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“Let’s talk about health visiting”

The Changing Context for Health Visiting

Kate Billingham

Deputy Chief Nursing Officer

Department of Health

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Part One: The policy context for health

Part Two:The policy context for children and families

Part Three:Implications for health visiting

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Future health challenges

Public expectations are changing – as patients and tax payers

Increasing and changing health needs

Scientific and technological change

HOW DO WE SUSTAIN A SERVICE THAT IS

TAX-FUNDED-FREE-AT-POINT-OF-USE?

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Challenges for health visiting Using new knowledge, new technologies and evidence of

what works e.g. parenting and neurological development

Preparing for impact of unhealthy living and global health threats

Inequalities in health

Public expectations are changing - as patients and tax payers

Finding HV’s unique contribution in a more varied and diverse workforce

Making the case for preventive services to commissioners

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The policy jigsawSupporting independence,healthy choices,

Adapting the workforce

Changing the system (funding, commissioning, IT,

regulation, providers)

Integrated services centred

on the community

Meeting changing needs, improving

health and reducing inequalities

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Modernising Nurse Careers: the strategic direction for nursing

• Constancy of nursing values and practice

• Quality care organised around people’s needs

• A community centred health service

• Better care for people with long term conditions (self-care)

• Effective preventive interventions

• Integration of services

• Able to meet physical and mental health needs

• Sufficient number with advanced skills

• Leaders of mixed teams

• Deliver high productivity and best value for money

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Health policies that impact on health visiting: ‘our health, our care, our say’

Public Health: obesity, inequalities, ‘fully engaged public’, pandemics

Primary care: ‘hospital to home’, long term conditions, choice, practice based commissioning, new providers, self-care and independence

Nursing: Modernising Nursing Careers, quality and reputation

System reform: Client/patient experience as the driver, active commissioning, better value for money/productivity, Connecting for Health, new providers, devolution

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Part Two:

The policy agenda for

children and families

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The policy agenda for children and families

Priorities: reducing poverty and social exclusion, best start in life, education

Prevention and early intervention

Progressive universalism

Balancing support with challenge

Integration of services in children’s centres

Health led during pregnancy to 3 years

Choice for parents from a range of different sources of support

Using what we know about risks and protective factors and what works

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Key priorities for children and young people since 97

Tackling child poverty

introducing welfare reforms to make work pay and financial support for families with children. The Government’s goal is to eradicate child poverty by 2020, halving it by 2010

Ensuring every child has the best start in life

recognising the importance of the early years through Sure Start, Children’s Centres and expanded early years education. The Government has invested more than £17 billion in these areas since 1997

Education

raising standards across the board while giving priority to improving standards in schools in the most challenging circumstances.

Investment per pupil (including capital spending) has risen from £2,500 in 1997 to over £5,000 today and is expected to exceed £5,500 by 2007-08.

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What is progressive universalism?

A universal preventive service that is systematically planned and delivered to give a continuum of support according to need at individual and population level in order to achieve ECM outcomes.

Those with greatest needs receiving more intensive support and those with lower levels of need a ‘lighter touch’

Why?

We know more about the impact of parenting and maternal health of outcomes for children

Inequalities (IMR 6x higher in Birmingham than Eastleigh)

It happens anyway but tends to be unplanned

The world is changing (expectations, technology, social relations)

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Progressive impacts – but concerns about the tail

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1996/7-2004/5 1979-1996/7

Faster income growth for poorer families since 1997 – particularly compared to 1979 - 1997

poorer families richer families

Source: Institute for Fiscal Studies

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Reaching Out: An Action Plan on Social Exclusion

Considerable progress made in tackling poverty and social exclusion since 1997

Need to do more to achieve the goal of progressive universalism and help those with the most entrenched and complex problems

Importance of support from the start – breaking intergenerational transmission of disadvantage

Research on risk and protective factors offers us considerable opportunities for early identification and more effective prevention

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Life chances are influenced by opportunities and constraints operating at different levels – at the heart of this model is the individual child and family

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‘Proximal’ factors (e.g. parenting and cultural capital): ‘distal’ factors (e.g. social class, income, assets)

Social capital; peers; concentrations of deprivation; discrimination

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Current well-beingBe healthy; stay safe; enjoy and achieve; make a positive contribution; economic

well-being

Future well-becoming Prospects and social mobility (inter- and

intra-generational)

Environment; housing; regional economy

Economic, fiscal and social policy

Choices Actions

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A ‘magic moment’ of opportunity“Like it or not, the most important mental and behavioural patterns, once

established, are difficult to change once children enter school”Nobel Laureate James Heckman (2005)

• Pregnancy and the first 3 years are vital to child development, life chances and future achievement

• Birth of a child is a ‘magic moment’ of opportunity when parents are uniquely receptive to support

• Universal midwifery and health visiting services are ideally placed to identify children and families at risk

• Embedding the principle of ‘progressive universalism’ into maternal services should be a priority to ensure that additional support is provided to those children and families at greatest risk

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What might this look like for a 16 year old single mother with her first

child?

Has chosen which HV she wants by seeing video clips of the team’s particular skills at the local children’s centre

The HV keeps in touch with the practice and all other services using the new IT systems that are in place, with all aware of progress

The mother has a collection of video clips of her baby’s development on her own Health Space which mum and the HV look at on the digital TV

Feels that she is benefiting from the intensive parenting support programme

She has a volunteer support worker who helps her with some of the practical day to day needs

Job centre staff at the children’s centre have helped her find a job and she has made new friends

Daily SMS messages sent via the HV’s PC are helping mum to keep off cigarettes

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Part Three

Implications for health visiting

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National developments The establishment of 10 health-led

parenting support demonstration projects from pre-birth to age 2

Working group to look at the future of health visiting

Modernising Nursing Careers

These workshops

Commissioning for health well being guidance

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What does this mean for health visiting?

Health visiting role within a service rather than a ‘HV service’?

Focus on improving the well being of children through progressive universalism, health-led prevention and early intervention

Evidence based interventions with known outcomes

Integration of child and family services

Changing landscape of primary health care

New career paths and educational preparation (level and content)

More ‘players on the field’ - public health role of the public

New roles in a new world – leading and delivering

Influencing commissioning and delivering a contract

Local decision making

New providers (general practice and children’s centres)

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The real social revolution we are living through is from a life that is largely organised for us

To a world where we have to be in charge of our own destiny

21 The Blue Book, Trevor Bradley Greive

22 The Blue Day Book – Trevor Bradley Grieve