Delivering health visiting service
transformation
Denise Thiruchelvam, NHS England
Contact: england.healthvisiting@nhs.net
Webinar 1- 10.00-10.50
14th November 2013
1 NHS | Presentation to [XXXX Company] | [Type Date]
Aim of Webinar 1
Define service transformation and the new model of health visiting
1.
0-5 Commissioning responsibilities of ATs (HCP, HV, FNP, CHIS), CCGs (maternity
services, adult and child mental health services, acute and community services) and
of local authorities including delivering school readiness.
2.
Transition of responsibilities for PH of 0-5s to local authorities from 2015
3.
Expectations on Area Teams in terms of delivery of service transformation: the 201314 spec, AT dashboard and provider performance framework
4.
2014-15 Commissioning intentions
5.
How the service transformation funding is intended to support Area Teams, Local
Authorities, and provider organisations in delivery of the new model of health visiting
in the context of new and future commissioning strategies – a systems approach.
2
Service transformation deliverables
1. Full delivery of new model of health visiting
including universal elements of healthy child
programme
2. Ensure that commissioning of public health
services for 0-5s is effective and embedded with
commissioning of other early years services
3. Improvement in defined public health outcomes
3
Delivery of the new model of health visiting
• Community: health visitors have a broad knowledge of community needs and
resources available
• Universal: health visiting teams lead delivery of the Healthy Child Programme.
• Universal Plus: families can access timely, expert advice from a health visitor
when they need it
• • Universal Partnership Plus: health visitors provide on-going support, playing a
key role in bringing together relevant local services, to help families with
continuing complex needs
4
Delivery of the Healthy Child Programme
• Universal, progressive, preventive
• Led by HVs but delivered in partnership
• Focus on outcomes
• Address inequalities
5 ]
New Commissioning Landscape
Current commissioning system
6 NHS | Presentation to [XXXX Company] | [Type Date]
Interdependencies and ensuring a ensuring a seamless
pathway
http://www.england.nhs.uk/wp-content/uploads/2013/08/comm-health-child-prog.pdf
7
Challenges
• Fractured commissioning
• Understanding
organisational boundaries
• Changing the current
model of work
• Short timeline
• Change fatigue
• Anxiety for the future
Opportunities
• Establish a local vision
• Using the Health and
Wellbeing Board, JSNA
and Health and
Wellbeing Strategy to
develop an integrated
approach to
commissioning
• Improved pathway
development
• Increased user
engagement
8
Transition of responsibilities for PH of 0-5s to local
authorities
• The direct commissioning responsibility for public health services for
children aged 0-5 (other than the national immunisation and screening
programmes) will transfer to local government from 2015.
• This offers considerable potential for developing more integrated
approaches to commissioning for 0-5s in 2013-14 and 14-15.
9
Potential Use of Health Visiting Transformation Funding
Role of area teams in term of delivery of service transformation
Bring together commissioners and define the role of
health visiting within the context of:
• Local needs
• Resources
• Priorities
10
Potential Use of Health Visiting Transformation Funding
Potential Use of Health Visiting
Bring
together commissioners
and providers and engage
Transformation
Funding
with them to deliver the new model of health visiting
implemented locally:
• In the context of 0-5 strategies
• Providing leadership across the system for improving
outcomes for 0-5s
• Leading delivery of the Healthy Child Programme
• Delivering the full new model of health visiting by April
2015
What are their support needs?
11
Using the funding to deliver a system-wide
approach
service
transformation
What is to
the
system
approach to
Toservice
deliver hightransformation
quality care and improved outcomes for
children and families for example through:
• Commissioner development, for example supporting partners in
developing and/or commissioning integrated 0-5 years strategies
• Provider development for example professional development to support
the delivery of evidence-based early attachment and parenting
programmes to deliver the integrated strategy
12
Webinar 1-Questions and Answers panel
• Sabrina Fuller- Health of Health Improvement, NHS England
• Denise Thiruchelvam- Public Health Project Manager, NHS England
• Victor Francis- Health Visiting Programme Commissioning Support,
NHS England
• Samantha Ramanah- Adviser – Community Wellbeing, Children and
Young People, Local Government Association
13
The requirements of NHS England in terms of assurance that the
proposals received will deliver the required outputs and outcomes
and value for money
Presented by Lois Shield FCIPS NHS England
Seminar 2- 11.00-11.50
14th November 2013
Topics covered:
• What a bid will be expected to cover– what are
the expectations in terms of meeting the criteria
set out in Appendix 4
• Supporting Area Teams who do not meet the
criteria
• Once the bid has been funded: NHS England
procurement rules
15
Successful Proposal Criteria
Each bid will be evaluated based on the criteria in this table
Name and contact details of Area Team Health Visiting lead
Yes
No
Is the proposal in not more than 500 words?
