ITEM 4b
Herts County Council
Health Visiting Scrutiny – May 18th 2011
Report Author: Cath Slater, Assistant Director of Operations, Hertfordshire Community NHS Trust.
The purpose of the Health Visiting Scrutiny is:To review the impact, capacity issues in the Health Visiting Service, has on the delivery of the commissioned Healthy Child Programme in Hertfordshire.Summary:
Health Visiting is a service provided for families with children who are 0-5 years old. The service aims to promote the health and wellbeing of children through a core programme, with specialised interventions for children and their families who are disadvantaged or vulnerable e.g. developmental delay, safeguarding.
Introduction
The Health Visiting service provides the health aspects of the Healthy Child Programme, (HCP) which is the universal prevention and early intervention programme for all children and families designed to enable them to achieve their optimum health and wellbeing.
The service offers elements to all families such as visits to all new babies, developmental reviews for all children at age milestones (1 years and 2.5 years)and support and advice on a range of child developments and family health issues to all families with children under 5.
A targetedservice is offered to families on the basis of need; child protection, support for families where domestic violence occurs, specialised parenting interventions, support for families with children with additional health needs and advice and support to mothers with post natal depression.
Present Service Delivery
The service delivery model in Hertfordshire is based on sixgeographical areas and link closely with local Sure Start Children’s Centres. The service is delivered from a range of community settings including clinics, sure start centres, pre schools and in the family home.
Health Visitors work in teams that include qualifies Health Visitors, qualified children’s nurses, nursery nurses and team assistants in order that a full range of service can be offered.
Key Challenges to delivering the commissioned specification equitably across the county.
- In some areas vacancies that have been hard to recruit to have meant that less of the service can be delivered than elsewhere, this is particularly the case in Broxbourne and Watford.
- In some areas historical underfunding and high numbers of under 5’s has meant that less of the service can be delivered than elsewhere which is the case in St Albans.
- In some areas the numbers of vulnerable children are higher (such as in Watford and Hertsmere) which means that the resources are focussed on this important work resulting in less capacity to undertake the preventative aspects of the Health visiting role.
- Nationally recognised problem of the increased age profile of the profession, (approx 15 HV’s retire every year from the service)
Actions taken to date.
Vacancies.
Some areas within Hertfordshire have had Health visiting vacancies for years and despite repeated attempts to advertise posts recruitment has been unsuccessful.
The areas of Watford, and the South locality remain a challenge to recruit HV’s have moved from Dacorum into Watford to minimise this.
The following have been put in place to minimise risk and promote service delivery:
- Retention and Recruitment salary premia in hard to recruit to localities.
- Trained nurses and nursery nurses employed to support service delivery.
- Movement of staff from well staffed areas to other areas of need.
- ‘Grow our own HV’ programme, i.e. supporting nurses through their HV training and employing them when they qualify.
- Robust risk assessment mechanism in place to review safeguarding practice and support to the most vulnerable areas.
High numbers of under 5’s in some areas.
Demand and capacity modelling is enabling HCT to target resources more accurately, funded posts have been moved in this years budget negotiations to enable more equitable caseloads and reduce caseload sizes in some areas based on local need.
Numbers of vulnerable children higher in some areas. (see Appendix 1)
In areas where the numbers of children with child protection plans and Children Looked after the Health Visiting teams receive clinical supervision so that they can discuss cases they are worried about and have specific safeguarding children supervision to discuss individual cases.
A prioritisation tool has been developed that clearly states the crucial pieces of work that should be undertaken as a priority.
Priority activities:
- New birth visits (all new babies and their families are visited within 14 days of birth.
- Contact with families who move into the area with children under 5.
- Child Protection visits
- Visits to vulnerable families (i.e. domestic violence history, children with complex health needs, parental mental health problems)
- One year reviews – offered to all children and an important opportunity to identify any concerns at an early age.
Increased age profile of Health Visitors.
This is a crucial part of the service’ workforce planning, by working closely with commissioners HCT aim to develop a robust plan to succession plan.
Future developments
A large scale review of Health visiting service delivery is being planned. It will focus on:
- Health Visiting Team resources allocation according to need
- Skills & recruitment aligned to team needs.
- Student placements in areas that are harder to recruit, to support them to feel competent and confident to work in those areas.
