29 June 2016 PHE Gateway number: Dear Colleague, Re: Children s public health 0-5 years review of mandation

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1 West Offices Station Rise York YO1 6GA T +44 (0) To: Leaders of the Council, Local Authority Chief Executives, Directors of Public Health, Directors of Children s Services, Local Authority Health & Wellbeing Board Chairs, Local Authority Lead member for Children and Young People, Local Authority Portfolio holder for Public Health, Local Authority Commissioner, CCG Commissioner, Service providers via NHS England Regions (Nursing Leads), Health Visitors CC: PHE Centre Directors, PHE Centre Children s Leads Dear Colleague, Re: Children s public health 0-5 years review of mandation 29 June 2016 PHE Gateway number: The Department of Health (DH) has commissioned Public Health England (PHE) to review the five mandated universal health visitor reviews following the transfer of commissioning for children s 0-5 public health services to local authorities on 1 October The current regulations, are designed to maintain the momentum achieved by the Health Visitor programme on service coverage, workforce levels and service transformation. The regulatory form will cease at the end of March 2017 unless Parliamentary action is taken. The regulations state that there will be a review of effectiveness and this has now been commissioned as set out above. The review will comprise an assessment and assurance of the sustainability of Health Visiting and the 0-5 years Healthy Child Programme, future commissioning intentions and the impact of innovative service models will also be considered. This will include the contribution of health visitors in the six high impact areas which link directly to measurable outcomes and also the potential to support delivery against national priorities such as childhood obesity, life chances and the new tobacco strategy. Ministers will determine future arrangements based on the outcomes of this review and make a decision whether the regulations are allowed to expire, or continue in force with or without amendment. In order to inform this decision PHE will look at the impact of the transfer, the appetite for mandation, the evidence of service transformation and risks to the 1

2 sustainability of the service from a range of perspectives using data from different sources and direct input from a wide range of stakeholders. A report will be published in Autumn. Information gathering PHE proposes to rely on a range of quantitative and qualitative information collected from local areas to support this review. This will include: service delivery and outcome indicators This will include health visiting service metrics and outcome indicators, which will be analysed at national, regional and local levels. The process by which this information is collected is already established. stakeholder survey Views of a wide range of stakeholders will now be gathered via the use of an on-line survey. This covers local leadership arrangements, views on mandation, commissioning intentions, benefits realisation and general comments on sustainability. The survey questions and the audiences for which they are proposed are outlined in Appendix 1. We would like to invite you to support this review by completing the survey from the perspective of your own role in your own organisation. We can assure you that all responses will be treated in confidence and that no individuals or organisation will be identified. Themes will be presented at national and regional levels but also from the perspectives of different stakeholder groups. It has also been agreed that once the results have been analysed by PHE that the separate professional bodies or membership organisations will be invited to provide a reflection on the findings on behalf of their own members for inclusion in the final report. other information We will also be collecting other sources of information both to inform the review of mandation (Autumn 2016) and also to inform a second report on benefits realisation which is not due until later in 2016/17. Yours sincerely Viv Bennett Chief Nurse Public Health England Phil Norrey Chief Executive, Devon County Council SOLACE Policy Spokesperson on Children and Families 2

3 Appendix 1 - Stakeholder survey Questions and intended audience QUESTION RESPONSES LA Chief DPH, CCG Health Exec, DCS, Comnr, Visitor H&WBB LA Comnr Service (Team) Chair, Provider LA elected member, LA portfolio Background Please tell us about your role. Are you giving us your views from the position of local authority chief executive director of public health director of children s services local authority lead member for children & young people local authority health & wellbeing board chair local authority portfolio holder for public health local authority commissioner CCG commissioner provider of health visiting services (management) health visitor (health visitor team) holder 3

