Angela Ladocha

Developing a seamless public health team for 0-19 years old people

Background

Locally we have commenced a new public health 0-19 years’ service specification. A significant aspect of this is to develop a truly integrated, seamless 0-19 years public health team. Previously we had a health visiting service which covered from 0-5 years (with staff levels bands 3-7) and a school nursing service aged 5-16 (with staff levels bands 3-7). These two services worked separately and the plan was to fully integrate them.  

Using the Calderdale framework I worked with different staffing groups to explore the development of an innovative service locally with an assurance around a competent workforce. This work led to the development of the following competency workbooks: 

  • Band 4, 0-11yrs induction workbook (for new staff) 
  • Band 4, 0-11yrs skills sharing workbook (for existing staff previously working in the 0-5 area of practice and the 5-11 area of practice) 
  • 0-5 years specialist community public health nurse (SCPHN) skills sharing workbook (for existing SCPHN school nurse to develop health visitors skills) 
  • 5-19 years SCPHN skill sharing workbook (for existing SCPHN health visitors to develop school nursing skills) 

The workbooks are comprehensive and include competencies for practice, e-learning resources, further reading and guidance for mentors and preceptors. This is supported by a reflective practice approach. Where there is a need for additional training a schedule for this is being developed.  

To date, 28 competencies have been developed to support the development of the 0-19 years’ workforce. These are in a testing phase before they go for ratification. 

 

The workbooks are comprehensive and include competencies for practice, e-learning resources, further reading and guidance for mentors and preceptors
 

As an organisation we are exploring the development of a database and systems to embed the competencies into the professional development review process to support sustainability of this approach. 

boy playing with tablet laughing

The benefits of this approach are many-fold and include:

  • A focus on skill and knowledge development which contributes to continuing professional development
  • Equity in staffing capacity across the 0-19 spectrum
  • The removal of unnecessary barriers or disruption to care, and prevents ‘silo’ working  
  • Maximising opportunities for support for families using a holistic approach by a multi skilled worker. This prevents duplication and fragmentation of care 
  • The maintenance of established relationships between families and professionals which supports continuity of care  
  • Provides enhanced opportunity to ‘make every contact count’ with children and families 
  • Provides an opportunity to review and scrutinise current practice
  • It maximises the contribution of already skilled and experienced support staff across the service


Aims and objectives

The aim of the project was to develop an integrated 0-19 years public health nursing service locally in line with the service specification.

Our objectives were:

  • To use the Calderdale framework process to work with colleagues at all levels to develop competencies for the different aspects of work that the service was commissioned to provide with a focus on skill sharing across SCPHN specialities and development of support staff (band 3 and 4)
  • Workbook development to reflect agreed competencies for each staffing group
  • Support for an initial cohort of health visitors and school nurses to undertake their practice in the alternative field. This cohort will then support the identification and development of competencies and training needs and act as ‘champions’ for 0-19 years practice.
  • To establish integrated 0-19 years teams across the patch 

 

The aim of the project was to develop an integrated 0-19 years public health nursing service locally in line with the service specification
 

Outputs to date

  • The development of competencies for all areas
  • Identification of areas for development of support staff 
  • Development of skills in colleagues from different areas of practice
  • Six SCPHN HV colleagues have completed their portfolio to date 
  • Four SCPHN SN colleagues are nearing portfolio completion
  • Fourteen additional colleagues have been identified to move into phase 2 of the project using the skills sharing competency workbooks. This is due to commence in January 2018 

Lessons learned 

We had to delay ‘School nurses developing health visiting skills’ due to capacity issues within the team. Unfortunately, my team leader colleague was not always in a position to support me with the CF process due to other work commitments. Some staff have been resistant about the impending change, and there have been several other changes to the service which has added further pressure on staff. Developing competencies has been challenging for colleagues with competing work pressures. The need for a wider system change to embed new ways of working has been identified. 


open book

Reflections on impact

 

The impact of the project for service users are that opportunities for support for families using a holistic approach by a multi skilled worker are maximised, preventing duplication and fragmentation of care.

Established relationships between families and professionals can be maintained, despite the child’s age, supporting continuity of care. It provides enhanced opportunity to ‘make every contact count’ with children and families.

 

[…] opportunities for support for families using a holistic approach by a multi skilled worker are maximised, preventing duplication and fragmentation of care

 

Measurement of this is challenging, although we are capturing and using stories from professionals to illustrate where this has occurred and sharing this good practice with colleagues on a regular basis through a 0-19 years’ development forum.

We will be using client feedback surveys to capture their feedback on both the service and their experience. 

We are also developing more outcome measures following completion of an episode of care.  


The way forward

Many health visiting and school nurse services nationally are moving into a 0-19 years’ integrated service. I feel that the work undertaken through this project could be shared to support development needs of other areas. The work completed could be written up for publication, presented at conference or consultancy support offered.