- Highly effective use of resources through tightly managed work allocation within teams
- Increase the face to face contact time between Health Visitors andfamilies, more home visiting will be put into practice as part of the national programme to modernise Health Visiting.
An exciting project will start in May that will implement ‘mobile working’ in Health Visiting.This relates to the electronic record that the Health Visitors use and will mean that they have special laptops that they will be able to take into families homes, schools and children’s centres to get quick access to information and notes for clients.
This initiative which the staff are very keen to pursue would deliver a number of benefits for the delivery of the service:
- Reduced travelling time for staff,
- Access to records will enable staff to work from the closest base to their work location
- Accessible information for staff at the client contacts.
- More efficient allocation of work enabling team leaders to plan staff dairies to maximise their available skills and resources.
On 21st October 2010 the DH announced that they would deliver 4200 new Health Visitors by 2015 to boost young children’s and families health and well being across England.
For Hertfordshire this means supporting and additional 68Health Visitingstudents over the next 3 years, and ensuring they have jobs to go into when they qualify, there is currently significant work going on within Hertfordshire to explore different ways of offering so many students the high level of support they will need.
Quality Commitments
HCT takes a variety of actions to assure the quality of services; client feedback, involvement in research and implementation of policies are a few of these.
A recent survey for parents attending the drop in clinics run by the service was undertaken and 1400 responses were received from across the county. The responses are being analysed currently, early indications are that a significant majority of clients are happy with the advice and support they receive from the service, with some work needed to standardise practice and review some environmental issues related to the premises the clinics use.
This service is also involved with aUniversity of Hertfordshire research project exploring support options for breastfeeding advice to mothers of breastfed babies.The service has written a breastfeeding policy and is embedding this in practice by ensuring all clinical staff have taken part in an e learning module and for some staff with specialist skills to receive the relevant training and updating to deliver breastfeeding advice expertise to clients.
Cath Slater
Assistant Director Operations - Children’s Universal Services
May 2011
APPENDIX 1
Locality profiles.
Although a national standard has been set for a caseload of 500, this does not
Account for variation in levels of need. Deprivation indices, levels of children in need, children looked after and children with a child protection plan are all indicators which give a critical insight into the competing demands placed on the HV service teams.
Children Looked After data.
This is not currently available by locality; the county figures are as follows:
- 1164 children in care.
- 249 under 5 years
- 595 aged 5 – 16 years
- 319 aged over 16 years.
Health Visitors are commissioned to undertake twice yearly health reviews on Children Looked After under 5 and yearly on those over 5 (in partnership with the CLA team)
South Locality
Average caseload – 455
Deprivation score – 16.22 (average)
Hertfordshire rank – 2nd
Children with Child Protection plans – 14(under 5) and 11 (over 5)
East Locality
Average caseload – 475
Deprivation score – 7.41 (average)
Hertfordshire rank – 10th
Children with Child Protection plans – 12 (under 5) and 17 (over 5)
North Locality
Average caseload – 479
Deprivation score – 10.69 (average)
Hertfordshire rank – 8th
Children with Child Protection plans – Total of 148 for North Herts and Stevenage.
Welwyn and Hatfield
Average caseload – 423
Deprivation score – 14.18 (average)
Hertfordshire rank – 4th
Children with Child Protection plans – Total of 57.
Stevenage
Average caseload – 453
Deprivation score – 16.42 (average)
Hertfordshire rank – 1st
Children with Child Protection plans – Total of 148 for North Herts and Stevenage
Watford and ThreeRivers
Average caseload – 629
Deprivation score Watford – 15.81 (average) Three Rivers - 10.74
Hertfordshire rank – Watford 3rd - Three Rivers - 6th
Children with Child Protection plans – 53 (under 5) and 38 (over 5)
St Albans and Harpenden
Average caseload – 647
Deprivation score – 8.88 (average)
Hertfordshire rank – 9th
Children with Child Protection plans – 19 (under 5) and 44 (over 5)
Hertsmere
Average caseload – 655
Deprivation score – 12.86 (average)
Hertfordshire rank – 5th
Children with Child Protection plans – 13 (under 5) and 26 (over 5)
Dacorum
Average caseload – 469
Deprivation score – 10.73 (average)
Hertfordshire rank – 7th
Children with Child Protection plans – 48 (under 5) and 73 (over 5)
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