Opportunities for Safeguarding Children
in the New NHS
Presentation workshop for London safeguarding Children Board Conference
Briony Ladbury
Senior Strategic safeguarding Children Advisor
NHS LONDON
December 2011
Where do the opportunities spring from?
• NHS Reforms
• Munro Review of Child Protection
• Nosgrove Review (of Children in the family
Justice System)
• Ofsted Review
• Big Society
Proposed NHS Reforms
Funding
Accountability
Public
Health
England
Parliament
Department of
Health
NHS
Commissioning
Board/s
Local bodies & senates
Monitor
Economic
Regulator
Integration
Patients interests
Competition safeguards
Care Quality
Commission
licencing
Local
Authorities
Local
HWB Boards
partnership
JSNA’s
Public Health
Clinical
Commissioning
Groups
contract
(Any Willing/Qualified)
Provider
& Networks
Accountability for results
Local Health
Watch
Patients and Public – (adults and children)
NHS Structure post reforms
Main Changes
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Directly funded Public Health Service
Public Health situated in Local Authority
National Commissioning Board – senates
Clinical Commissioning Groups – members & networks
Health and Wellbeing Boards
Healthwatch
Much yet to be clarified
NHS Reforms Statement
• NHS Overall Accountability
– NHS Commissioning Board and Clinical
Commissioning Groups to:
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Promote the NHS constitution
Core principles and values
18 week waits
Duty to promote a comprehensive health service
Principle & opportunity
• Clinical advice and leadership
– GP consortia will become Clinical Commissioning
Groups
– Demostrate LA alignment
– Governing Bodies must have a nurse and specialist
doctor as members
– Commissioners supported by clinical networks and
clinical senates
– Informed by health and social care professionals in
discussion with patients, carers, voluntary sector
and other partners
Principle & opportunity
• Choice and competition
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Promote patient choice
Level playing field
Best providers (public, private and voluntary sector)
‘Monitor’ to protect and promote interests of patients (not
competition
– Safeguards against cherry picking and privatisation
– Commissioners and ‘Monitor’ have duty to promote integration
• Personal health budgets
• Joint health and social care budgets
– Promote innovative integrated care
Principle & Opportunity
• Developing the workforce
– Robust safe transition for training and education
– Deaneries to oversee training of junior Drs and
Dentists
– Leadership and management training
– Protected education and training funds
• Fairly distributed
• Transparent process
Timetable for Change
– Clinical commissioning groups established April 2013
– CCGs take control when ‘ready and willing’
• Aligned to LA boundaries – Clustered into ‘federations’
– Monitor have powers to 2016 to maintain standards of governance.
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SHAs Clustered from October 3rd 2011 (No change for London)
Oct 2011 – NHS Commissioning Board Established
April 2012 – Choice of Any Qualified Provider extended
Oct 2012 – NHS Commissioning Board established & independent (limited
functions)
Oct 2012 – Monitor takes on regulatory functions
Oct 2012 – HealthWatch England & local HealthWatch established
April 2013– SHA’s & PCTs abolished (NHS Commissioning Board takes
over) Public Health England established, CCGs fully established
(expected to be ‘ready and willing’)
April 2014 – Trusts are Foundation Trusts (any outstanding get new
management)
Public Health
• Public Health England will fund services by:
– Commissioning & providing services from itself, i.e vaccines, campaigns, health
protection
– Asking the NHS Commissioning Board to commission services i.e screening –
elements of GP contract
– Granting a ring fenced budget to local government
– Each body will be required to comply with the Equality Act 2010 and expected to
undertake their functions in a way that is most likely to reduce health inequalities
Public Health Programme
HEALTH VISITOR
PROGRAMME ?
Spheres of influence
Funding
Accountability
Parliament
Department of
Health
Public
Health
England
NHS
Commissioning
Board
Monitor
Local offices & senates
Local
Authorities
HWB Boards
JSNA’s
Care Quality
Commission
licencing
Local
partnership
Clinical
Commissioning
Groups
contract
(Any Qualified)
Provider
supported ‘clinical’ networks
LSCB
Local Health
Watch
Accountability for results
Patients and Public – (adults and children)
Reforms - NHS London
Where are we now in London?
