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19 November 2013

19 November 2013. Joint Health Visiting Workshop. Welcome Lisa Bayliss-Pratt Director of Nursing,HEE Hilary Garrett Director of Nursing, Commissioning and Health Improvement, NHS England. Workforce growth Lisa Bayliss-Pratt Director of Nursing, HEE Tom Houston

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19 November 2013

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  1. 19 November 2013 Joint Health Visiting Workshop

  2. Welcome • Lisa Bayliss-Pratt • Director of Nursing,HEE • Hilary Garrett • Director of Nursing, Commissioning and Health Improvement, NHS England

  3. Workforce growth • Lisa Bayliss-Pratt • Director of Nursing, HEE • Tom Houston • National Delivery Officer, NHS England • Carol Jollie • Education and Training Policy Manager and Health Visiting Programme Lead, HEE

  4. HEE’s purpose… HEE exists for one reason and one reason only: to help improve the quality of health and healthcare by ensuring that our workforce has the right numbers, with the right skills, values and behaviours, at the right time and place. Investing in our current and future workforce is the only way to ‘future proof’ the NHS. The healthcare workforce is the means by which the ambitions of the NHS are realised. HEE and the Local Education and Training Boards (LETBs) have been created for this purpose.

  5. LETBs Total of 13 LETBs Committees of HEE Not Statutory Bodies Provider led Stakeholder representation Core leadership of: Managing Director Independent Chair Director of Education and Quality Head of Finance Dispersed HEE leadership Deaneries part of LETBs

  6. HEE’s roles and responsibilities Workforce Planning Recruiting for values and behaviours into education and the workforce Commissioning undergraduate and postgraduate education (numbers and content) Leadership of CPD NHS Careers Education, training and development strategy for the non-professionally qualified workforce £4.9bn per annum = £10,000 per minute 159,000 students directly or indirectly funded by HEE

  7. HEE Mandate The Mandate sets out the Government’s strategic objectives in the areas of workforce planning, health education, training and development for which HEE and the LETBs have responsibility The Mandate aligns with the Mandate for NHS England and the Francis Report, as well as with the Education Outcomes Framework and the requirements of the NHS, Public Health and Social Care Outcomes Framework

  8. Strategic priorities Gamification and the careers service Non-surgical cosmetics Values-based recruitment Pre-degree care experience Widening participation Trainee feedback app Four-year GP training Older people, complex needs Bands 1-4 strategy Dementia awareness CPD Genomics

  9. HV in HEE Mandate “The commitment to an additional 4,200 FTE health visitors, by April 2015, will help to ensure vital support to new families and give children the best start in life. HEE has a key role to play in commissioning sufficient training places across the country to ensure the additional staff are available in the right place at the right time. To achieve this, HEE will need to work closely with the NHS England to align training commissions with service plans and with PHE and local authorities to ensure sustainable development and smooth transfer of commissioning.”

  10. Health Visitor MDS UpdateJoint NHS England and HEEHealth Visiting Event19th November 2013

  11. What and why? • Demonstrate delivery of the 4200 FTE national workforce growth target • Demonstrate the training pipeline is on track to deliver the required growth • Informs policy and drives practical, on-the-ground initiatives including via KLOE follow up reports • Show monthly progress vs trajectories at national, regional and area team levels • Reporting requirement under Section 7A of the Public Health Operating Framework reporting system inherited from the DH • Show progress against plans under ROCR license ROCR/OR/2156/003MAND NHS England

  12. Where are we now? fte Qualified Health Visitors BY REGION – ENGLAND Summary The number of health visitors in July 2013 has converged with plans to represent a national shortfall of 2 FTE In July 2013, a reduction of 20 FTE from June 2013 was reported. 9103 FTE Health Visitors are now employed in England. Trajectories were forecast to fall by 30 FTE in this period due to the seasonal combination of very low outturn from education in this period and steady turnover; more than 1000 newly qualified health visitors are forecast to complete training in the next two month period. National delivery is reported as being 2 FTE (0.02%) below the planned figure of 9,105. Data Quality: Actual figures may be subject to minor fluctuations for a few months from April 2013 as Area Teams develop mature systems to fully capture local provider/commissioner flows and accurately adjust reporting to accommodate structural changes including shift to community settings. Specific work is underway to ensure that Area Teams capture all of the health visitors working for providers not linked to ESR systems; typically 3-4% of the national total. Whilst ESR providers’ data is automatically fed into national reporting, bespoke collections by area teams are needed for these to be included. COMMENTS NHS England

  13. Qualified Health Visitors - ENGLAND NHS England

  14. Where are we now? Training Cumulative NUMBER OF Students STARTING TRAINING BY region – ENGLAND (INCL. Full-time, part-time & return to practice). NHS England

