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

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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.

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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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