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“Let’s talk about health visiting”

The Changing Context for Health Visiting

Kate Billingham Deputy Chief Nursing Officer Department of Health

Part One: The policy context for health Part Two: The policy context for children and families

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Part Three: Implications for health visiting

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Future health challenges

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Public expectations are changing – as patients and tax payers

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Increasing and changing health needs

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Scientific and technological change

HOW DO WE SUSTAIN A SERVICE THAT IS TAX-FUNDED-FREE-AT-POINT-OF-USE?

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Challenges for health visiting

Using new knowledge, new technologies and evidence of what works e.g. parenting and neurological development  Preparing for impact of unhealthy living and global health threats  Inequalities in health  Public expectations are changing - as patients and tax payers  Finding HV’s unique contribution in a more varied and diverse workforce  Making the case for preventive services to commissioners

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The policy jigsaw

Supporting independence, healthy choices, Integrated services centred on the Meeting changing community needs, improving health and reducing inequalities Adapting the workforce Changing the system (funding, commissioning, IT, regulation, providers)

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Modernising Nurse Careers: the strategic direction for nursing

Constancy of nursing values and practice Quality care organised around people’s needs A community centred health service Better care for people with long term conditions (self-care) Effective preventive interventions Integration of services Able to meet physical and mental health needs Sufficient number with advanced skills Leaders of mixed teams Deliver high productivity and best value for money 6

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Health policies that impact on health visiting: ‘our health, our care, our say’

 Public Health: obesity, inequalities, ‘fully engaged public’, pandemics  Primary care: ‘hospital to home’, long term conditions, choice, practice based commissioning, new providers, self care and independence  Nursing: Modernising Nursing Careers, quality and reputation  System reform: Client/patient experience as the driver, active commissioning, better value for money/productivity, Connecting for Health, new providers, devolution

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Part Two:

The policy agenda for children and families

The policy agenda for children and families

 Priorities: reducing poverty and social exclusion, best start in life, education  Prevention and early intervention  Progressive universalism  Balancing support with challenge  Integration of services in children’s centres  Health led during pregnancy to 3 years  Choice for parents from a range of different sources of support  9 Using what we know about risks and protective factors and what works

Key priorities for children and young people since 97

Tackling child poverty

 introducing welfare reforms to make work pay and financial support for families with children. The Government’s goal is to eradicate child poverty by 2020, halving it by 2010

Ensuring every child has the best start in life

 recognising the importance of the early years through Sure Start, Children’s Centres and expanded early years education. The Government has invested more than £17 billion in these areas since 1997

Education

  raising standards across the board while giving priority to improving standards in schools in the most challenging circumstances.

Investment per pupil (including capital spending) has risen from £2,500 in 1997 to over £5,000 today and is expected to exceed £5,500 by 2007-08.

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What is progressive universalism?

A universal preventive service that is systematically planned and delivered to give a continuum of support according to need at individual and population level in order to achieve ECM outcomes.

 Those with greatest needs receiving more intensive support and those with lower levels of need a ‘lighter touch’ Why?

We know more about the impact of parenting and maternal health of outcomes for children Inequalities (IMR 6x higher in Birmingham than Eastleigh) It happens anyway but tends to be unplanned The world is changing (expectations, technology, social relations) 11

3% 2% 1% 0% -1% -2%

Progressive impacts – but concerns about the tail

5% 4%

Faster income growth for poorer families since 1997

– particularly compared to 1979 - 1997

poorer families

1996/7-2004/5 1979-1996/7

richer families

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Reaching Out: An Action Plan on Social Exclusion

Considerable progress made in tackling poverty and social exclusion since 1997 

Need to do more to achieve the goal of progressive universalism and help those with the most entrenched and complex problems

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Importance of support from the start

– breaking intergenerational transmission of disadvantage  Research on risk and protective factors offers us considerable

opportunities for early identification and more effective

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prevention

Life chances are influenced by opportunities and constraints operating at different levels – at the heart of this model is the individual child and family Economic, fiscal and social policy

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Current well-being Choices Actions Be healthy; stay safe; enjoy and achieve; make a positive contribution; economic well-being Future well-becoming Prospects and social mobility (inter- and intra-generational)

‘Proximal’ factors (e.g. parenting and cultural capital): ‘distal’ factors (e.g. social class, income, assets) Social capital; peers; concentrations of deprivation; discrimination Environment; housing; regional economy

A ‘magic moment’ of opportunity

“Like it or not, the most important mental and behavioural patterns, once established, are difficult to change once children enter school” Nobel Laureate James Heckman (2005)

• • • • Pregnancy and the first 3 years are vital to child development, life chances and future achievement Birth of a child is a ‘magic moment’ of opportunity when parents are uniquely receptive to support Universal midwifery and health visiting services are ideally placed to identify children and families at risk Embedding the principle of ‘progressive universalism’ into maternal services should be a priority to ensure that additional support is provided to those children and families at greatest risk 15

What might this look like for a 16 year old single mother with her first child?

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Has chosen which HV she wants by seeing video clips of the team’s particular skills at the local children’s centre The HV keeps in touch with the practice and all other services using the new IT systems that are in place, with all aware of progress The mother has a collection of video clips of her baby’s development on her own Health Space which mum and the HV look at on the digital TV Feels that she is benefiting from the intensive parenting support programme She has a volunteer support worker who helps her with some of the practical day to day needs Job centre staff at the children’s centre have helped her find a job and she has made new friends Daily SMS messages sent via the HV’s PC are helping mum to keep off cigarettes

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Part Three

Implications for health visiting

National developments

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The establishment of 10 health-led parenting support demonstration projects from pre-birth to age 2

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Working group to look at the future of health visiting

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Modernising Nursing Careers

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These workshops

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Commissioning for health well being guidance

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What does this mean for health visiting?

Health visiting role within a service rather than a ‘HV service’?

Focus on improving the well being of children through progressive universalism, health-led prevention and early intervention Evidence based interventions with known outcomes Integration of child and family services Changing landscape of primary health care New career paths and educational preparation (level and content) More ‘players on the field’ - public health role of the public New roles in a new world – leading and delivering Influencing commissioning and delivering a contract Local decision making New providers (general practice and children’s centres)

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The real social revolution we are living through is from a life that is largely organised for us

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To a world where we have to be in charge of our own destiny

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The Blue Book, Trevor Bradley Greive

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The Blue Day Book – Trevor Bradley Grieve