Presentation by Josephine Johnson at the Institute of Health Visiting Regional Professional Conferences 2015. Josephine Johnson is Project Lead at 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

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• 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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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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• 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?

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• 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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• 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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NHS England
support for
HV
leadership

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• 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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• 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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