  15. Cumulative NUMBER OF Students Starting Training –ENGLAND (INCL. Full-time, part-time & return to practice). NHS England

  16. Cumulative NUMBER OF Students completing training BY REGION – ENGLAND (INCL. Full-time, part-time & return to practice). NHS England

  17. Cumulative NUMBER OF Students Completing Training –ENGLAND (INCL. Full-time, part-time & return to practice). NHS England

  18. The next period is critical • Workforce growth: • 1300 FTE growth in #s required by end of December • (report due March) • Training numbers: • 2665 students expected to begin FT, PT and RTP programmes by the end of January • (report due April) NHS England

  19. Developing the mds • Requests from the SoS for greater insights into the likelihood of delivery • Failings of MDS report to capture critical information on other key factors: course attrition, staff turnover • Trajectories contain implied national attrition and turnover values • Additional metrics to be added on the basis that they: • Represent minimal additional burden • Utilise information already held in the system wherever possible • Can be used to identify areas for support and development work • Information fed back to area teams and LETBs NHS England

  20. CHALLENGES AND NEXT STEPS • Workforce planning and reporting workshop • Trajectory setting for 2014/15 • Reporting in 2014/15 and beyond • Switchover to LA commissioning • HV Definitions and new metrics for reporting • Non-ESR provider reporting • Best practice collaboration: LETBs and ATs • Questions and support offer NHS England

  21. Completers to end Oct

  22. Starters to end Sep/Oct 2013 1HE South West: Number of RtP starters at end October is 11 lower than the figure given for end September. This was due to the fact that some providers were providing estimate of planned not actual. The figures have now been adjusted down to accurately reflect actual numbers of starters.

  23. Offers at end Oct

  24. Service transformation • Examples of local LETB-led initiatives: • London – super training hubs • Thames Valley/Wessex – 2 new posts to help with preceptorship and Practice Teacher and Mentor support • KSS – action research project with action learning sets looking at implementing new service model • EoE – Communities of Practice, Building Community Capacity programme, rapid appraisal, leadership programme • North West and North East – supporting local Communities of Practice • LETBs have a role in supporting Area Teams to: • get the training right for a transformed service • strengthen development opportunities for existing staff • support new ways of working • develop Practice Teachers and mentors and flexible models of support • work with providers to ensure preceptorship and clinical professional and personal development opportunities

  25. Commissioner-led health visitor service transformation Hilary Garratt Director of Nursing NHS England Sabrina Fuller Head of health improvement NHS | Presentation to [XXXX Company] | [Type Date]

  26. Service transformation deliverables • Full delivery of new model of health visiting • Universal components of the Healthy Child Programme • Understanding and supporting the needs of communities • Targeted specialised support • Intensive multi-agency working to meet complex needs • Ensure that commissioning of public health services for 0-5s is effective and embedded with commissioning of other early years services. • Improvement in defined public health outcomes

  27. Commissioner-led service improvement • Strategic overview of 0-5s commissioning • Local relationships with LA early years commissioning and CCGs • Strategic partnership working through HWB Board and/or Childrens Partnerships • Clear commissioning expectations through service specification and performance management framework • Strong relationships with provider organisations • Providing assurance of success – service delivery and outcomes • Partnership with Regions, LETBs and PHE

  28. Clinical leadership • Nursing directorate working in partnership with commissioners • Area Team Directors of Nursing working closely with provider Directors of Nursing • Providing leadership on delivery of service transformation, quality, safety and improved outcomes. • Regional support from Chief Nurses • Ambassadors for health visitors as 0-5 health and wellbeing experts and leaders of partnership teams

  29. Achievements so far • 2013-14 spec in contracts sets out new model of health visiting • Performance framework used to establish national baseline for service delivery • Working with PHE child health network on atlas of benchmarked PH outcomes for 0-5s • Close partnership working locally and nationally on delivery of evidence-based assessments and interventions to improve outcomes.

