHS Presentation workshop for London safeguarding Children Board Conf

1. Opportunities for Safeguarding Children in the New NHSPresentation workshop for London safeguarding Children Board Conference Briony Ladbury Senior Strategic safeguarding Children Advisor NHS LONDON December 2011

2. Where do the opportunities spring from? • NHS Reforms • Munro Review of Child Protection • Nosgrove Review (of Children in the family Justice System) • Ofsted Review • Big Society

3. Proposed NHS Reforms Funding Accountability Parliament Department of Health Public Health England Monitor Economic Regulator Integration Patients interests Competition safeguards NHS Commissioning Board/s Local bodies & senates Care Quality Commission licencing Local Authorities HWB Boards JSNA’s Public Health (Any Willing/Qualified) Provider Clinical Commissioning Groups & Networks Local partnership contract Accountability for results Local Health Watch Patients and Public – (adults and children)

4. NHS Structure post reforms Main Changes • Directly funded Public Health Service • Public Health situated in Local Authority • National Commissioning Board – senates • Clinical Commissioning Groups – members & networks • Health and Wellbeing Boards • Healthwatch Much yet to be clarified

5. NHS Reforms Statement • NHS Overall Accountability • NHS Commissioning Board and Clinical Commissioning Groups to: • Promote the NHS constitution • Core principles and values • 18 week waits • Duty to promote a comprehensive health service

6. Principle & opportunity • Clinical advice and leadership • GP consortia will become Clinical Commissioning Groups • Demostrate LA alignment • Governing Bodies must have a nurse and specialist doctor as members • Commissioners supported by clinical networks and clinical senates • Informed by health and social care professionals in discussion with patients, carers, voluntary sector and other partners

7. Principle & opportunity • Choice and competition • Promote patient choice • Level playing field • Best providers (public, private and voluntary sector) • ‘Monitor’ to protect and promote interests of patients (not competition • Safeguards against cherry picking and privatisation • Commissioners and ‘Monitor’ have duty to promote integration • Personal health budgets • Joint health and social care budgets • Promote innovative integrated care

8. Principle & Opportunity • Developing the workforce • Robust safe transition for training and education • Deaneries to oversee training of junior Drs and Dentists • Leadership and management training • Protected education and training funds • Fairly distributed • Transparent process

9. Timetable for Change • Clinical commissioning groups established April 2013 • CCGs take control when ‘ready and willing’ • Aligned to LA boundaries – Clustered into ‘federations’ • Monitor have powers to 2016 to maintain standards of governance. • SHAs Clustered from October 3rd 2011 (No change for London) • Oct 2011 – NHS Commissioning Board Established • April 2012 – Choice of Any Qualified Provider extended • Oct 2012 – NHS Commissioning Board established & independent (limited functions) • Oct 2012 – Monitor takes on regulatory functions • Oct 2012 – HealthWatch England & local HealthWatch established • April 2013– SHA’s & PCTs abolished (NHS Commissioning Board takes over) Public Health England established, CCGs fully established (expected to be ‘ready and willing’) • April 2014 – Trusts are Foundation Trusts (any outstanding get new management)

10. Public Health • Public Health England will fund services by: • Commissioning & providing services from itself, i.e vaccines, campaigns, health protection • Asking the NHS Commissioning Board to commission services i.e screening – elements of GP contract • Granting a ring fenced budget to local government • Each body will be required to comply with the Equality Act 2010 and expected to undertake their functions in a way that is most likely to reduce health inequalities

11. Public Health Programme HEALTH VISITOR PROGRAMME ?

12. Spheres of influence Funding Accountability Parliament Department of Health Public Health England NHS Commissioning Board Local offices & senates Monitor Care Quality Commission licencing Local Authorities HWB Boards JSNA’s Public Health Local partnership (Any Qualified) Provider Clinical Commissioning Groups supported ‘clinical’ networks contract LSCB Accountability for results Patients and Public – (adults and children) Local Health Watch

