Shared Understanding/Definitions
One of the major challenges in developing an integrated approach to commissioning and delivery of the HCP is developing a shared understanding of the statutory duties of the LA in the provision of services to children and families and both the statutory and policy requirements of services provided by the NHS.
Across the range of statutory guidance and policy documentation appropriate to the HCP there are a variety of terms used to describe the level of service provision. In addition, where a common term is used e.g. Universal the definition of the level of service provision varies between documents.
HCP
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HV Call to Action
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Statutory Guidance CC
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Midwifery
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Universal Programme of interventions that are delivered to all.
Universal Progressive More intense programme of interventions that are delivered based on the needs of the individual
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Universal Nationally defined programme of interventions that will be delivered to all.
Universal Plus More intense programme of interventions that are delivered by the HV team based on the needs of the individual.
Universal Partnership Plus More intense programme of interventions that are delivered by a multidisciplinary group of professionals or agencies based on the needs of the individual.
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Universal Programme of interventions or services that are available for all to access.
Targeted Specific range of interventions or services that are provided to a specific group based on the needs of the individual or a community
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Core Service Programme of interventions that are delivered routinely to all pregnant mothers.
Complex A variety of more intense interventions required to meet the specific medical needs of the mother/ unborn baby. This will involve the delivery by a multi-disciplinary team.
Note: The above may also be referred to as: Midwifery led or Consultant led.
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For the purpose of this document we have used the following working definitions:
Universal
The range of services and or interventions that must be delivered/should be available, to children and families
within a local area.
Universal Plus
The range of services and or interventions, predominantly by a single profession or service, provided to a targeted
group of children and families based on an identified individual need.
Universal Partnership Plus
The range of services and or interventions, by a multi-disciplinary range of professions or services/agencies,
provided to a targeted group of children and families based on the identification of more complex individual need.
Transition
A common theme within Serious Case Reviews for children and young people is the communication within and between health and social care teams/systems and across organisational/agency boundaries. Therefore the transition points and communication between services, supported by interagency protocols, are essential to the effective and safe delivery of integrated care.
Both Commissioners and providers within a local health & social care system will need to ensure that appropriate systems and processes exist to ensure effective and safe transition and communication.
Some of the key areas of focus should be:
- Effective notification of pregnancy process between midwifery services, the GP, the Health Visiting services and the relevant local authority services including Children’s centres.
- Ensuring notification is provided to HV services and Children’s centres following the registration of families, who are new to the area, at local GP surgeries.
- Ensuring formal handover of care between midwifery services and HV at the point midwifery services discharge mothers postnatally.
- Ensuring formal handover between HV and school nursing services.
- Development of effective interagency protocols that support effective communication and information sharing particularly relating to safeguarding.
Interdependencies and Seamless Pathways
It is essential that the HCP 0-5 years is not commissioned or provided in isolation of other healthcare services. It is also crucial that operational and strategic relationships with colleagues in local government, such as Children’s centres, are maintained and strengthened. The new commissioning arrangement split responsibility for the commissioning of the children’s pathway between three responsible commissioners. In addition to the HCP 0-5 years, NHS England will commission other important services used by children including primary care services and specialised services. CCG’s will commission Maternity Services, children’s community services and most secondary care services, and local authorities will commission a wide range of services for children. All commissioners share a responsibility for safeguarding.
A range of the interdependencies are represented in Figure 3 below.
To support the effective delivery of the above it would be useful for local systems to develop and agree a formal memorandum of understanding.
Values and Principles
All commissioners and providers need to ensure that the approach taken in both the commissioning and delivery of services supports the national values and principles. In summary this is:
“To ensure that all parents and children have access to the support they need to get off to the best possible start in life, and promote their health and resilience as they grow up. Provide early intervention to ensure additional support for those who need it, including the most vulnerable families.”
HCP Leadership
Whilst all of the professionals delivering services to children and families have a unique and essential role, the HCP specifically identified that the health-visiting workforce was central to its delivery and is defined as:
- leading the delivery of the HCP to a defined population; and
- delivering intensive preventive programmes to the most at-risk families with young children.
Local commissioners through effective workforce planning for the HCP will need to ensure that the health visitor has a lead role in the HCP and has the skills and knowledge needed to lead and deliver the programme.