4 Please tell us which area drop down list of all PHE centre of the country you work in areas/government Office Regions Leadership Within your Local Authority director of Public Health Yes Yes No No which Director is director of Children s Services responsible for children s other public health 0-5 years? don t know If other please specify Free text field Yes Yes No No Within your Local Authority lead member for Children & Young People Yes Yes No No which elected member is portfolio holder for public health responsible for children s other public health 0-5 years? don t know If other please specify Free text field Yes Yes No No Mandation Existing legislation, the mandation is extended in its current mandating the five form universal health visitor the mandation is extended but in a revised form reviews (antenatal, new the mandation is allowed to expire as baby, 6-8 weeks, 1 year planned and / 2 years) are don t know delivered for every child, is due to expire at the end of March What would you recommend happens next? What are your reasons for Free text field this recommendation? If you are recommending that the mandation is extended in a revised form Free text field 4

5 what changes would you like to see and why? In your opinion, how valuable is universal / consistent performance of the mandated checks for 0-5 s to your local population s health and well -being compared, for example to other currently mandated services? More valuable Less valuable Neither more or less valuable Don t know Yes Yes No No Note: Other mandated Public Health functions include National Child Measurement Programme, NHS Health Checks, Sexual Health Services, Public Health advices and Health protection What are your reasons for your response? Free text field Yes Yes No No Commissioning/ Commissioning intentions/service levels In your area how did improved service levels for the five stayed the same universal health visitor deteriorated reviews change last year? don t know (2015/16) In your area how will improve 5

6 service levels for the five universal health visitor reviews change this year? (2016/17) In your area how do you expect service levels for the five universal health visitor reviews to change next year? (2017/18) How confident are you that the introduction of new service models, including the integration of services, has enabled you /will enable you to commission for/deliver better outcomes? Note: You will be invited at the end of the survey to provide contact details if you would like to share examples of good practice with the review team. What impact do you expect future service models for children s public health will have on the health visiting workforce? stay the same deteriorate don t know improve stay the same deteriorate don t know extremely confident very confident somewhat confident not so confident not at all confident don t know require more health visitors require about the same number of health visitors require fewer health visitors don t know 6

7 Please tell us about any future commissioning intentions Please tell us how you have addressed any boundary issues (registered versus resident population) Benefits realisation How important do you think the universal health visitor reviews are to delivering the benefits of the Healthy Child Programme 0-5 years in the following areas? a) Transition to parenthood supporting the parents, providing advice and guidance healthy lifestyle and preparing the home for the new baby Free text field Yes Yes No No Free text field No Yes No No For each No Yes Yes Yes extremely important very important somewhat important not so important sot at all important don t know b) Transition to parenthood contraceptive and sexual health advice to support 7

8 planned pregnancies or parenthood c) Transition to parenthood advice and guidance on smoking cessation in pregnancy and to reduce harm to baby from second hand smoke (tobacco control priority) d) Transition to parenthood advice and guidance on establishing secure attachment and bonding, home learning environment e) Maternal mental health assessment, brief intervention and signposting to other support services; being mindful of paternal wellbeing and good mental 8

9 health as a mechanism for supporting healthy relationships f) Breastfeeding advice, education and practical support, including signposting to other support services in order to initiate and sustain breastfeeding (childhood obesity priority) g) Healthy weight advice and education on nutrition, weaning, healthy eating (including access to means tested vouchers for fresh fruit, vegetables and vitamins) and physical activity (childhood obesity priority) h) Managing minor illnesses & accident prevention advice & guidance, illness 9

10 escalation approaches, support uptake of childhood immunisations, home safety environment i) Healthy 2 year olds and school readiness safety net on new-born and infant screening, child development assessment aged / 2 years, supporting parents to articulate development concerns (special needs) with access to early help, onward referral to other services (paediatrics, speech and language etc.) How important do you believe the universal health visitor reviews are to delivering the wider benefits of child health and wellbeing in the following For each very important somewhat important not very important not at all important 10

11 areas? a) Escalation of safeguarding concerns b) Child protection don t know To what extent do you believe the universal health visitor reviews deliver a positive return on investment? I.e. these services save more money in the wider system than they cost to deliver. General Comments Please let us have any other comments on the sustainability of these services. In particular what are the main risks, mitigating actions and opportunities for innovation? positive (e.g. save more than they cost) neutral (e.g. save about the same as they cost) negative (e.g. cost more than they could ever save) don t know Free text field Thank you for your participation in the survey. If you would be interested in sharing your learning and best practice more widely via the production of anonymised case studies then please contact us at Interimreporting@phe.gov.uk 11

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