A Vision for Health Visiting in Wales, Lecture notes of Public Health

Download A Vision for Health Visiting in Wales and more Lecture notes Public Health in PDF only on Docsity! A Vision for Health Visiting in Wales ANNEX 1 Table of Contents 1. Introduction 3 2. The Vision for Health Visiting in Wales 3 2.1. Better Health 3 2.2. Access to Services for children and families 4 2.3. Better service safety and quality will improve health outcomes 4 3. The Foundations 5 4. Challenges 5 4.1. Health as improved but not for everyone 5 4.2. Expectations are continually rising 6 4.3. Staffing is becoming a real limitation on our services 6 4.4. Funding is limited 7 5. The Next phase 7 5.1. Improving health outcomes 7 5.2. One system for health 9 5.3. Health Visiting for the 21st Century 10 ANNEX 4  Promoting infant, maternal and family health.  Reducing ill health by safeguarding children from abuse.  Developing community capacity, with additional Health Visitors in areas of greatest need. 2.2 Access to services for children and families will improve–  All families with a preschool child will be offered a universal health visiting service delivered in many settings, including the home environment.  All families will be supported through an All Wales Healthy Child Programme.  Families with additional identified needs will have extra support either through targeted and or intensive health visiting led interventions.  Through increased investment, the Welsh Government is supporting families in Wales through doubling the number of families that are eligible for Flying Start4,5 the number of pioneer sites for Integrated Family Support Services6 and Family First funding2. 2.3 Better service safety and quality will improve health outcomes-  All children and families will be treated with dignity and respect.  Health Visiting intervention will be evidence based and reflect current research.  Families will have individual comprehensive health assessments completed by a qualified health visitor, which will be reviewed at key stages throughout a child’s early years; this will be underpinned by a common assessment.  Utilising community capacity to improve health.  Excellent communication and IT links to ensure that clinical staff have safe and secure access to information.  Using information to improve the quality and outcomes of services. 4 Welsh Government (2011) Five for a Fairer Future. 5 Welsh Assembly Government (2009) Flying Start Guidance 2009-2010. 6 Welsh Assembly Government (2010) Integrated Family Support Services: Statutory Guidance and Regulations. ANNEX 5 3. The foundations Health Visitors are one of the few professional groups trained in public health, they have dual registration and have to achieve specific standards to register with the NMC7. The foundations of service delivery are underpinned by four core principles8. These include:  The search for health needs.  The stimulation of an awareness of health needs.  The influence of policies affecting health.  The facilitation of health-enhancing activities. These core principles have firm foundations in public health nursing, child and family health and community knowledge. Health Visitors recognise that to effectively achieve positive outcomes, they must work collaboratively as part of a multidisciplinary/multiagency team. 4. Challenges 4.1 Health has improved but not for everyone Whilst the health of the population continues to improve9, there continues to be a growing inequitable gap in health and wellbeing dependent on geography and social circumstance, which are apparent at the youngest age. For example, infant mortality (an internationally recognised measure of health of a society) shows that infant mortality rates are much worse in disadvantaged groups and areas of deprivation. 7 NMC (2004) Standards of Proficiency for Specialist Community Public Health Nursing. 8 Twin S, Cowley, S (1992) The Principles of Health Visiting: a re-examination. 9 Jewell, T (2010) Chief Medical Officer for Wales Annual Report (2009) ANNEX 6 Evidence taken from the Marmot Review: Fair Society, Healthy Lives10 concluded that; One Quarter of all deaths under the age of one would potentially be avoided if all births had the same level of risk as those to women with the lowest level of deprivation. 4.2 Expectations are continually rising The needs of children, families and communities are becoming increasingly more complex. These complexities are at individual and family level and include, promoting child attachment and development, safeguarding children, the emotional impact of children exposed to domestic abuse, children with complex health needs, deprivation, teenage parents and substance abuse, as well as at a community level with poverty, housing, unemployment etc. It is also important to consider the challenges of delivering services to children and families who live in rural areas. Rurality may often bring about different vulnerabilities, such as access to services and isolation. In addition there are areas in Wales that have are experiencing significant increases in local birth rates which has impacted on Health Visitor workload without extra resourcing. To be able to fulfil public, local partners and commissioner expectations, health visitors will have to adopt different ways of working. 4.3 Staffing is becoming a real limitation on our service Creating a sustainable workforce is an increasingly difficult challenge for Health Visitors services in Wales. The pressures of an aging workforce, the financial economic climate, in addition to the development of early years initiatives has depleted the available generic Health Visitor workforce. This has resulted in core 10 Marmot Review Team (2010) Fair Society, Healthy Lives: Strategic Review of Health Inequalities in England post -2010. ANNEX 9 Action 3 Welsh Government to consider implementing the Family Nurse Partnership Programme alongside existing programmes to support teenage mothers. 