Section 9

Summary of Recommendations

Scope & Purpose of the Project


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.


To support the effective delivery & commissioning of an integrated HCP 0-5 it would be useful for local systems to develop and agree a formal memorandum of understanding.

Values & 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.

HCP Leadership

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.

​Best Practice Pathways


Commissioners and providers should work collaboratively to ensure the best practice pathways are implemented as appropriate within their local area.


Hearing Screening

Commissioners and providers need to ensure:

  • That there is clarity regarding the agreed local pathway for delivery, particularly where there may be a combination of community and acute provider.
  • That all providers and commissioners can clearly identify the roles and responsibilities for the local day to day operational delivery of this service.
  • That all providers and commissioners are clear about the funding streams attached to the operational delivery of this service.

Management of DNAs

Providers and commissioners should consider:

  • The development and implementation of a consistent DNA policy across all providers to be added to existing service specifications
  • What systems, processes or multi-agency forums need to be in place to allow:
    • System wide sharing of DNA data from local provider services
    • The routine ‘root cause analysis’ of DNA’s by all providers.
    • The development of co-ordinated plans/initiatives to reduce the incidence and risks associated with DNA’s.

Co-ordination of Local Service Delivery

Local systems will need to consider how they can maximise the use of groups such as the Health & Wellbeing Board and Children’s Partnerships to:

  • Undertake a co-ordinated local needs assessment.
  • Understand both the individual and collective service capacity of the providers through the use of a robust capacity planning model which can be reviewed regularly.
  • Develop a system wide delivery plan that:
    • Addresses local demographics and clearly identifies the range of services required and means of delivery.
    • Provides clarity of roles and responsibilities for providers through clear locally adapted or single service/pathway specifications.
    • Ensure shared information and monitoring of the delivery plan.

Midwifery PbR

The current Midwifery PbR system may or is currently impacting on the following, which will need to be addressed if commissioners and providers are to successfully deliver an integrated 0-5 service.

  • There is anecdotal evidence that capacity constraints and maximisation of PbR income are having an impact on the time available to engage effectively in the delivery of integrated working. This in turn will impact on the effectiveness of relationships between professions and services.
  • There would appear to be a lack of clarity across providers as to what is included within the PbR system and what still remains as part of a block contact/specification.
  • In addition to the above there would appear to be an inconsistency between providers which is causing confusion within the services.
  • There is a lack of clarity regarding the systems and processes required to manage cross boundary issues between providers and commissioners.

Standardised use of assessment tool

Commissioners and providers within a local system should consider:

  • What evidence based assessment tools should be adopted across the health and social care system.
  • The approach required to ensure the consistent implementation/roll-out of these tools across services, including the training and demonstration of competence of staff to use the tools
  • What systems and processes need to be in place to monitor:
    • Consistent use of the agreed tools within provider organisations.
    • The impact and outcomes of using the agreed tools.
    • What areas of unmet need are being identified as a result of using the agreed tools and what additional or amended pathways need to be considered.
  • How will use of these tools be reviewed with individual staff within the organisations supervision systems and processes.

Information sharing

Commissioners in collaboration with providers, should consider how the local Health & Wellbeing Board can influence the development of:

  • A HCP information sharing protocol & policy which is agreed and signed-off by all partners and addresses:
    • The specific needs of the local system.
    • All data protection legalities
    • User engagement and consent

Organisational & Professional Respect

Commissioners and providers, could start to address some of the underlying issues. These include:

  • The development of a clearly articulated shared values and vision and behaviours for the local system.
  • A joint agreement between all organisations to the above
  • A mechanism by which individuals and organisations can escalate issues where behaviour has not been consistent with the shared values, vision and behaviours.
  • An approach and behaviours that are transparent and encourages shared ownership of issues/barriers.
  • The development of increased shared learning opportunities

Staff Supervision

Service specifications should exist that:

  • Require organisations to have an agreed supervision policy that:
    • Identifies the type, delivery method (group, individual) and frequency of supervision (safeguarding, clinical/ restorative, managerial) available to individual staff groups (qualified, unqualified);
    • Identifies the number of trained supervisors available within the organisation;
    • Methodology, approach and frequency for the auditing of supervision uptake across the service.
  • Require organisations to provide performance data relating to the delivery and uptake of supervision within the service.

2 – 2 ½ year Reviews

Commissioners and providers should explore further the operational delivery of joint 2 – 2 1⁄2 Year reviews as a significant developmental opportunity. This work should draw on learning from both local and national pilot areas and explore:

  • How health visiting, early years providers and children’s centres should approach the delivery of a joint review;
  • The potential nature and extent of logistical problems associate with delivery and potential solutions;
  • The potential inherent difficulties to embedding this across a whole system and potential solutions;
  • The establishment of a service wide measure for the identification of the number of joint 2-21/2 year reviews being undertaken.

Delivery of Consistent Messages by Health & Social Care Staff

In addition to the four key public health messages commissioners and providers should work together to:

  • Identify and agree the key messages that are of particular relevance to the physical and mental health of children and families.
  • Identify and agree appropriate national/evidence based guidance relating to each of the above.
  • Develop and implement the necessary training for staff within provider organisations, utilising opportunities for the provision of joint training.
  • Develop and implement the necessary contracts, payments, incentives and monitoring arrangements (including user feedback) to encourage providers to ensure the required messages are delivered consistently.

Outcomes & Key Performance Indicators

Principles of Care

Commissioners and providers should ensure that services are commissioned and delivered in line with the agreed ‘Principles of Care’.