www.england.nhs.uk

Health Visitors as

leaders in the

transfer to local

authority

commissioning

Sabrina Fuller Head of health improvement NHS England

27/01/2015

www.england.nhs.uk

• Context for health visiting leadership going forward: transfer of 0-5 commissioning to local authorities; what are health visitors leading? who are they leading?

• What is leadership? what makes a good leader? What sort of leader are you and how can you develop your strengths?

• How can you apply leadership principles in the context of the transfer? What are the opportunities? What are the challenges?

• NHS England’s support for health visiting transformation work: service spec; transformation programme; outcomes work

Health visitors as leaders: leading

through influence

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www.england.nhs.uk

Context

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• October 2015 commissioning (not employment) of 0-5 PH services transfers to local authorities

• Local authorities already commission range of 0-5 services including early years and social care.

• Local authorities already commission public health services including 5-19 services.

• Local authorities are democratically accountable to their electorate.

• Certain universal checks and reviews will be mandated for time limited period.

• Many local authorities face considerable financial challenges

Context: transfer of 0-5 PH

commissioning

www.england.nhs.uk

• A four-tiered progressive model of delivery

• Community

• Universal

• Targeted packages of care

• Multiagency working to meet complex needs egsafeguarding, troubled families

• Delivery of the evidence-based healthy child programme

• 5 mandated checks and reviews: antenatal, NBV, 6-8 weeks, 12 month, 2-2 and a half year.

• Improved outcomes for young children and their families

• E.g. 6 high impact areas: maternal mental health, early attachment, breastfeeding, healthy weight, child development and school readiness, accident prevention

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What are health visitors leading?

www.england.nhs.uk

• Health visitors already lead skill-mixed health visiting teams.

• Many health visitors, as the early years experts and HCP leaders, are now leading wider teams including early years staff.

• The future is the wider team – with health visitors leading on improved health and wellbeing outcomes for young children and their families.

• The wider team includes early years workers, local authority commissioned workers, primary care, voluntary sector and many others.

• LEADING THROUGH INFLUENCE RATHER THAN LINE MANAGEMENT RESPONSIBILITY.

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Who are health visitors leading?

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Leadership

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• These individuals have had a significant effect on how

regular people live their lives today and have had a

large impact on how modern society works.

" 8

Significant leaders or good leaders?

Of course, significant doesn’t always mean good………

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• Self awareness – how can you optimise the way you come across to others?

• Working with others – building and maintaining relationships

• Managing the resources available – people, budgets, and realising potential resource

• Improving services: safety, evaluation, improvement, innovation, transformation

• Setting direction: context for change, knowledge and evidence, making decisions and evaluating

NHS Leadership Academy

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What makes a good leader?

www.england.nhs.uk

• What were we born with? Our own natural tendencies to

lead (or not).

• What motivates us to lead (a desire to make a difference:

to give the best opportunities to all children and families?)

• What are our existing strengths, weaknesses and

development needs?

• What resources will help us develop our strengths and

address our development needs?

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Our own leadership journey:

reflecting on who we are, who we

can become and our own leadership

style

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Applying

leadership

principles in the

context of transfer

of commissioning

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• Are you shaping the future or despairing about it?

• Do you take opportunities to communicate what it is

you contribute?

• Do you take opportunities for self development (work-

based and outside work, as well as CPD)

• Do you manage your stress levels and enjoy what you

do?

• Are you seen to act with integrity?

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Self awareness

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• Working within teams: wider 0-5 teams, early years, social care, troubled families. Shared purpose and understanding each others’ contribution.

• Building and maintaining relationships: with children’s centres and early years, with social care, schools, 5-19 services, troubled families etc.

• Encouraging contribution

• Developing networks: knowing about good practice in other areas and sharing your own good practice and successes

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Working with others 1

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• Shared purpose and understanding each others’

contribution is critical:

• What are the local priorities in terms of 0-5

outcomes?

• What does the evidence base tell us re effective

interventions?

• What competencies are needed to deliver to who?