5.2 One system for Health To meet the health needs of children, families and communities in Wales, services must interact and engage effectively to be able to meet demand and expectations, while continuing to provide local sustainable services. Future service delivery and successful health visiting teams will continue to be dependent on having collaborative working arrangements with their Primary Care colleagues (GP’s and Practice Nurses), Midwives16 and School Nurses17. Each has a unique and interlinked role to ensure that children and families have smooth transitions in and out of services, with clear communication pathways and joined up working delivered through a team around the child approach. The Health Visitors role with young children and families will be to coordinate an All Wales Healthy Child Programme. The Healthy Child Programme for early life stages will focus on a universal preventative service, providing with a programme for screening, immunisations, health and development reviews, supplemented by advice around health, wellbeing and parenting18. This will be achieved through continual assessment and review using a common assessment tool, recognised by both Health and Local Authorities. Protecting and safeguarding children is an area of statutory responsibility for multiagency partners and partnership working is key to making a difference to the most vulnerable for children and families in Wales19. The role of the Health Visitors is crucial in terms of safeguarding and protecting children, through the provision of assessments, health promotion, identifying risks and delivering support that can prevent maltreatment occurring.20 16 Welsh Government (2011) A Strategic Vision for Maternity Services in Wales. 17 Welsh Assembly Government (2009) A Framework for a School Nursing Service in Wales. 18 Department of Health (2009) Healthy Child Programme. Pregnancy and the first five years of life. 19 All Wales Child Protection Procedures (2008). 20 NSPCC (2011) All Babies Count: Prevention and Protection of Vulnerable Babies. ANNEX 10 ACTIONS Action 4 The Welsh Government will support the development of 3 initiatives, that will be implemented across Wales:  All Wales Healthy Child Programme of which child health surveillance will be component part.  All Wales common assessment tool for Health Visitors and their teams.  All Wales Parent Held Child Health Record. 5.3 Health Visiting for the 21st Century The Health Visitor’s primary focus will be on prevention, early identification and intervention in relation to a population’s health and social need as opposed to “treatment”. In Wales, a universal Health Visiting Service will be provided to the total population of young children aged 0-5yrs and their families within their local community. This population will receive access to appropriate, high quality services, irrespective of where they live, their ethnic group, their language or their social circumstance21. Health Visitors are trained to identify families that require enhanced or intensive support; by using their clinical and professional skills and judgment they will work with families to develop individual plans. The Health Visiting service will offer families with additional needs;  Targeted Interventions, this maybe short or longer term interventions (e.g. maternal mental health). 21 National Service Framework for Children, Young People and Maternity Services in Wales (2005) Welsh Assembly Government. ANNEX 11  Intensive intervention and support (statutory) to families in greatest need (children with complex health needs and children that need protecting), delivered through a multi-agency approach with key partners. In Wales there will be an empowered multi-disciplinary workforce led by Health Visitors providing expert clinical leadership to a team that have the skills and competencies to meet the needs of service users and to deliver quality outcomes set by the Government. Skill mix will not be used to replace or dilute the professional role of the Health Visitor, but as an enhancement. This will enable health visitors to use their skills and knowledge to the best advantage, while delegating appropriate tasks to other members of the team22. 5.3.1 The future role of the qualified Health Visitor in Wales will be;  An expert in child development.  Delivering on and leading a new All Wales Healthy Child Programme.  Complete comprehensive health and wellbeing assessment and reviews of preschool children and families, using an all Wales Assessment tool.  Implement programmes of prevention to meet identified need, with the ultimate focus to improve public health and take children out of poverty.  Deliver on intensive programmes, with key partners to the most vulnerable children and families.  Have wider public health knowledge of the local community, understand the determinants that may impact on health, develop preventative health programmes and target resources and signpost appropriately.  Provide expert clinical leadership to a multi-disciplinary team.  Nurse Prescriber.23  Competent and confident practitioners in safeguarding and child protection. 22 NMC (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. 23 NMC (2006) Standards of Proficiency for Nurse and Midwife Prescribers. ANNEX 14 adequate supervision and review the effectiveness of interventions they have undertaken. 