Does the proposal give full details of how funding will be used to support provider and
commissioner development and represents value for money?
Yes
Yes
No
No
Are there milestones for the programme? (Key deliverables and dates).
Yes
No
Does the proposal support delivery of the new model of health visiting as set out in the core
national health visiting service specification and the health visitor implementation plan?
Yes
No
Does the proposal support an integrated approach to commissioning and provision of services for
0-5 years?
Does the proposal specify the outputs expected?
Will the outputs improve public health outcomes for young children and their families?
Yes
No
Yes
Yes
No
No
Does the proposal indicate availability of a report on programme implementation, achievements,
outputs and outcomes at the end of the project, and an intermediate report in March 2014?
Yes
No
Is there evidence of support for the proposal from each of the following or their representatives:

Chair of health and wellbeing board/Children’s partnership/Children’s Trust.

Constituent Local Authority Directors of Children’s Services/ Director of Public Health

Commissioned Health Visitor Provider Directors of Nursing

CCG children’s/maternity commissioners
Yes
No
Is there any information in the proposal in respect of further funding and how it would support
delivery of the service specification and the new model of health visiting?
Yes
16
No
Successful Proposal Criteria
• A "yes“ decision will take due account of NHS England's responsibility to ensure that this funding
delivers the required outputs and value for money.
•
If its a "no" then feedback will be given to the area team to ensure they are clear on our expectations
• Bids that have yes as specified in the table will go forward to a reference group for further review and
endorsement of decision.
• Those not meeting the evaluation criteria will get full written and verbal suggestions for improvement and
invited to resubmit their proposal within 2 weeks.
17
NHS England Procurement Rules
• Applies to all employees of NHS England and also to the Commissioning
Support Units (CSUs) and other Hosted Bodies.
• The Public Contracts Regulations 2006 (as amended) (the “Regulations”) divides
services into two types, Part A and Part B services.
• Examples of Part A services include telecommunication services, financial
services, computer and related services, advertising services and property
management services.
• Examples of Part B services include health and social services, education and
vocational health services, legal services and recreational, cultural and
supporting services. Clinical services fall under health services and will be
categorised as Part B services.
18
NHS England Procurement Rules
• When awarding contracts for services, it is important to determine whether the
service to be procured is a Part A or Part B service as different obligations under
the Regulations will then apply to the procurement process.
• Part A services are subject to the Regulations in their entirety while Part B
services are only subject to certain limited parts of the Regulations including
obligations to treat bidders equally, to act in a transparent way, to act in a nondiscriminatory way, the use of technical specifications and the requirement to
submit a contract award notice.
• All procurement activity is underpinned by the EU Treaty Principles.
19
EU Thresholds
The current thresholds are as follows:• Supplies & Part A Services (except R & D, and certain telecom services)
Schedule 1 bodies (including NHS bodies)
- £113, 057
• Part B Services & R & D, and certain telecom services and subsidised services
(Regulation 34)
All bodies
- £173, 934
• Determining the contract value – total life or whole life costing approach. Values
exclude VAT
20
Above the EU Threshold
• For expenditure over the EU threshold the EU Procurement Directives may
apply.
• There are a number of procurement routes under the Regulations – Open,
Restricted, Negotiated and Competitive Dialogue procedures
• The procedure to be followed in each case will largely depend on the type of
goods and/or services being procured and the complexity of the procurement.
• Use of Frameworks should be considered by the ATs for direct placements or
further competitions from EU compliantly procured frameworks.
21
Lower Thresholds
Should the value of the services being procured fall below the EU threshold above
then the following procurement routes should be applied:Under £50,000
• must obtain three written quotes from potential suppliers.
Above £50,000 but below the relevant EU Threshold
• must obtain five written tenders from potential suppliers
22
Considerations in Service Procurement
• When procuring services, NHS England must also comply with the Public
Services (Social Value) Act 2012.
• This set out requirements for public authorities to comply with prior to the
commencement of their procurement processes for services (so before the
OJEU notice/tender documents are published). NHS England will need to
consider:
• how the service that is being procured might improve the economic, social and
environmental wellbeing of the local area;
• how that improvement might be secured through the procurement process;
and
• whether to hold a consultation on the potential improvements themselves.
23
Healthcare Services Procurement
• When procuring health care services for the purposes of the NHS, NHS England
must comply with the National Health Service (Procurement, Patient Choice and
Competition) (No.2) Regulations 2013 (the "2013 Regulations").
• The 2013 Regulations provide that when procuring health care services for the
purposes of the NHS ("Health Care Contracts") whatever the value, NHS
England must act with a view to:
• securing the needs of the people who use the services;
• improving the quality of the services; and
• improving efficiency in the provision of the services.
24
Healthcare Services Procurement
• both regulations include wording to ensure that when procuring Health Care
Contracts, NHS England must act in a transparent and proportionate way and
treat providers equally and not discriminate.
