19 November 2013 Joint Health Visiting Workshop. Welcome Lisa Bayliss-Pratt Director of Nursing,HEE Hilary Garrett Director of Nursing, Commissioning

19 November 2013

Joint Health Visiting Workshop

WelcomeLisa Bayliss-PrattDirector of Nursing,HEEHilary GarrettDirector of Nursing, Commissioning and Health Improvement, NHS England

Workforce growthLisa Bayliss-PrattDirector of Nursing, HEETom HoustonNational Delivery Officer, NHS EnglandCarol JollieEducation and Training Policy Manager and Health Visiting Programme Lead, HEE

www.hee.nhs.ukwww.hee.nhs.uk

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 rightnumbers, with the right skills, values and behaviours, at the right

time andplace.

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 beencreated for this purpose.


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


HEE’s roles and responsibilities

Workforce Planning NHS

Careers

Recruiting for values and

behaviours into education and the workforce

Commissioning undergraduate and

postgraduate education (numbers

and content)

Education, training and development strategy for the

non-professionally qualified workforce

Leadership of CPD

£4.9bn per annum = £10,000 per minute

159,000 students directly or indirectly funded by HEE


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


Strategic priorities

Pre-degree care experience

Non-surgical cosmetics

Dementia awareness CPD

Trainee feedback app

Gamification and the careers service

Widening participation

Older people, complex needs

Four-year GP training

Values-based recruitment

Genomics

Bands 1-4 strategy


“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.”

HV in HEE Mandate

Health Visitor MDS Update

Joint NHS England and HEEHealth Visiting Event

19th November 2013

11 July 2013

WHAT AND WHY?

NHS England

• 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

12 July 2013

COMMENTS

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.

QUALIFIED HEALTH VISITORS BY REGION – ENGLAND

NHS England

Baseline

Jul 2013/14 May-10

Actual Plan 2013/14 Delivered 2014/15 Delivered Actual

North 3,200 3,186 14 0% -24 -1% 3,555 90% 3,811 84% 2,747 453 16%Midlands & East 2,663 2,649 14 1% -4 0% 3,172 84% 3,683 72% 2,311 352 15%London 1,139 1,135 4 0% -8 -1% 1,584 72% 1,842 62% 1,151 -12 -1%South 2,101 2,135 -34 -2% 14 1% 2,479 85% 3,009 70% 1,883 218 12%England 9,103 9,105 -1 0% -20 0% 10,790 84% 12,345 74% 8,092 1,011 12%

3c Qualified HVs (full time equivalent, rounded to nearest integer, - denotes zero denominator and no percentage calculated).

Full Year Operating PlanLatest Month

Difference from Plan

Difference from Previous Month

Difference fromBaseline

WHERE ARE WE NOW? FTE

13 July 2013

QUALIFIED HEALTH VISITORS - ENGLAND

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Plan 9,132 9,147 9,135 9,105 9,096 9,429 9,942 10,352 10,399 10,473 10,600 10,790

Actual 9,075 9,149 9,124 9,103

6,000

7,000

8,000

9,000

10,000

11,000

12,000

Fu

ll T

ime

Eq

uiv

ale

nt

6,000

7,000

8,000

9,000

10,000

11,000

12,000

13,000

2011/12 2012/13 2013/14 2014/15

Annual Position (Total) 2011/12-2014/15

Plan Actual

NHS England

14 July 2013

CUMULATIVE NUMBER OF STUDENTS STARTING TRAINING BY REGION –ENGLAND (INCL. FULL-TIME, PART-TIME & RETURN TO PRACTICE).

NHS England

Jul 2013/14

Actual Plan Number % 2013/14 %

North 1 0 1 - 541 0%Midlands & East 0 30 -30 -100% 961 0%London 0 0 0 - 382 0%South 10 2 8 400% 848 1%England 11 33 -22 -67% 2,732 0%

Latest Month

4d HVs starting training (cumulative, rounded to nearest integer, - denotes zero denominator and no percentage calculated).