5.3.7 Where will interventions be delivered? Services will be delivered in a variety of settings with the importance of home visiting remaining key and central to achieving results. Assessing children and families within their home environment will and does improve both health and social outcomes. Provision of appropriate community accommodation is essential. This will need to be suitable for community development activities, with room for clinical practice and confidential discussion. In addition, wherever Health Visiting teams are accommodated, if this be in a community premises or GP Practice, adequate space should be provided where there is room to store records, as well as good access to IT systems. To promote and enhance partnership working, it would be expected wherever possible that Health Visitors working in Flying Start will be collocated with the multiagency team. ACTIONS Action 5 HEIs will deliver training to Health Visitors and teams to be able to fully implement the Healthy Child Programme of which Health Visitors will take the lead. Action 6 Local Health Boards and Partners to consider Family First Funding to support the employment of skill mix within Health Visiting teams and through integrated and joint planning consider Family First Funding for the delivery of Health Visiting interventions in both the preventative and protection agenda for children and families. Action 7 Welsh Government and Health Boards to work with NWIS to review IT systems with ANNEX 15 a longer term plan to introduce electronic records. Action 8 Health Boards need to ensure appropriate accommodation is provided for Health Visiting services, which could be in a number of settings including Primary Care. 5.4 Aiming at excellence The Welsh Government recognises, it is what parents do, as being more important than who they are, especially in a child’s earliest years. The right kind of parenting is a bigger influence on their future than wealth, class, education or any other common social factor. So the future Health Visiting service will be evidence based and reflect current scientific advances, particularly in relation to neuroscience and child development, improving parenting capacity, in addition to supporting and delivering on the public health agenda for this population (see attached evidence based Interventions). Activity will focus around:  Assessment (of all relevant family members).  Regular developmental assessments of all children focusing on social and emotional health.  Attachment and positive parenting.  Parenting support.  Evidence based parenting programmes.  Health education and health information.  Public health challenges.  Community development.  Safeguarding and child protection issues.  Advocacy to meet the rights of the child.25 The Health Visitor component of Flying Start through reduced caseloads is to deliver on the above. To achieve this the Government has committed to training additional Health Visitors and are working with the NLIAH and Education providers to increase the number of Health Visitors that will be trained over the next three years. ACTIONS 25 United Nations Rights of the Child (1989/2004) ANNEX 16 Action 9 Health Boards to work with NLIAH to develop an appropriate staffing and workforce tool to deliver safe and effective Health Visiting services, based on workload and caseload profiling. Action 10 Welsh Government will continue to work with NLIAH, HEI’s and Health Boards to ensure that the agreed commitment for Flying Start is delivered in terms of Health Visitor workforce, including the additional Practice Teachers. Action 11 Health Boards to ensure that all Health Visitors and their teams have appropriate levels of safeguarding training and clinical supervision to work in partnership with the multiagency framework of the Local Safeguarding Boards. 5.5 Absolute transparency on performance Historically the health visiting contribution to improving the health of a population has been very difficult to measure. It is therefore essential that service delivery is outcomes based with performance managements systems built in. The success of the future Health Visiting Services will be measured by their contribution to improving the health outcomes of the defined population. To support this approach standard assessment tools are needed to be able to accurately benchmark across the Local Health Boards of Wales. ACTIONS Action 12 Welsh Government to identify key performance outcome measures for Health Visiting Services. Action 13 Health Boards to adequately resource Health Visitor Teams to be able to meet the agreed outcomes. ANNEX 19 Local Health Boards and other partners that lead, plan and deliver services are crucial to improving the life chances of children. The Welsh Government, the NHS, its partners and the public, have a responsibility to support children, families within the communities in which they live. 8. A continuing challenge Decades of late intervention from health, education and social services has failed, early intervention is critical. A range of well-tested programmes, low in cost, high in results, can have a lasting impact on all children, especially the most vulnerable. If we intervene early enough we can give children a vital social and emotional foundation which will keep them happy, healthy and achieving throughout their lives and, above equip them all to raise children of their own, who will also enjoy higher levels of well-being31. 