Women’s and Children’s Powys tLHB

Practice Development: Developing Practice. 2011-2016

Contents:

  1. Introduction:
  1. Background:
  2. Practice Development Flow chart
  3. Drivers for change
  4. Model for Improvement
  5. Women’s and Children’s life cycle
  6. Tiered model of care provision
  1. Priorities in Practice:
  2. Promote Health and wellbeing
  3. Continuously improve safety, effectiveness and patient experience
  4. Capture the benefits of integration
  5. Empower our staff
  6. Live within our means
  1. SMART Objectives:
  2. Midwifery
  3. Health Visiting
  4. School nursing
  5. CAHMS
  6. Speech and Language therapy
  7. Physiotherapist Paediatrics/transition & LD
  8. LAC
  9. Safeguarding Children
  10. Paediatrics
  1. Standards for health care Services Mapping:

1. Introduction:

This Practice Development Strategy provides a framework which will help direct the investment in training and development for the period April 2011 - March 2016. It reflects the values of the Management team and the commitment to improving client care. It intends to provide realistic targets and expectations whilst achieving the requirements of clinical governance and the wider political agendas. The Practice Development Plan has been designed to reflect our commitment to achieving effective change in Women’s and Children’s services and to be congruent with Powys LHB Strategies including:

  • Women’s and Children’s workforce plan
  • Women’s and Children’s training plan
  • The annual operating framework
  • The LHB Nursing and Midwifery strategy
  • The LHB’s Business Plan
  • The LHB Training plan.
  • LHB Policies and Procedures
  • LHB Clinical Governance strategy

The overall aim of Practice Development within Women’s and Children’s services is to meet Service and individual development needs whilst addressing relevant local and national guidance on developing a quality service. Women’s and Children’s staff are key professionals in ensuring that families have a safe and emotionally satisfying experience during their individual life cycle. This strategic plan sets out the contribution health professionals and support staff will make to achieving quality, cost effective services for families across Powys. They are a highly skilled workforce with the scope to provide a world class service.

The Practice Development plan sets out the prioritised actions to be taken over the 5 years to respond to the key messages within all the national and local drivers described below. As well as meeting the requirements for standards for healthcare services (WAG 2010).The Practice Development Strategy will steer the focused work to address the key prioritises, and fits with the Powys Nursing and Midwifery strategy. Care closer to home; less unnecessary care outside Powys; focuses on community orientated services, and services using the finite healthcare resources to ensure that clients are treated in the right place at the right time by the right people.

2. Background:

Practice development within women’s and Children’s services encompasses aspects of research, training, and change in practice. Underpinning all developments in practice is an understanding of a citizen based care provision as part of a continuous life cycle using a tiered model of care. This model of care encourages service provision at tier 1&2 to concentrate on the prevention of illness and the promotion of health and wellbeing to all.Enabling resources in tier 3&4 to be used more effectively for those families with high additional needs. An individual may access care from women’s and children’s services right from before birth through pregnancy, childhood and adolescents to returning for care when starting their own family in a complete life cycle. Families may access care at different tiers depending on need at different times within their life cycle and move up and down the tiers as the needs of the family change over time.

Practice Development: Developing Practice 2011-2016 Final: Marie Lewis Practice Development Midwife. 2011

2.1

Practice Development: Developing Practice 2011-2016 Final: Marie Lewis Practice Development Midwife. 2011

2.2 Drivers for Change taken from W&C Powys tLHB Workforce Plan 2011.

This Practice Development strategy is designed to work alongside and in conjunction with the Workforce plan and the training plan. It should be recognised that the achievement of the Practice Development Strategy can only be successful if the workforce plan and training plan are viewed and achieved as a unified process for successful change.