• treating providers equally and in a non-discriminatory way, will include not
treating one provider, or type of provider, more favourably than any other
provider, in particular on the basis of their ownership.
25
Exemptions
• It may be possible for the ATs to award a contract for services to another public
body without running a procurement process in accordance with the Regulations.
This is referred to as the Teckal exemption.
• to satisfy the exemption the recipient of the funding would have to ensure that
the entity or entities contracting with NHS England carried out the principal part
of its activities with NHS England;
• is controlled in a similar way to that which NHS England exercises control over
its own internal departments;
• is funded wholly or mainly by NHS England; and
• has no private sector participation or financing
26
Webinar 3-Questions and Answers panel
• Lois Shield, FCIPS, NHS England
• Sabrina Fuller- Health of Health Improvement, NHS England
• Denise Thiruchelvam- Public Health Project Manager, NHS England
• Victor Francis- Health Visiting Programme Commissioning Support,
NHS England
27
Supporting health visitor service
transformation
Seminar 3- 12.00-12.50
14th November 2013
Topics covered:
• Developing a system-wide approach to service transformation and the
new model of health visiting
• Bringing together commissioners and providers – managers and clinical
leaders
• Developing or building on 0-5s strategies with a clearly articulated role
for health visitors
• Supporting the process
• What will be the development needs of health visitors
• What are the current resources available to support those development
needs
• How can they be accessed
29
Key stakeholders
Commissioners
• Area Teams
• Local authorities
• CCGs
Providers
Providers of health visitor services
Health visitor clinical leads and front line staff
Providers of early years services
Primary care etc.
30
Commissioner and provider partnership
Benefits to commissioners
• Builds successful implementation in to the strategy
• Wins hearts and minds
• Tackles potential barriers to implementation
Benefits to providers
• Understanding and influencing the agenda
• Building relationships
• Benefits to children and families: services
better meeting needs and improving outcomes
• Examples of good practice
31
Local resources – JSNA and Health and Wellbeing Strategy
32
Defining the role of health visitors in a wider
0-5s strategy
• Relatively skilled and highly paid professionals in early
years.
• Early years experts – delivery of evidence-based
interventions
• Leading delivery of healthy child programme
• Supporting good parenting and early attachment as the
foundation for happy, healthy, achieving families and
communities
• New model of health visiting – leading through universal,
targeted and safeguarding.
33
Relating strategy to health visiting development needs
• Shared understanding of priority needs for 0-5s across
commissioners and providers
• Shared understanding of what the evidence and policy
guidance tells us is effective
• What are we doing well now and where are the gaps?
• What is the role of the different providers in delivery and
how do they work together?
• What are the development needs of health visitors to
delivery this strategy.
• Is integrated or uni-professional workforce development
required?
34
Web links
• Association of Directors of Public Health http://www.adph.org.uk/
• Department of Education
http://www.education.gov.uk/childrenandyoungpeople/healthandwellbeing
• Healthwatch www.healthwatch.co.uk
• NHS England http://www.england.nhs.uk/
• Public Health England https://www.gov.uk/government/organisations/publichealth-england
• RCN (Royal College of Nursing) www.rcn.org.uk
• Local Government Association www.local.gov.uk
• SOLACE www.solace.org.uk
35 N | Presentation to [XXXX Company] | [Type Date]
Institute of Health Visiting (iHV)
• Its focus is on supporting the development of high quality and
consistent health visiting practice.
• It was established with support from the Royal Society for Public
Health and works with many educational, statutory and third sector
partners.
• The iHV aims to become a Centre of Excellence for health visitors
and health visiting
• Contact Dr Cheryll Adams, Director: cheryll.Adams@ihv.org.uk
• Website www.ihv.org.uk
•
36
CPHVA
• Working at a strategic level with policy makers, we are in the
unique position of being the conduit with the profession
throughout the UK to listen, engage, advocate, understand
and develop evidenced based best practice.
• Develop professional standards and uphold and defend the
services that our members deliver.
• Provide extensive resources to members and the wider
health sector to support them in their practice and to enable
them to develop and deliver safe and effective services.
• Contacts: cphva@unitetheunion.org
37 NHS | Presentation to [XXXX Company] | [Type Date]
Future support for health visitor transformation
• December 2014-March 2015- weekly webinar
surgeries
• Monthly talks from experts- any topic requests?
• One to one support for area teams from the
national team
38 NHS | Presentation to [XXXX Company] | [Type Date]
Webinar 3-Questions and Answers panel
• Sabrina Fuller- Health of Health Improvement, NHS England
• Denise Thiruchelvam- Public Health Project Manager, NHS England
• Victor Francis- Health Visiting Programme Commissioning Support,
NHS England
39 NHS | Presentation to [XXXX Company] | [Type Date]