31 HM Government (2011) Early Intervention: The Next Steps. An Independent Report to Her Majesty’s Government, Graham Allen MP. 20 ANNEX 1 Summary of Key Actions As well as key actions at a local level, there are a number of specific strategic actions identified throughout the document, which are key to delivering on this vision. These strategic key actions are set out in the table below. ACTIONS BY WHEN Action 1 Welsh Government and HEIs to work with practitioners to develop and agree the necessary competencies and skills required for Health Visitors and the team members. Action 2 Welsh Government to consider implementing the Family Nurse Partnership Programme alongside existing programmes to support teenage mothers. Action 3 The Welsh Government will support the development of 3 initiatives, that will be implemented across Wales:  All Wales Healthy Child Programme of which child health surveillance will be component part.  All Wales common assessment tool for Health Visitors and their teams.  All Wales Parent Held Child Health Record. Action 4 HEIs will deliver training to Health Visitors and teams to be able to fully implement the Healthy Child Programme of which Health Visitors will take the lead. March 2013 March 2013 September 2013 September 2013 A Vision for Health Visiting in Wales ANNEX 1 Table of Contents 1. Introduction 3 2. The Vision for Health Visiting in Wales 3 2.1. Better Health 3 2.2. Access to Services for children and families 4 2.3. Better service safety and quality will improve health outcomes 4 3. The Foundations 5 4. Challenges 5 4.1. Health as improved but not for everyone 5 4.2. Expectations are continually rising 6 4.3. Staffing is becoming a real limitation on our services 6 4.4. Funding is limited 7 5. The Next phase 7 5.1. Improving health outcomes 7 5.2. One system for health 9 5.3. Health Visiting for the 21st Century 10 ANNEX 4  Promoting infant, maternal and family health.  Reducing ill health by safeguarding children from abuse.  Developing community capacity, with additional Health Visitors in areas of greatest need. 2.2 Access to services for children and families will improve–  All families with a preschool child will be offered a universal health visiting service delivered in many settings, including the home environment.  All families will be supported through an All Wales Healthy Child Programme.  Families with additional identified needs will have extra support either through targeted and or intensive health visiting led interventions.  Through increased investment, the Welsh Government is supporting families in Wales through doubling the number of families that are eligible for Flying Start4,5 the number of pioneer sites for Integrated Family Support Services6 and Family First funding2. 2.3 Better service safety and quality will improve health outcomes-  All children and families will be treated with dignity and respect.  Health Visiting intervention will be evidence based and reflect current research.  Families will have individual comprehensive health assessments completed by a qualified health visitor, which will be reviewed at key stages throughout a child’s early years; this will be underpinned by a common assessment.  Utilising community capacity to improve health.  Excellent communication and IT links to ensure that clinical staff have safe and secure access to information.  Using information to improve the quality and outcomes of services. 4 Welsh Government (2011) Five for a Fairer Future. 5 Welsh Assembly Government (2009) Flying Start Guidance 2009-2010. 6 Welsh Assembly Government (2010) Integrated Family Support Services: Statutory Guidance and Regulations. ANNEX 5 3. The foundations Health Visitors are one of the few professional groups trained in public health, they have dual registration and have to achieve specific standards to register with the NMC7. The foundations of service delivery are underpinned by four core principles8. These include:  The search for health needs.  The stimulation of an awareness of health needs.  The influence of policies affecting health.  The facilitation of health-enhancing activities. These core principles have firm foundations in public health nursing, child and family health and community knowledge. Health Visitors recognise that to effectively achieve positive outcomes, they must work collaboratively as part of a multidisciplinary/multiagency team. 4. Challenges 4.1 Health has improved but not for everyone Whilst the health of the population continues to improve9, there continues to be a growing inequitable gap in health and wellbeing dependent on geography and social circumstance, which are apparent at the youngest age. For example, infant mortality (an internationally recognised measure of health of a society) shows that infant mortality rates are much worse in disadvantaged groups and areas of deprivation. 7 NMC (2004) Standards of Proficiency for Specialist Community Public Health Nursing. 8 Twin S, Cowley, S (1992) The Principles of Health Visiting: a re-examination. 9 Jewell, T (2010) Chief Medical Officer for Wales Annual Report (2009) ANNEX 6 Evidence taken from the Marmot Review: Fair Society, Healthy Lives10 concluded that; One Quarter of all deaths under the age of one would potentially be avoided if all births had the same level of risk as those to women with the lowest level of deprivation. 4.2 Expectations are continually rising The needs of children, families and communities are becoming increasingly more complex. These complexities are at individual and family level and include, promoting child attachment and development, safeguarding children, the emotional impact of children exposed to domestic abuse, children with complex health needs, deprivation, teenage parents and substance abuse, as well as at a community level with poverty, housing, unemployment etc. It is also important to consider the challenges of delivering services to children and families who live in rural areas. Rurality may often bring about different vulnerabilities, such as access to services and isolation. In addition there are areas in Wales that have are experiencing significant increases in local birth rates which has impacted on Health Visitor workload without extra resourcing. To be able to fulfil public, local partners and commissioner expectations, health visitors will have to adopt different ways of working. 