• Transition?
PCT Clustering
TCS and vertical integration
FT pipeline
Performance
• Commissioning
Commissioning support
Clinical Commissioning Groups / Federations? & authorisation
• Clinical [Safeguarding] Networking
Designated Professionals, Named Nurses Acute, Named Nurses Community
Named Midwives
• Health Visitor Project
Munro 4 themes
1.
A system that values professional expertise
MUNRO REVIEW
Less beurocracy – remove assessment
timescales etc
Improve quality of assessment and services –
locally determined
Rewrite Working Together
Remove constraints to local innovation
(national - forms, KPIs, IT systems)
Involving health in Joint unannounced
Inspection Process
Data set agreed
2.
PRACTICAL APPLICATION IN NHS
Less practice guidance – local interpretation
More [health] professional discretion in
assessments and care planning – pilots in
progress
Use own initiative and professional expertise
for developing and evaluating services,
researching practice models, utilising evidence
based practice
Comprehensive observation of practice by
Ofsted/CQC unannounced inspections
Sharing responsibility for the provision of early help
MUNRO REVIEW
Impact of NHS Reforms
Shared understanding of NHS roles &
responsibilities
Retention of professional expertise
Relationship of LSCB & HWB Board
CCG development
NHS (CQC) inspection
Coordinated effective early help assessment
processes and services (JSNA)
PRACTICAL APPLICATION IN NHS
Health Visitor Programme,
MASH Projects
School Nurse Development
Family Nurse Partnerships
Integrated Early Help Teams
Working in the community and other
partners – Vol Sector & Social Care
Peer Review and audit
Sharing good practice
Munro 4 themes
3. Developing [Social Work] Expertise and Supporting Practice
MUNRO REVIEW
NOT NHS SPECIFIC BUT SHOULD ALSO
BE REFLECTED BY NHS
High quality practice placements
Professional capability framework
CPD framework & performance appraisal
Career pathways
Leadership
Recognition of specialism
PRACTICAL APPLICATION IN NHS
Good NHS initial training in HEIs
Good post graduate – in-service training
Appraisals to reflect safeguarding competency
performance and training needs
Developing a career pathway – succession
planning
Leadership Courses
4. Clarifying accountabilities and creating a learning system.
MUNRO REVIEW
PRACTICAL APPLICATION IN NHS
NOT NHS SPECIFIC BUT SHOULD ALSO
BE REFLECTED BY NHS
Training for health staff on systems approaches
including RCA
LSCB annual reports to CE & Leader of
Council, Police & Crime Commissioner, Chair
of HWB
LSCBs to monitor effectiveness of
CHILDRENS services and senior managers
Researching options for using a systems
methodology for SCRs
NPSA assisting development with methodology
and accountability
Ensuring lessons are learned and applying
performance management to ensure
improvement
Ofsted Review
• Unannounced inspections
• Ofsted and CQC combined – no longer parallel processes
• Pilots already underway
• Will review 50 not 20 cases – thoroughly!!!!!
• Map the child’s journey and experience of services
• Includes practice observation in the field
• 4 judgment areas
– Effectiveness of service
– Effectiveness of interventions (including early help)
– Quality of practice
• Effectiveness of leadership and governance
• Regular peer review and audit will help you to prepare!
Nosgrove Review
• Review of children in family justice system
• Quicker timescales
• Less delays (expert witnesses)
• More emphasis on child’s wishes and feelings
• More reliance on good Social Work assessment
• Health Professionals able to be more involved in providing
Social care colleagues with health aspects of assessment
• Multi-agency training
Big Society & localism
• Fits public health agenda well
• Working with communities
– Meets needs of the most vulnerable
– Enables community participation
– Children’s voice heard in design and evaluation
• Health Visitor Programme Strands
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Community
Universal
Universal Plus
Universal Partnership Plus
• Enables other skilled professionals to support
community health system eg Children’s Charities
and support groups
Parting Shot
Be the change that you want to see
in the world.
An ounce of practice is worth more
than tons of preaching.
Mohandas Gandhi
Questions & Discussion
• What do YOU have to do as a children’s safeguarding
professional (in any professional context) to ensure that
the new NHS grasps the opportunities and improves
safeguarding children services ?