Hounslow and Richmond Community Healthcare Trust designed a new delivery model for services for children aged up to five, and won the 2018 HSJ Award for Workforce Initiative of the Year
In 2015, Hounslow and Richmond Community Healthcare Trust faced challenges in its provision and delivery of the 0-5 Healthy Child Programme. Being unable to deliver a universal antenatal contact or individual appointments for the one and two year old child health reviews, a high vacancy rate and a reliance on agency staff prompted the trust to design a new delivery model for services for children aged up to five.
Co-designed with commissioners, families and 0-5 partners – early years services, the local safeguarding children board, GPs, social care – the programme developed a universal antenatal contact, rather than a targeted contact approach, resulting in early identification of needs within the whole population and appropriate interventions at an earlier age.This means all expectant women, mothers and children in the area receive five quality mandated contacts, expected to improve long-term outcomes, as outlined by the Healthy Child Programme.
The contacts are with women more than 28 weeks pregnant, children aged one day to two weeks, children aged six to eight weeks, children aged nine to 15 months and those aged 24 to 30 months.
The new model includes a workforce skill mix of 60: 40 nurses to health visitors. Staff nurses have been trained to support delivery of the universal new baby review, enabling health visitors more time to be able to offer the universal antenatal contact to every expectant woman.
Despite an overall reduction in budget of 12 per cent, all five mandated contacts in the locality’s 0-5 healthy child programme are now being delivered. There is a 90 per cent uptake of antenatal contact in the locality and 95 per cent of new babies receive a review by the service within 14 days.
The capacity to deliver individual one year and two year reviews by the service has increased from 42 per cent to 66 per cent. By January 2017 the trust had recruited 14 staff nurses to vacant health visitor posts and enjoys a low vacancy rate; it went from 21.3 per cent to seven per cent in a year (2016 to 2017). This in turn ended the service’s dependency on expensive agency staff; at the time of entering the award, no agency staff had been used since December 2016.
A survey of mothers who use the service found 100 per cent found the health visitor visits helpful, with every visit conducted at home, with more time available for them to be able to ask questions, compared to visits from midwives.
The new model incudes a workforce skill mix of 60: 40 nurses to health visitors. Staff nurses have been trained to support delivery of the universal new baby review, enabling health visitors more time to be able to offer the universal antenatal contact to every expectant woman
“Some health visitors have been concerned that the roles we have established have meant encroaching on their work but the staff nurses doing more routine work such as supporting feeding frees the health visitors up to do more complex safeguarding work,” says Judy Zur, practice development lead for children’s’ services at Hounslow and Richmond Community Healthcare Trust.
She says establishing a competencies framework has been key to the successful implementation of the model as it gives staff nurses the skills and knowledge to undertake duties traditionally undertaken by health visitors. Staff nurses on the programme have reported feeling well supported in their new roles, having received high quality training and learning that meant they felt prepared for the practice required in their roles and able to competently deliver care.
“I see the staff nurses every week for some training so as to be able to continue the establishment of competencies; they benefit from the consistency of always having the training delivered by the same person,” says Ms Zur.
She says her team was “delighted and excited” to win the HSJ award. “On the way home from the awards ceremony we were already talking about what we could enter next.
“Gaining recognition for the work that has been done – and it has been two years of hard work to get [to] this point – is very gratifying, as you feel your work has been validated. It is especially gratifying as we are a small trust – and it is usually the big trusts that are seen as the trailblazers – it is unusual for smaller trusts to win things when you are going up against massive trusts with a lot more resources. Having said that, smaller trusts have the flexibility to try out new things.”
Ms Zur says winning the award has led to increasing its profile.
“Senior managers were delighted with the win; we went to a board meeting with the trophy and they were thrilled. We have also presented on it to both borough leaders [of the local authorities served by the trust], to forums across the borough and in inner London.”
The capacity modelling used for the 0-5 service re-design has since been rolled out across the trust and the competency framework has been adapted within its adult nursing teams to help address challenges faced by the district nursing workforce.
For more information on Hounslow and Richmond Community Healthcare Trust’s winning entry visit HSJ Solutions
The HSJ Awards 2019 are now open for entries. For more information on the Workforce Initiative of the Year category visit https://awards.hsj.co.uk/categories