Let’s talk about health visiting

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Lets 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
TwoThe policy context for children and
familiesPart ThreeImplications 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 HVs unique contribution in a more varied
  and diverse workforce
• Making the case for preventive services to
  commissioners

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The policy jigsaw
Supporting independence, healthy choices,
Integrated services centred on the community
Meeting changing needs, improving health and
reducing inequalities
Changing the system (funding, commissioning, IT,
regulation, providers)
Adapting the workforce
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Modernising Nurse Careers the strategic
direction for nursing

• Constancy of nursing values and practice
• Quality care organised around peoples 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 childrens 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
  Governments 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, Childrens 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

• 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
Economic, fiscal and social policy
Current well-being
Be healthy stay safe enjoy and achieve make a
positive contribution economic well-being
Choices Actions
Opportunities Constraints
Family
Community
Region
Nation
Future well-becoming
Global
Prospects and social mobility (inter- and
intra-generational)
Proximal factors (e.g. parenting and cultural
capital) distal factors (e.g. social class,
income, assets)
Social capital peers concentrations of
deprivation discrimination
Environment housing regional economy
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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 teams particular skills at the
  local childrens 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
  babys 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 childrens centre have
  helped her find a job and she has made new
  friends
• Daily SMS messages sent via the HVs 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 childrens
  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
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The Blue Book, Trevor Bradley Greive
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The Blue Day Book Trevor Bradley Grieve