4.3 Staffing is becoming a real limitation on our service Creating a sustainable workforce is an increasingly difficult challenge for Health Visitors services in Wales. The pressures of an aging workforce, the financial economic climate, in addition to the development of early years initiatives has depleted the available generic Health Visitor workforce. This has resulted in core 10 Marmot Review Team (2010) Fair Society, Healthy Lives: Strategic Review of Health Inequalities in England post -2010. ANNEX 9 Action 3 Welsh Government to consider implementing the Family Nurse Partnership Programme alongside existing programmes to support teenage mothers. 5.2 One system for Health To meet the health needs of children, families and communities in Wales, services must interact and engage effectively to be able to meet demand and expectations, while continuing to provide local sustainable services. Future service delivery and successful health visiting teams will continue to be dependent on having collaborative working arrangements with their Primary Care colleagues (GP’s and Practice Nurses), Midwives16 and School Nurses17. Each has a unique and interlinked role to ensure that children and families have smooth transitions in and out of services, with clear communication pathways and joined up working delivered through a team around the child approach. The Health Visitors role with young children and families will be to coordinate an All Wales Healthy Child Programme. The Healthy Child Programme for early life stages will focus on a universal preventative service, providing with a programme for screening, immunisations, health and development reviews, supplemented by advice around health, wellbeing and parenting18. This will be achieved through continual assessment and review using a common assessment tool, recognised by both Health and Local Authorities. Protecting and safeguarding children is an area of statutory responsibility for multiagency partners and partnership working is key to making a difference to the most vulnerable for children and families in Wales19. The role of the Health Visitors is crucial in terms of safeguarding and protecting children, through the provision of assessments, health promotion, identifying risks and delivering support that can prevent maltreatment occurring.20 16 Welsh Government (2011) A Strategic Vision for Maternity Services in Wales. 17 Welsh Assembly Government (2009) A Framework for a School Nursing Service in Wales. 18 Department of Health (2009) Healthy Child Programme. Pregnancy and the first five years of life. 19 All Wales Child Protection Procedures (2008). 20 NSPCC (2011) All Babies Count: Prevention and Protection of Vulnerable Babies. ANNEX 10 ACTIONS Action 4 The Welsh Government will support the development of 3 initiatives, that will be implemented across Wales:  All Wales Healthy Child Programme of which child health surveillance will be component part.  All Wales common assessment tool for Health Visitors and their teams.  All Wales Parent Held Child Health Record. 5.3 Health Visiting for the 21st Century The Health Visitor’s primary focus will be on prevention, early identification and intervention in relation to a population’s health and social need as opposed to “treatment”. In Wales, a universal Health Visiting Service will be provided to the total population of young children aged 0-5yrs and their families within their local community. This population will receive access to appropriate, high quality services, irrespective of where they live, their ethnic group, their language or their social circumstance21. Health Visitors are trained to identify families that require enhanced or intensive support; by using their clinical and professional skills and judgment they will work with families to develop individual plans. The Health Visiting service will offer families with additional needs;  Targeted Interventions, this maybe short or longer term interventions (e.g. maternal mental health). 21 National Service Framework for Children, Young People and Maternity Services in Wales (2005) Welsh Assembly Government. ANNEX 11  Intensive intervention and support (statutory) to families in greatest need (children with complex health needs and children that need protecting), delivered through a multi-agency approach with key partners. In Wales there will be an empowered multi-disciplinary workforce led by Health Visitors providing expert clinical leadership to a team that have the skills and competencies to meet the needs of service users and to deliver quality outcomes set by the Government. Skill mix will not be used to replace or dilute the professional role of the Health Visitor, but as an enhancement. This will enable health visitors to use their skills and knowledge to the best advantage, while delegating appropriate tasks to other members of the team22. 5.3.1 The future role of the qualified Health Visitor in Wales will be;  An expert in child development.  Delivering on and leading a new All Wales Healthy Child Programme.  Complete comprehensive health and wellbeing assessment and reviews of preschool children and families, using an all Wales Assessment tool.  Implement programmes of prevention to meet identified need, with the ultimate focus to improve public health and take children out of poverty.  