• So agreeing most effective and cost-effective roles,

contributions and pathways (see core HV spec)

Working with others 2

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• Planning: know your local authority priorities for 0-5s; workin in the context of their Starting Well strategy; know your data and use it to inform the local authority’s priorities

• Performance: know your service specification; plan to deliver against performance managements requirements; ensure decent data systems

• Resources: know your budget, service costs (and fill your vacancies)

• People: take a wider view of the resource available to you –working with the wider team.

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Managing services

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• Ensuring patient safety: safeguarding is major local authority priority – ensure the preventive elements eg early attachment, parenting skills, are valued.

• Critically evaluating: parents’ and staff perspective on what you do well. Using your data. Building intelligence.

• Encouraging improvement and innovation: ensuring that you act on intelligence gathered for continuous improvement.

• Facilitating transformation: have you a plan in place to meet requirements of service specification – the 4, 5, 6 model.

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Improving services

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• Record keeping systems

• Working with other agencies

• Skill mix

• Continuity of care

• Case load and clinics

• Clinical supervision

• Supportive management

Christine Bidmead

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Improving services 2:

Evidence on what supports success in meeting

your parents’ needs:

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• Identifying the context for change; knowing your local authority priorities and how you deliver them.

• Applying knowledge and evidence: health visitors as early years experts – delivering evidence-based interventions.

• Making decisions: in partnership with commissioner and other providers – who needs to do what in order to deliver effectively and cost-effectively.

• Evaluating impact: demonstrating your value and ensuring that commissioners and elected members know about your successes.

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Setting direction 1

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Setting direction 2: Meeting local authority

priorities: the evidence base

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• NBO and NBAS to promote secure attachment

• Baby friendly in the community across the system

• Use of Ages and Stages 3 to assess development at

two to two and a half years

• Incredible Years Pre-school Basic - parenting groups

• HENRY: tackling childhood obesity

Setting direction 3: examples of

evidence-based initiatives

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www.england.nhs.uk

• Use case studies of health visiting impact at different

levels for commissioners

• Local councillors are interested in people

• Explain how your service meets LA priorities eg

safeguarding children, promoting a positive home

learning environment, school readiness

Setting direction 4

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• Joined up working with early years and children’s social care services; for joint

care planning and delivery – child centred.

• Joined up working of 0-5 public health services with 5-19s services to allow a

family centred approach.

• Closer links to early intervention services such as Troubled Families

• The ability to contribute effectively to public service reform through the evidence

base on early attachment, school readiness, attainment and its links to building

local economies.

• Ability to affect the wider determinants of health through links to commissioning

of housing, planning etc.

• Full potential of expertise and leadership role that health visitors can offer in

improving health and wellbeing outcomes for 0-5s and their families.

Opportunities

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www.england.nhs.uk

• Case studies create a strong message and a strong means of evidencing the

work of health visitors and your role as a leader

• Support how health visitors fit into future community public health agenda

• Enable future commissioners, local authorities, gain a better understanding of the

impact on improving outcomes for young children and their families

• But:

• Go beyond the story – put into context of local authority priorities and

‘language’

• Why? – what prompted this – articulate against local priorities, local

needs

• Strong evidence of impact and how this will continue to move the

agenda forward

• Parent feedback – giving voice to the strength of personal experience

Bringing it all together: Case studies

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www.england.nhs.uk

NHS England

support for

HV

leadership

www.england.nhs.uk

• NHS England core service specification (basis for local

specification) 2013-14, 14-15, 15-16.

• Investment in Area Team-led service transformation

initiatives – involving LA commissioners + providers.

• 0-5 benchmarked PH outcomes: profiles and guide

with PHE

http://atlas.chimat.org.uk/IAS/dataviews/earlyyearsprofile

NHS England: supporting sustainable

transformation through the commissioning

process

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www.england.nhs.uk

• Take responsibility for making a success of transfer of

commissioning

• Understand your local authority priorities and how you

deliver to meet them.

• Work closely with partner organisations around

agreed priorities and evidenced based delivery.

• Ensure that commissioners and elected members

have the opportunity to understand what you do.

Health visitor leadership

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