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www.england.nhs.uk
Health Visitors as
leaders in the
transfer to local
authority
commissioning
Sabrina Fuller
Head of health improvement
NHS England
27th February 2015
www.england.nhs.uk
• Context
• What is leadership?
• How can you apply leadership principles in the context of the transfer?
• Challenges?
• Opportunities?
Health visitors as leaders: leading through influence
2
www.england.nhs.uk
• 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 eg safeguarding,
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?
www.england.nhs.uk
• What were we born with? Our own natural tendencies to lead (or not).
• Transactional, transformational, autocratic, participative, laissez-faire.
• 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
www.england.nhs.uk
• 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.
" 9
Significant leaders or good leaders?
Of course, significant doesn’t always mean good………
www.england.nhs.uk
• 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
• 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 enjoy what you do?
• Are you seen to act with integrity?
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Self awareness
www.england.nhs.uk
• Shared purpose and understanding each others’ contribution is critical:
• What are the local priorities? How do 0-5s fit?
• Shared 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)
• Building and maintaining relationships
• Building and using your networks
Working with others
www.england.nhs.uk
• Planning: know your local authority priorities for 0-5s; working 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
www.england.nhs.uk
• 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: use that intelligence for continuous improvement.
• Facilitating transformation: plan to meet requirements of service specification – the 4, 5, 6 model.
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Improving services
www.england.nhs.uk
• Context: JSNA, joint health and wellbeing strategy
• Applying knowledge and evidence: leading delivery of evidence-based interventions.
• Making decisions: in partnership with commissioner and other providers – developing pathways
• Evaluating impact: demonstrating your value
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Setting direction
www.england.nhs.uk
• Promoting secure attachment
• Baby friendly in the community across the system
• ASQ 3
• Incredible Years Pre-school Basic - parenting groups
• HENRY: tackling childhood obesity
Setting direction: leading effective intervention
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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:
• safeguarding
• promoting a positive home learning environment, school readiness, attainment
• early intervention, troubled families
• addressing inequalities.
Setting direction: comms
www.england.nhs.uk
• 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
• 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.
• NHS England is supporting you!
Health visitor leadership
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