Deliver on intensive programmes, with key partners to the most vulnerable children and families.  Have wider public health knowledge of the local community, understand the determinants that may impact on health, develop preventative health programmes and target resources and signpost appropriately.  Provide expert clinical leadership to a multi-disciplinary team.  Nurse Prescriber.23  Competent and confident practitioners in safeguarding and child protection. 22 NMC (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. 23 NMC (2006) Standards of Proficiency for Nurse and Midwife Prescribers. ANNEX 14 adequate supervision and review the effectiveness of interventions they have undertaken. 5.3.7 Where will interventions be delivered? Services will be delivered in a variety of settings with the importance of home visiting remaining key and central to achieving results. Assessing children and families within their home environment will and does improve both health and social outcomes. Provision of appropriate community accommodation is essential. This will need to be suitable for community development activities, with room for clinical practice and confidential discussion. In addition, wherever Health Visiting teams are accommodated, if this be in a community premises or GP Practice, adequate space should be provided where there is room to store records, as well as good access to IT systems. To promote and enhance partnership working, it would be expected wherever possible that Health Visitors working in Flying Start will be collocated with the multiagency team. ACTIONS Action 5 HEIs will deliver training to Health Visitors and teams to be able to fully implement the Healthy Child Programme of which Health Visitors will take the lead. Action 6 Local Health Boards and Partners to consider Family First Funding to support the employment of skill mix within Health Visiting teams and through integrated and joint planning consider Family First Funding for the delivery of Health Visiting interventions in both the preventative and protection agenda for children and families. Action 7 Welsh Government and Health Boards to work with NWIS to review IT systems with ANNEX 15 a longer term plan to introduce electronic records. Action 8 Health Boards need to ensure appropriate accommodation is provided for Health Visiting services, which could be in a number of settings including Primary Care. 5.4 Aiming at excellence The Welsh Government recognises, it is what parents do, as being more important than who they are, especially in a child’s earliest years. The right kind of parenting is a bigger influence on their future than wealth, class, education or any other common social factor. So the future Health Visiting service will be evidence based and reflect current scientific advances, particularly in relation to neuroscience and child development, improving parenting capacity, in addition to supporting and delivering on the public health agenda for this population (see attached evidence based Interventions). Activity will focus around:  Assessment (of all relevant family members).  Regular developmental assessments of all children focusing on social and emotional health.  Attachment and positive parenting.  Parenting support.  Evidence based parenting programmes.  Health education and health information.  Public health challenges.  Community development.  Safeguarding and child protection issues.  Advocacy to meet the rights of the child.25 The Health Visitor component of Flying Start through reduced caseloads is to deliver on the above. To achieve this the Government has committed to training additional Health Visitors and are working with the NLIAH and Education providers to increase the number of Health Visitors that will be trained over the next three years. ACTIONS 25 United Nations Rights of the Child (1989/2004) ANNEX 16 Action 9 Health Boards to work with NLIAH to develop an appropriate staffing and workforce tool to deliver safe and effective Health Visiting services, based on workload and caseload profiling. Action 10 Welsh Government will continue to work with NLIAH, HEI’s and Health Boards to ensure that the agreed commitment for Flying Start is delivered in terms of Health Visitor workforce, including the additional Practice Teachers. Action 11 Health Boards to ensure that all Health Visitors and their teams have appropriate levels of safeguarding training and clinical supervision to work in partnership with the multiagency framework of the Local Safeguarding Boards. 5.5 Absolute transparency on performance Historically the health visiting contribution to improving the health of a population has been very difficult to measure. It is therefore essential that service delivery is outcomes based with performance managements systems built in. The success of the future Health Visiting Services will be measured by their contribution to improving the health outcomes of the defined population. To support this approach standard assessment tools are needed to be able to accurately benchmark across the Local Health Boards of Wales. ACTIONS Action 12 Welsh Government to identify key performance outcome measures for Health Visiting Services. Action 13 Health Boards to adequately resource Health Visitor Teams to be able to meet the agreed outcomes. ANNEX 19 Local Health Boards and other partners that lead, plan and deliver services are crucial to improving the life chances of children. The Welsh Government, the NHS, its partners and the public, have a responsibility to support children, families within the communities in which they live. 8. A continuing challenge Decades of late intervention from health, education and social services has failed, early intervention is critical. A range of well-tested programmes, low in cost, high in results, can have a lasting impact on all children, especially the most vulnerable. If we intervene early enough we can give children a vital social and emotional foundation which will keep them happy, healthy and achieving throughout their lives and, above equip them all to raise children of their own, who will also enjoy higher levels of well-being31. 