Difference(Actual vs Plan)

Full Year Operating Plan

WHERE ARE WE NOW? TRAINING

15 July 2013


Plan 2 28 31 33 34 1,805 1,879 1,880 1,883 2,676 2,677 2,731

Actual 1 1 6 11

0

500

1,000

1,500

2,000

2,500

3,000

He

ad

Co

un

t

0

500

1000

1500

2000

2500

3000

2011/12 2012/13 2013/14 2014/15


Plan Actual

CUMULATIVE NUMBER OF STUDENTS STARTING TRAINING –ENGLAND (INCL. FULL-TIME, PART-TIME & RETURN TO PRACTICE).

NHS England

16 July 2013

CUMULATIVE NUMBER OF STUDENTS COMPLETING TRAINING BY REGION –ENGLAND (INCL. FULL-TIME, PART-TIME & RETURN TO PRACTICE).

NHS England

Jul 2013/14

Actual Plan Number % 2013/14 %

North 3 2 1 50% 533 1%Midlands & East 0 20 -20 -100% 673 0%London 2 0 2 - 229 1%South 4 8 -4 -50% 457 1%England 9 30 -21 -70% 1,892 0%

Difference(Actual vs Plan)

Full Year Operating Plan

Latest Month

5a+b HVs completing training (cumulative, rounded to nearest integer, - denotes zero denominator and no percentage calculated).

17 July 2013

CUMULATIVE NUMBER OF STUDENTS COMPLETING TRAINING –ENGLAND (INCL. FULL-TIME, PART-TIME & RETURN TO PRACTICE).


Plan 4 5 25 30 238 1,036 1,115 1,317 1,320 1,739 1,764 1,893

Actual 3 4 5 9

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000

He

ad

Co

un

t 0

500

1000

1500

2000

2500

3000

2011/12 2012/13 2013/14 2014/15


Plan Actual

NHS England

18 July 2013

THE NEXT PERIOD IS CRITICAL

NHS England

• 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)

19 July 2013

DEVELOPING THE MDS

NHS England

• 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:

o Represent minimal additional burden

o Utilise information already held in the system wherever possible

oCan be used to identify areas for support and

development work

oInformation fed back to area teams and LETBs

20 July 2013

CHALLENGES AND NEXT STEPS

NHS England

• Workforce planning and reporting workshop

o Trajectory setting for 2014/15

o Reporting in 2014/15 and beyond

o Switchover to LA commissioning

o HV Definitions and new metrics for reporting

o Non-ESR provider reporting

o Best practice collaboration: LETBs and ATs

o Questions and support offer


Completers to end Oct

Region Total planned completers to end October

Total actual completers to end October

Total planned completers to end 2013/14

Number of starters who have not yet completed studies

Total actual completers + starters not yet completed

Total maximum potential ‘oversupply’

North 379 272 533 261 533 0London 155 158 229 96 254 +25Midlands & East

273 560 673 270 830 +157

South 308 348 457 246 594 +137TOTAL 1,115 1,338 1,892 873 2,211 +319Assume attrition of 10%

-87 +232


Starters to end Sep/Oct 2013

Region Cumulative planned numbers to end September (incl RtP)

Cumulative number of starters to end September

Cumulative planned numbers to end October

Cumulative number of starters to end October

North 309 308 382* 344

London 208 162 208 162

Midlands & East 749 621 750 621

South 538 519 538 5081

TOTAL 1,804 1,610 1,878 1,635

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.


Offers at end OctRegion Total

planned training commissions 2013/14

Number of starters to date

Number of commissions remaining to be filled

Number of offers for January/February cohorts

Shortfall as at end October

North 535 344 191 173 18

London 382 162 220 75 145

Midlands & East

955 621 334 324 10

South 860 508 352 177 175

TOTAL 2,732 1,635 1,097 749 348


Service transformation

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

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

NHS | Presentation to [XXXX Company] | [Type Date]25

Commissioner-led health visitor service transformation

Hilary Garratt Director of Nursing NHS EnglandSabrina Fuller Head of health improvement

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

26

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

27

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

28

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.