Define the national forces/drivers for change that will impact on the organisation in the future.
National Service Framework for Maternity, Children and Young People – the NSF is a ten year plan that sets out standards to be achieved on a multi-agency basis across Wales. They include ‘flagged’ standards that should be regarded as priorities. A number of the standards require new roles, resources, and multi-agency collaboration.
For maternity services the focus is to have midwives ‘visible’ in the community, to be first point of contact for pregnant women, to increase the number of low risk women offered early labour home assessments and consider home births as a safe and preferred option.
Child and Adolescent Mental Health Service Strategy – ‘Everybody’s Business’. This document sets out the strategic direction for the development of CAMH Services in Wales between 2001 and 2011. Its focus is on building capacity and competencies regarding children’s emotional health and well being in primary care and universal services. The document has been updated through the publication of ‘Breaking the Barriers’ in 2010. This sets out specific targets for areas of concern such as follow-up for young people that ‘Do Not Attend’ and appointment. Powys Health Board has an action plan setting out how ‘Breaking the Barriers’ will be delivered and how the annual operating framework targets for specialist CAMHS will be deliver. Linked to the CAMHS strategy the School Counselling Strategy from the Welsh Assembly Government is intended to strengthen ‘Tier 1’ CAMHS provision and help manage demand on specialist services.
Welsh Assembly Government Children and Young People’s Partnership Guidance – this is statutory guidance that requires all statutory sectors within Powys to work collaboratively to develop and deliver a ‘single plan’ for children and young people, agreed at Chief Executive level. The CYPP sits alongside the Health, Social Care and Well Being Strategy group which is the equivalent planning body for adult services. In Powys the work of the Children and Young People’s Partnership and the Health, Social Care and Well Being strategy group are being brought together under the Powys Service Board and the Single Plan for Powys.
Realising the Potential – Welsh Assembly Government Nursing Strategy. Published in 1999 this document is due for revision in 2009. A number of ‘briefing papers’ under this document set out priorities for nursing education, midwifery, child and adolescent mental health and paediatric nursing.Delivering the future for Maternity services focuses on midwives being the lead professionals for low risk women, by booking 60% of the caseload as midwife led care and to increase to a 10% home birth service.
Welsh Audit Office report for Maternity services’ focus to develop a Maternity strategy for Wales, to implement an ‘All Wales Maternity Data Set’, to review user involvement for maternity services and develop patient information and increase accessibility to antenatal education for all pregnant women.
Midwifery 20:20 Delivering Expectations recently publicised in 2010 which presents new challenges and opportunities for midwives to develop further their role as practitioners, partners and leaders in delivering and shaping maternity services.
Sexual Health Quality Requirements; the focus is to increase the availability of long acting contraception, screening for Sexually Transmitted Infections to be available within two working days, partnership between health and social care for residents living with HIV and locally accessible termination of pregnancy services. The HIV Care Pathway sets out the partnership arrangements between health and social care for Powys residents living with HIV.
Towards a Stable Life and a Brighter Future – this is statutory guidance giving minimum requirements to ensure safe, appropriate and adequate health provision to children looked after by local authorities. Implementing this strategy requires new roles in monitoring the health needs and health provision to look after children, and capacity to link with other NHS organisations and local authorities for children placed within and without the county.
Modernising Medical Careers and European Working Time Directive – The development of Women and Children’s Services in Powys must ensure that there is sufficient medical capacity to meet clinical governance requirements to ensure safe medical practice. At the same time, there will need to be sufficient capacity to meet waiting time targets and to meet the increasing number of statutory requirements in relation to Safeguarding, Fostering and Adoption, Childhood Immunisations, Statements of Special Educational Needs etc. It’s imperative that care pathways are in place to enable medical staff to work efficiently and effectively, making the best use of their skills and competencies. Increasing the number of medical sessions alone is not a solution.
National Health Service Annual Operating Framework – this document sets out the Welsh Assembly Government’s performance targets for the NHS. There are specific targets in 2010/11 for CAMHS, Sexual Health and Childhood Immunisations: Human Papillomavirus Vaccination Programme - Since September 2009, the school nursing team have delivered the HPV catch-up campaign to pupils in all secondary schools in Powys in Years 8, 10 and 11. The HPV vaccination was introduced in September 2008 to help protect girls against cervical cancer. Three doses of Cervarix vaccine is given to all eligible girls. Childhood Immunisation Programme - The health visiting and school nursing team are instrumental in promoting the childhood immunisation programme to help ensure Powys Teaching Health Board achieves the Welsh Assembly Government target of 95% uptake. Work continues on highlighting the importance of the measles, mumps and rubella vaccination campaign. BCG – A health visitor led BCG service is delivered by a dedicated health visitor to all children under school age deemed at risk of contracting tuberculosis.
Agenda for Change – provides scope for the reconfiguring of NHS services, and allows for the development of Skill Mix within teams based on competencies and skills rather than membership of a specific discipline. The current NHS staff configuration arising out of Agenda for Change reviews has been shown to be unsustainable and ‘not fit for purpose’.
Welsh Assembly Government Strategies for Eating Disorders, Autistic Spectrum Disorder and Suicide Prevention all has a bearing on this workforce plan.
The Welsh Assembly Government Family Nurse Project will require a full time Band 6 School Health Nurse based within every secondary school in Powys by October 2011. This provides opportunities to review arrangements to support Health Assessments in schools and the local multi-agency planning and delivery management arrangements across each of the six areas identified in the Single Plan for Children and Young People.
Rural Health Plan
“Mind Exercise Nutrition… Do It” or ‘MEND’: a multi-agency targeted treatment programme for childhood obesity. It includes services provided by NHS dietetics, Public Health and Powys County Council’s Leisure department.