  30. Taking service transformation forward in partnership • Local authority led commissioning from 2015 • 2014-15 commissioning with local authorities • Provider organisations and clinical staff need to understand, support and deliver to the requirements of the new system • Development and implementation of partnership (HWBS) strategies to improve public health outcomes for young children and families

  31. Commissioner-led health visitor service transformation Hilary Garratt Director of Nursing NHS England Sabrina Fuller Head of health improvement NHS | Presentation to [XXXX Company] | [Type Date]

  32. In summary • Challenge of rapid system-wide transformation • Area teams leading across system – with HWB board partners and providers • Providing assurance of delivery • Focus on outcomes and a shared strategic approach • Retaining our workforce • Opportunity to improve current and future health and wellbeing for children and young families

  33. Resource to support service transformation • Clear criteria for bids to provide assurance on delivery of outcomes and outputs and VFM • Strategy development involving commissioner and providers; workforce development for delivery • Benchmarked against criteria end of November. • Support offered to Area Teams bids below not meeting standards • Intermediate and final evaluation

  34. Retaining our workforce • Working with DH to commission web-based and one to one support for providers on workforce analysis and strategy • Know your workforce, professional engagement and development, flexible employment and retirements, staff health and wellbeing. NHS | Presentation to [XXXX Company] | [Type Date]

  35. Next steps • Consultation on 14-15 service specification and amending to meet 7A requirements and other developments • Data quality assurance so can establish baselines • Local agreements with providers on delivery plan for new model of health visiting • Using PHOF benchmarking to guide local strategy development

  36. In summary • Challenge of rapid system-wide transformation • Area teams leading across system – with HWB board partners and providers • Providing assurance of delivery • Focus on outcomes and a shared strategic approach • Retaining our workforce • Opportunity to improve current and future health and wellbeing for children and young families

  37. PHE role in supporting delivery of Health Child Programme(0-5 years) Dr Ann Hoskins Director for Children, Young People and Families Public Health England

  38. Why Children and Young People are a Priority • The evidence base shows we can make a difference through early intervention and public health approaches (http://www.dwp.gov.uk/docs/early-intervention-next-steps.pdf and www.earlyinterventionfoundation.org.uk • There are economic and social arguments for investing in childhood. The Family Nurse Partnership estimated savings five times greater than the cost of the programme in the form of reduced welfare and criminal justice expenditures; higher tax revenues and improved physical and mental health (Department for Children, Schools and Families (2007) Cost–Benefit Analysis of Interventions with Parents. Research Report DCSF-RW008).. • Marmot showed that of c. 700,000 children born in 2010, if policies could be implemented to eradicate health inequalities, then each child could expect to live two years longer. (http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review) • Child poverty has short, medium and long term consequences for individuals, families, neighbourhoods, society and the economy. These consequences relate to health, education, employment, behaviour, finance, relationships and subjective well-being (http://www.jrf.org.uk/system/files/2301-child-poverty-costs.pdf.).

  39. Key factors for poor development outcomes • Parental worklessness • Teenage mother • Parental lack of basic skills, which limits daily activities • Household overcrowding • Parental depression* • Parental illness or disability • Smoking in pregnancy* • Parent at risk of alcoholism • Domestic violence • Financial stress* • Teenage mother, smoking in pregnancy and parental depression frequently occur together • * Associated with worst outcomes – cognitive emotional, conduct, hyperactivity, peer & pro-social Analysis of MCS, Sabates & Dex, 2013

  40. LAC Population Snapshot, March 2012AYPH, 2013 • 67,050 • children • in England

  41. Healthy Child Programme (0-5)Rapid, limited review of the evidence • HCP published 2009, since then many more studies relating to early years • Review will look to update evidence in certain key areas e.g. parent infant attachment, speech language and communication etc • Look at implications for delivery of the programme both at a service and practitioner level and handover between services • Cost benefits of the programme for health and wider society • NOT cover imms/vacc and screening services Presentation title - edit in Header and Footer

  42. PH workforce for children and young people • Initially mapping out programme for PH and PHE staff (working with LGA ) • Link with learning from other initiatives eg Early Intervention Foundation, Big Lottery, Greater Manchester, London, Solihull • Develop wider programme picking up integrated, asset based working, (keen to work with HEE) • Include some specific skills in relation to leadership, K&I, behavioural change and social marketing Presentation title - edit in Header and Footer

  43. PHE/NHS E developing HV dashboard

  44. Work in progress

  45. Standard template Tailored at a regional level Local Authority Child Health Profiles “We found this information very useful for setting priorities and assessing interventions”

  46. http://www.chimat.org.uk/default.aspx?QN=CHMK1 Improving the health and wellbeing of school aged children

  47. Commissioning for PreventionImportance of the H&WB boards

  48. CMO Annual report: Our children deserve better: prevention pays Sets out the challenges to the health and wellbeing of our children and young people Supports life course approach Makes the economic case for improving the lives of children and young people Emphasises importance of data, service provision and prevention Highlights importance of early life determinants such as parenting and the inequalities in child health Emphasises importance of the voice of children and young people Highlights need for everyone in the public services to “think family and children and young people” at every interaction Challenges and opportunities for achieving public health outcomes for children and young people

  49. The Task of Commissioning for Prevention To prevent early adversities becoming biosocially embedded 688,100 new opportunities available last year in the England

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