31 HM Government (2011) Early Intervention: The Next Steps. An Independent Report to Her Majesty’s Government, Graham Allen MP. 20 ANNEX 1 Summary of Key Actions As well as key actions at a local level, there are a number of specific strategic actions identified throughout the document, which are key to delivering on this vision. These strategic key actions are set out in the table below. ACTIONS BY WHEN Action 1 Welsh Government and HEIs to work with practitioners to develop and agree the necessary competencies and skills required for Health Visitors and the team members. Action 2 Welsh Government to consider implementing the Family Nurse Partnership Programme alongside existing programmes to support teenage mothers. Action 3 The Welsh Government will support the development of 3 initiatives, that will be implemented across Wales:  All Wales Healthy Child Programme of which child health surveillance will be component part.  All Wales common assessment tool for Health Visitors and their teams.  All Wales Parent Held Child Health Record. Action 4 HEIs will deliver training to Health Visitors and teams to be able to fully implement the Healthy Child Programme of which Health Visitors will take the lead. March 2013 March 2013 September 2013 September 2013 21 Action 5 Local Health Boards and Partners to consider Family First Funding to support the employment of skill mix within Health Visiting teams and through integrated and joint planning consider Family First Funding for the delivery of Health Visiting interventions in both the preventative and protection agenda for children and families. Action 6 Welsh Government and Health Boards to work with NWIS to review IT systems with a longer term plan to introduce electronic records. Action 7 Health Boards need to ensure appropriate accommodation is provided for Health Visiting services, which could be in a number of settings including Primary Care. Action 8 Health Boards to work with NLIAH to develop an appropriate staffing and workforce tool to deliver safe and effective Health Visiting services, based on workload and caseload profiling. Action 9 Health Boards to ensure that all Health Visitors and their teams have appropriate levels of safeguarding training and clinical supervision to work in partnership with the multiagency framework of the Local Safeguarding Boards. Action 10 Welsh Government to identify key performance outcome measures for Health Visiting Services March 2013 March 2013 March 2013 September 2013 March 2013 March 2013 24 recommendations.  Early Identification of depression and to ensure that mothers have the appropriate support, intervention and or treatment to meet their need.  Listening visits offered if appropriate  Work and communicate with the primary care team.  Referrals to the relevant agencies if necessary.  National Institute for Health and Clinical Excellence (2007) Antenatal and Postnatal Mental Health. Clinical Management and Service Guidance. NICE Clinical Guidance 45. Developed by the National Collaborating Centre for Mental Health the management of maternal mental health.  Health Visitors should utilise the Perinatal Mental Health e- learning programme.  Health Visitors to have the skills and competencies in supporting women develop self-help strategies and non-directive counselling delivered in a home environment. Area Health Visitor/team role Evidence/Strategy Recommendations Safeguarding  Early recognition and identification of children who are at risk or need protection.  Providing appropriate health interventions, advice and support.  Supporting parents.  Appropriate and timely referrals.  Working as part of a multiagency team.  Attend and contribute at Child Protection Case Conference and core group.  All Wales Child Protection Procedures (2008).  HM Government (2006) Working Together to Safeguard Children. A guide to interagency working to safeguard and promote the welfare of children.  NSPCC (2011) All Babies Count: Prevention and Protection of Vulnerable Babies.  Children Act (1989/2004)  NSPCC (2011) All Babies Count: Prevention and Protection of Vulnerable Babies.  The Protection of Children  Health Visitors to be trained to level 3 Safeguarding.  Health Visiting team to be trained to minimum of Level 2.  Health Visitors to have POVA training to level 2.  Health Visitors to be trained in recognised evidence based parenting programmes. 25 in England: A Progress Report, The Lord Laming (2009)  Welsh Assembly Government (2010) Integrated Family Support Services: Statutory Guidance and Regulations. Area Health Visitor/team role Evidence/Strategy Recommendations Domestic Abuse  To ensure that Routine Enquiry questions are asked both antenatal and postnatal and forms part of the comprehensive health assessment.  Adequate advice, support and information provided to ensure that the risks of living in an abusive situation are understood.  Appropriate and safe choices discussed to enable protection.  Work collaboratively with the multi-agency team, identifying risks and sharing the relevant information when necessary.  Engage with the Multi-Agency Risk Assessment Conferences (MARAC).  