29

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

30


Commissioner-led health visitor service transformation

Hilary Garratt Director of Nursing NHS EnglandSabrina Fuller Head of health improvement

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

32

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

33

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.


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

35

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

36

PHE role in supporting delivery of Health Child Programme(0-5 years)

Dr Ann HoskinsDirector for Children, Young People and FamiliesPublic Health England

38

• 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.).

Why Children and Young People are a Priority

http://www.dwp.gov.uk/docs/early-intervention-next-steps.pdf

http://www.earlyinterventionfoundation.org.uk/

Key factors for poor development outcomes• 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

39

• Parental worklessness

• Teenage mother

• Parental lack of basic skills, which limits daily activities

• Household overcrowding

LAC Population Snapshot, March 2012AYPH, 2013

67,050children

in England

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

41 Presentation title - edit in Header and Footer

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

42 Presentation title - edit in Header and Footer

PHE/NHS E developing HV dashboard

Work in progress

Improving the health and wellbeing of school aged children

Local Authority Child Health Profiles

Standard templateTailored at a regional level

“We found this information very useful for setting priorities and assessing interventions”

47 Improving the health and wellbeing of school aged children

http://www.chimat.org.uk/default.aspx?QN=CHMK1

Commissioning for PreventionImportance of the H&WB boards

Female health 15-44 years• Smoking Cessation • Weight Management• Emotional health and wellbeing• Domestic abuse prevention & support for women

Pregnancy• Smoking Cessation • Weight Management• Family Nurse Partnership

Foundation Years• Health Visiting Services • Peer Breastfeeding Support• Parenting support

• 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

49 Challenges and opportunities for achieving public health outcomes for children and young people

CMO Annual report: Our children deserve better: prevention pays

688,100 new opportunities available last year in the England

To prevent early adversities becoming biosocially embedded

The Task of Commissioning for Prevention

For support or to find out more

Contact your local specialisthttp://www.chimat.org.uk/default.aspx?QN=CHIMAT_LOCAL

www.gov.uk/phe

www.chimat.org.ukTwitter@PHE_children

51

http://www.gov.uk/phe

http://www.gov.uk/phe

http://www.chimat.org.uk/

Health Visiting in the Wider Context of

Public Health Commissioning for 0-5s

NHS England

19 November 2012

Sandra Anglin

Assistant Head of Public Health Commissioning

Overview

• NHS England functions and values

• 0 to 5 Specifications

• Challenges and Opportunities for Commissioning


All Area Teams

54

• 27 Area Teams responsible for Primary Care and Public Health commissioning (including Dental, Pharmacy, Optical)

• Responsible for Healthy Child 0-5 programme (including Health Visitor and Family Nurse Partnership)

Aims and Ambitions of NHS England

• We exist to:

• Save and improve lives: to make people better when they are ill.

• Design and deliver care around the needs and choices of each individual patient. We want to make the NHS the best customer service in the world.

• To ensure that every person who comes in to contact with the NHS is treated fairly and equally, whether a patient or a member of staff.

• To allocate valuable public resources to secure the best possible outcomes for patients now and in future generations.

• To uphold the NHS Constitution.

The NHS belongs to us all.

55

Public Health Functions Commissioned by all 27 ATs

• Public Health of offenders and detained settings

• Child Health Information Systems (CHIS)

• Immunisation Programmes

• Screening Programmes

• (Sexual Assault Referral Centres)*

• Children’s Public Health Services - 0 to 5 years

56

Children’s Public Health Services for 0 to 5 year olds

57

Commissioning responsibilities

CCGs Maternity services, Adult and child mental health services, Acute and community services

Area Teams Child Health Information System (CHIS)Health VisitorsFamily Nurse Partnerships