13. Reforms - NHS London Where are we now in London? • Transition? PCT Clustering TCS and vertical integration FT pipeline Performance • Commissioning Commissioning support Clinical Commissioning Groups / Federations? & authorisation • Clinical [Safeguarding] Networking Designated Professionals, Named Nurses Acute, Named Nurses Community Named Midwives • Health Visitor Project

14. Munro 4 themes • MUNRO REVIEW • Less beurocracy–remove assessment timescales etc • Improve quality of assessment and services – locally determined • Rewrite Working Together • Remove constraints to local innovation (national - forms, KPIs, IT systems) • Involving health in Joint unannounced Inspection Process • Data set agreed PRACTICAL APPLICATION IN NHS Less practice guidance – local interpretation More [health] professional discretion in assessments and care planning – pilots in progress Use own initiative and professional expertise for developing and evaluating services, researching practice models, utilising evidence based practice Comprehensive observation of practice by Ofsted/CQC unannounced inspections • A system that values professional expertise 2. Sharing responsibility for the provision of early help • MUNRO REVIEW • Impact of NHS Reforms • Shared understanding of NHS roles & responsibilities • Retention of professional expertise • Relationship of LSCB & HWB Board • CCG development • NHS (CQC) inspection • Coordinated effective early help assessment processes and services (JSNA) • PRACTICAL APPLICATION IN NHS • Health Visitor Programme, • MASH Projects • School Nurse Development • Family Nurse Partnerships • Integrated Early Help Teams • Working in the community and other partners – Vol Sector & Social Care • Peer Review and audit • Sharing good practice

15. Munro 4 themes • MUNRO REVIEW • NOT NHS SPECIFIC BUT SHOULD ALSO BE REFLECTED BY NHS • High quality practice placements • Professional capability framework • CPD framework & performance appraisal • Career pathways • Leadership • Recognition of specialism PRACTICAL APPLICATION IN NHS Good NHS initial training in HEIs Good post graduate – in-service training Appraisals to reflect safeguarding competency performance and training needs Developing a career pathway – succession planning Leadership Courses 3. Developing [Social Work] Expertise and Supporting Practice 4. Clarifying accountabilities and creating a learning system. PRACTICAL APPLICATION IN NHS Training for health staff on systems approaches including RCA NPSA assisting development with methodology and accountability Ensuring lessons are learned and applying performance management to ensure improvement • MUNRO REVIEW • NOT NHS SPECIFIC BUT SHOULD ALSO BE REFLECTED BY NHS • LSCB annual reports to CE & Leader of Council, Police & Crime Commissioner, Chair of HWB • LSCBs to monitor effectiveness of CHILDRENS services and senior managers • Researching options for using a systems methodology for SCRs

16. Ofsted Review • Unannounced inspections • Ofsted and CQC combined – no longer parallel processes • Pilots already underway • Will review 50 not 20 cases – thoroughly!!!!! • Map the child’s journey and experience of services • Includes practice observation in the field • 4 judgment areas • Effectiveness of service • Effectiveness of interventions (including early help) • Quality of practice • Effectiveness of leadership and governance • Regular peer review and audit will help you to prepare!

17. Nosgrove Review • Review of children in family justice system • Quicker timescales • Less delays (expert witnesses) • More emphasis on child’s wishes and feelings • More reliance on good Social Work assessment • Health Professionals able to be more involved in providing Social care colleagues with health aspects of assessment • Multi-agency training

18. Big Society & localism • Fits public health agenda well • Working with communities • Meets needs of the most vulnerable • Enables community participation • Children’s voice heard in design and evaluation • Health Visitor Programme Strands • Community • Universal • Universal Plus • Universal Partnership Plus • Enables other skilled professionals to support community health system eg Children’s Charities and support groups

19. Parting Shot Be the change that you want to see in the world. An ounce of practice is worth more than tons of preaching. Mohandas Gandhi

20. Questions & Discussion • What do YOU have to do as a children’s safeguarding professional (in any professional context) to ensure that the new NHS grasps the opportunities and improves safeguarding children services ?