Have a local and community knowledge to signpost families to appropriate services to keep  Welsh Assembly Government (2005) Tackling Domestic Abuse: The All Wales National Strategy. A Joint-Agency Approach.  Health Visitors to be trained and confident to routinely enquire about Domestic Abuse. 26 them safe. Area Health Visitor/team role Evidence/Strategy Recommendations Infant Mortality  A comprehensive health assessment to commence in the antenatal period to assess risk factors and continue through the early years.  Health promotion education and advice in relation to;  Sudden Infant Death Syndrome  Smoking  Feeding and nutrition  Environment  Housing  Welsh Assembly Government (2011) Fairer Health Outcomes for All: Reducing Inequities in Health Strategic Action Plan.  Welsh Assembly Government (2009) Our Healthy Future Technical Working Paper. Welsh Assembly Government  Comprehensive health assessment to commence in the antenatal period.  Health Visitors must work closely with the Primary Care Team, particularly Midwifery Service.  Health Visiting teams must have up to date knowledge and skills in delivering public health messages.  Health Visitors to be trained to deliver smoking cessation interventions. Area Health Visitor/team role Evidence/Strategy Recommendations Nutrition (infant, young child and family)  Encourage and support breast feeding mothers.  Timely and adequate advice on weaning.  Advice and support for families who chose to formula feed their babies on safe feeding practices.  Healthy diet and nutrition advice to prevent obesity.  Ensure parents recognise their role in determining the lifestyle choices of their children.  Monitor growth of infant and young child.  Ensure that families are aware of  World Health Organisation (2008) Strengthening Action to improve feeding of infants and young children aged 6-23 months of age in nutrition and child health. UNICEF.  Welsh Assembly Government (2001) Investing in a better start: Promoting breastfeeding in Wales.  All Health Visitors are BFI trained.  Improvements in data collection.  Health Visitors to be skilled in facilitating group based activities.  **Health Visitors to provide free vitamins for all preschool children and mothers 29 contacts. 15.  World Health Organisation (2008) World Report on Child Injury Prevention.  Children in Wales (2009) Working Towards a Child Safety Strategy for Wales. Area Health Visitor/team role Evidence/Strategy Recommendations Immunisation and Vaccinations  Provide health information and education to parents to ensure that they have informed choice.  Work as part of the primary care team with HVs having a defined role.  Health promotion advice on immunisations to be given at every contact.  Public Health Wales (2011) Vaccine Uptake in Children in Wales, January to March 2011.  Compliance with Healthy Child Programme. Area Health Visitor/team role Evidence/Strategy Recommendations Oral Health  Parents to be advised how to maintain good dental health and hygiene for children.  Nutrition advice.  Encourage registration with local dentist.  Welsh Oral Health Information Unit (2006/06) A Picture of Oral Health in Wales. Survey of 5 year olds oral health 2005/06.  Designed to Smile  Health Visitors and the team should be regularly updated on nutrition and weaning. Area Health Visitor/team role Evidence/Strategy Recommendations Smoking  To offer public health advice and support at every opportunity.  Ensure that parents and family understand the importance of a smoke free environment for children and the impact that smoke exposure can have on  National Institute for Clinical Excellence (2006) Brief Interventions and referral for smoking cessation in Primary Care and other settings.  Health Visitors to be trained to deliver Brief Intervention Therapy.  Health Visitors to be trained in motivational interviewing techniques. 30 their health(particularly in relation to Sudden Infants Deaths).  Health Visitor to offer brief intervention therapy to support smoking cessation.  Health Visiting team to refer as appropriate and be aware of local support groups. 31 ANNEX 3 GLOSSARY OF TERMS TERM DEFINITION All Wales Healthy Child Programme A national Health Promotion focused ‘Early Years Programme’ that describes required interventions from the key professionals, e.g. General Practitioner, Health Visitor, Paediatrician etc. with robust and measurable outputs for families with pre-school children Child Protection Child Protection is a part of safeguarding and promoting welfare. This refers to the activity which is undertaken to protect specific children who are suffering or are at risk of suffering significant harm as a result of abuse or neglect. Comprehensive Health Assessments An All Wales holistic family health assessment undertaken by the Registrant Health Visitor. Family This is a group of adult/s and children that is not necessarily dependant on a specific status or living arrangements but where there is a responsibility of care for preschool children and where there are usually ties of marriage, blood or adoption or instead where they have consented to an arrangement similar to those ties. Flying Start A targeted programme aimed at 0-3 year olds in the most disadvantaged communities in Wales. Health Visitor A qualified Registered Nurse or Midwife who has undertaken additional Specialist training to assess health needs of individuals, families and the wider community. They aim to promote good health and prevent ill health. A Health Visitors remit involves working within homes with families and young children and working closely with at- risk or deprived groups. They are registered as a Health Visitor on the 3rd part of the Nursing Midwifery Council Register (NMC 2012)