Presentation by Sabrina Fuller at the Institute of Health Visiting Regional Professional Conferences 2015. Sabrina Fuller is Head of Health Improvement, NHS England.

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Health Visitors as
leaders in the
transfer to local
authority
commissioning
Sabrina Fuller
Head of health improvement
NHS England
27th February 2015

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• 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
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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

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• 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?

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• 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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• 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

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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.
" 9
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?

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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 enjoy what you do?
• Are you seen to act with integrity?
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Self awareness

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• 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

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• 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

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• 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

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• 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

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Setting direction: evidence-base

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• 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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• 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

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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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• 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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