1000 Lives Plus Campaign – Although primarily aimed at inpatient services, Women and Children’s Services are committed to the principles set out in ‘1000 Lives plus’ and developing community based programmes to support the campaign.
NICE guidance in relation to a variety of childhood diagnoses and care pathways have a bearing on this plan.
Statutory considerations in relation to Safeguarding such as Children Act 2008 and the Baby P enquiry recommendations all have a bearing on this plan.
The Mental Health Act 1983 (Amended 2007) and the Mental Capacity Act 2007 have specific requirements relating to the consent and treatment for Children and Young People. The Mental Capacity Act requirements relate to NHS provision in all settings and specialities. To be enacted in 2010 the Mental Health Measure places specific requirements on Child and Adolescent Mental Health Services such as entitlement to a specialist mental health assessment.
Designed for Life – Women and Children’s Services provided by Powys Health Board are community based and support the principle that health care should be safely provided as close as possible to the patient’s home. The development plan for Powys Women and Children’s Services is aimed at effectively managing patient pathways so that admissions to obstetric and paediatric inpatient services are appropriate and so that inpatient stays are kept to the minimum necessary time. The care pathway through hospital services for Powys patients should dovetail with our community services so that patients experience a seamless transition of care.
There are a number of other national drivers for change that will have an important but service specific impact on Women and Children’s Services provided by Powys Health Board:
  • 14 to 19 Learning Pathways
  • Healthy Schools Initiative
  • Suicide Prevention Action Plan
  • Hidden Harm - strategy for parents who misuse substances.
  • Standards for Specialist NHS Children’s Services
  • Community Nutrition initiative
  • Youth Justice Plan for Wales
  • Welsh Artificial Limb and Appliance Service (ALAC)
Powys Single Plan for Children and Young People – The single plan sits alongside the Health, Social Care and Wellbeing Strategy for Powys and realises the statutory commitment to produce a single multi-agency three year plan for Children and Young People. The plan commits tHB services for children and young people to be integrated with Social Care, Education and third sector provision in order to provide seamless services that deliver the “Powys Nine” objectives set out in the Single Plan. This commitment provides scope to maximise efficiencies across shared resources, and to reconsider traditional professional roles and models of service provision.
Safe Solutions for Rural Services – this document is a response to a review of clinical governance arrangements for Powys Health Board provided services, undertaken by the Welsh Assembly Government Delivery and Support Unit in 2006/07. This review highlighted the risks associated with small numbers of specialist staff working in isolated communities. There are specific recommendations regarding Women and Children’s Services, directing Community Medical Paediatrics and specialist Child and Adolescent Mental Health Services to be provided by larger NHS organisations with a large enough body of clinicians to provide adequate support for PDP activity and service cover. Powys teaching Health Board is currently considering whether these arrangements could be met adequately through a Managed Clinical Network arrangement.
In 2010, specific proposals are being developed in relation to an Integrated Children with Disabilities Team that, it is anticipated, will form the first phase of service integration across Powys’ statutory agencies for children. Developments, including building work, are now taking place in three of the six Community Focused Schools proposed under the Powys Single Children’s Plan, which will form the multi-agency administrative base for multi-agency teams.
Powys Community Safety Partnership – In 2010 the Partnership has developed a Service Specification for Substance Misuse Services for Children and Young People. This workforce plan must take account of care pathways between this service, community paediatrics, the NHS component of Powys Youth Offending Team and specialist Child and Adolescent Mental Health.
This workforce plan will take account of Powys Health Board’s revised Locality Management Structure. It is expected that Women and Children’s Services will become directly involved in helping to manage Long Term Agreements and Service Level Agreements with neighbouring NHS organisations; NHS Continuing Care; NHS Individual Patient Commissioning; budgets for equipment for disabled children and young people. While no new resources are available to Women and Children’s Services to undertake this work, there are opportunities to create efficiencies through quality assuring these contracts and provisions, and there is scope to invest in community provision through redesign of care pathways.
This workforce plan will take into account the efficiencies and improvements to practice that can be provided by developments in Information Technology. These will include the anticipated increasing use of telephone and video conferencing, electronic storage of clinical records, Clinical Workstation, the integration of NHS and Powys County Council e-mail systems, digital dictation, telemedicine, Community Health Across Agencies Project (CHAAP), and Technology In Maternity Services (TIMS).
Local Implementation Plan for School Health Nursing – A plan for Powys Teaching Health Board has been developed in response to the Framework for School Health Nursing which requires all secondary schools in Wales to have a Band 6 School Nurse in post before the end of the Assembly term. These posts are currently going through the vacancy approval and appointment process.
Flying Start – Flying Start funding continues until the end of March 2012. This WAG initiative which is delivered via a partnership approach between Powys County Council and Powys Teaching Health Board was introduced in April 2007. Currently there are 3.8 wte health visitors seconded to this programme. The Flying Start Initiative provides a holistic programme in partnership with parents to support a child’s personal and social well-being. This includes linguistic, physical, intellectual, emotional, moral and spiritual development. Eligible children living in the Flying Start areas of Welshpool, Newtown and Ystradgynlais receive a broad and balanced range of activities and experiences appropriate to their needs that will support their development and aim to improve their outcomes in preparation for school and in the long term. Evidence gathered by the Powys Children and Young People’s Partnership in 2010 has demonstrated that the presence of Flying start in specific areas correlates with a decrease in the numbers of children in need, on this basis Flying Start type initiatives are planned for other parts of Powys. Health visitors are vital for the success of this initiative.
The Powys Speech & Language Therapy schools project developed in partnership with the Powys Schools Service, aimed at developing speech and language therapy skills and support amongst Powys teaching staff will be reflected in this Workforce Plan.

2.3 Model for Improvement: