In the previous sections we have identified the best practice pathways, outcome measures and enablers required to deliver effective integrated service delivery and monitoring. Whilst these are all essential elements the overall quality and effectiveness of services to children and families will depend heavily on the knowledge and skills of the workforce that deliver them.

Historically workforce development, like other areas of service delivery and commissioning, has been approached from a uni-professional/organisational perspective despite the fact that the core skills and knowledge required by anyone who works with children and young people is the same.

The complex nature of services for children and families requires a clear focus on the need for both integrated delivery and commissioning if the ambitions of the HCP are to be achieved. The same principles should also be applied to the development of the workforce responsible for delivering the services.

The following section describes a system wide model for the integrated development of the children and families workforce.

The needs of children and families receiving services delivered through the HCP will be diverse, and the knowledge and skills required in the workplace need to reflect this diversity. In addition any model needs to take into account the individual roles and responsibilities of staff and the knowledge and skills required to support effective delivery. It is therefore essential that any educational model reflects the various levels of learning interventions required to enable the safe and effective provision of care from the core skills through to the complex and specialist skill.

The model described below (figure 8) proposes three levels of education and training provision to reflect the differing levels of knowledge and skills required to ensure appropriate, safe delivery of the HCP programme.

It should be noted that in developing this model a number of key assumptions have been made, these are: • Supervision and mentorship is available for all staff

• All staff have an annual appraisal and personal development plan;
• All staff have access to training and development opportunities relevant to their role;
• Robust formal mentorship and preceptorship programmes are in place to support new staff.

Level 1

At the first level is the provision of core knowledge which all staff that come into contact with children and families should poses in order to deliver the HCP 0-5 years. This can be delivered through e-learning, workshops or resource packs and should be widely available across the system. The focus of this training is to ensure that all staff that are delivering services to children and families are equipped with the necessary skills and knowledge to ensure provision of relevant, up to date and consistent advice.

Level 2

At the second level, the educational input required to develop the necessary knowledge and skills will be tailored to the specific needs of staff depending on their role, and may include decision making, assessment skills and planning as examples. This may take a combined approach of face to face and e learning, depending upon the local system. This will still be based on a generic skill set, necessary to support integrated working, but will be underpinned with a need to provide increased knowledge and skills in specific areas of care for children and their families.

Level 3

The third level of educational input focuses on those staff that, by virtue of their role, are responsible for the delivery of care to children and families who are more vulnerable or have highly complex or specialist needs. As a result this group of staff are likely to be smaller in number but will require more complex or specialist knowledge and skills. In addition to providing the necessary level of learning, this level should provide an increased focus on an integrated approach to educational delivery that ensures multi-professional cohorts are learning together to aid understanding and support the delivery of integrated care pathways.

Whilst it is acknowledged that the training needs of staff working within individual health & social care systems may vary according to the needs of their local population, the following tables identify the range and nature of training likely to be required at the three levels identified within the proposed model.

Level 1

It is recommended that all new staff should undertake the following training within the first year of employment or when identified separately within the table.

Level 2

It is recommended that, where appropriate to their role, staff should undertake the following training over a two year period.

Level 3

As indicated above level 3 training will be targeted at a relatively small number of staff, who by virtue of their role will require more complex or specialist knowledge and skills. Given the differing needs of local populations the nature and level of training required will vary between different health & social care systems. For this reason it is difficult to identify the full range of training likely to be needed at this level; however examples of the type of training that may be included in this level are:

• Masters Level courses e.g. MA Infant Mental Health
• Deeper knowledge of adult Mental Health issues
• Specific courses related to infant mental health e.g. Attachment theory, Brazleton, Newborn Behavioural Observation
• Working with the Courts
• Lifestory work with Children
• Listening to young Children
• Reflective supervision/supervisor training
• Vulnerable Adults, Relationships and Sexuality (Learning Disability)
• Mental Health First Aid
• Knowledge of cultural issues impacting on families - e.g. working with African families (Witchcraft and Kendoki), working with traveller families, female genital mutilation, child trafficking.
• Domestic Abuse – delivering groupwork and programmes
• Infant feeding specialist knowledge
• Children with disabilities specialist knowledge

The importance of integrated commissioning and delivery of services is well understood and acknowledge by those actively involved in the delivery of the health child programme and has provided a clear focus over recent years. However, the importance and benefits of providing an integrated approach to the delivery of training and education specific to the health child programme appears to date to have lacked the same focus.

The ability to provide relevant, purposeful and role appropriate integrated training will assist local systems to provide a skilled, consistent and stable workforce capable of delivering high quality services to children and families. Whilst there is a need to acknowledge the differences in professional roles, responsibilities and accountability, specialist skills should where possible be nurtured, shared and celebrated.

In order to maximise both the service and cost benefits of delivering a local integrated workforce development plan, individual areas will need to ensure the appropriate systems and processes are in place to co-ordinate, manage and commission the necessary training.

To achieve this local health & social care systems should, under the leadership of the Health & Wellbeing board or through local workforce partnership groups, consider the establishment of a ‘Health & Social Care - HCP Partnership plus Workforce Development Team’. Whilst the membership of this team would need to be agreed at a local level it should include a range of stakeholders such as:

• Local workforce partnership groups
• NHS provider services
• Social Care providers
• NHS Education/training leads
• Local Authority Education/training leads
• Higher Education Providers

The core responsibilities of this group would include:

• ensure appropriate systems and processes are in place to provide a robust training needs analysis of local services and staff;
• identification of standard training packages at both level 1 and level 2;
• identification of appropriate training packages, dependent on local need , at level 3;
• identification of specialist skills within the local workforce which can be used to facilitate/provide training;
• co-ordinate, where necessary, the promotion and delivery of identified training programmes/courses;
• identification and management of joint training budgets.