NHS Public Health Steering Group

Health Visitor Programme

Board*^

Health & Justice Partnership Delivery

Group

Screening Programme Board

Immunisation Programme Board SARCs Programme

Board

BSS Programme Board*

Immunisation new prog Project

Boards

NHS Public Health Senior Oversight

Group

LGAInternal Structures

PHE Internal Structures

DH Internal Structures

NHS England Internal Structure

DH & LG Strategic Forum

Public Health System Group

HTTG

NHS PH Functions AgreementKey:Green – accountability ^ – for transition to LAsBlue – advisory * PM priorities reporting

CHISProgramme

Board^

FNPProgramme

Board^

Children’s H&WBPartnership

Individual Organisation’s agreed views feeding in – DH, PHE, NHS England, HEE, NHS TDA, CCGs, LAs etc

X Govt Health & Justice Partner-

ship Board

NHS England will commission Children’s Public Health Services

“ Our ambition is to help give children the best start in life, promote their health and resilient as they grow up, and the governments commitment to an additional 4200 health visitors by 2015 will help to ensure vital support to families”.

59

Programme Baseline Progress Spring 2012 TargetHealth Visitors 8,092 8,449 12,292Family Nurse Partnership 6,500 9,200 16,000

Commissioning Specifications (1)

Supporting Delivery

Securing Excellence In Commissioning For the Healthy Child Programme 0-5 Years

Sets out the operating model through which NHS England will secure the best possible health outcomes for children and young families

http://www.england.nhs.uk/wp-content/uploads/2013/08

/comm-health-child-prog.pdf

Including Health Visiting and Family Nurse

Partnership Programmes

60

http://www.england.nhs.uk/wp-content/uploads/2013/08/comm-health-child-prog.pdf



Commissioning Specifications (2)

61

Health Visitor Service Specification

Universal Element of Health Child Programme 0-5 yearsEarly intervention and prevention programme offered universally including offer of screening, immunisations, development reviews, and information to support children and parenting

Commissioning Specification

62

Outcome MeasuresHealth Improvement

(PHOF 2.2) Breastfeeding initiation and prevalence at 6-8 weeks after birth (PHOF 2.5) Child development at 2-2½ years (PHOF 2.6) Excess weight in 4 – 5 year olds (PHOF 2.7) Hospital admissions caused by unintentional and deliberate

injuries in under 5s (PHOF 2.21) Access to non-cancer screening programmes

Health Protection(PHOF 3.3) Population vaccination coverage (PHOF 4.1) Healthcare public health and preventing premature mortality

Infant mortality (PHOF 4.2) Tooth decay in children aged 5

Improving wider determinants of health(PHOF 1.2) School readiness

Specification Goal

63

1. Full delivery of new model of health visiting including universal elements of healthy child programme

2. Ensure that commissioning of public health services for 0-5s is effective and embedded with commissioning of other early years services

3. Improvement in defined public health outcomes

Interdependencies and ensuring a seamless pathway

• The outcomes above highlight that it is essential that the healthy children's programme 0-5 is not commissioned or provided in isolation to other healthcare services

• It is crucial that operational relationships with social care, children's centres, local authorities, health & justice partnerships are maintained and strengthened.

64

Challenges

65

• Fractured commissioning

• Understanding organisational boundaries

• Changing the current model of work

• Short timeline

• Change fatigue

• Anxiety for the future

Opportunities

66

• Establish a local vision

• Using the Health and Wellbeing Board, JSNA and Health and Wellbeing Strategy to develop an integrated approach to commissioning

• Improved pathway development

• Increased user engagement

Questions?

19 November 2013

Workshops


Enjoy your lunch!

19 November 2013

Regional Networking Meetings

19 November 2013

Viv Bennett, Director of Nursing, Department of Health and Public Health England


Questions for panel

19 November 2013

Hilary GarrettDirector of Nursing, Commissioning and Health Improvement, NHS EnglandKate Davis OBEHead of Public Health, Armed Forces Health and Offender Health, NHS England


Thank you for coming

Have a safe journey home

Documents

19 November 2013 Joint Health Visiting Workshop. Welcome Lisa Bayliss-Pratt Director of Nursing,HEE Hilary Garrett Director of Nursing, Commissioning