Dr Deirdre McCormick
NHS Health Scotland Early Year Annual
Conference: Getting it Right for Every Child
– The Story so Far….
Thursday 1st March 2012
Sterling Management Centre
HKAAHKFHA
Modernising Nursing in the Community
Dr Deirdre McCormick
Nursing Officer – Scottish Government
Commission on the Future Delivery of
Public Services – Key Conclusions
•
Budget constraints and increasing demand for
services mean that Scotland’s public services have to
work in a different way
•
Reform should pursue:
i.
services built around people and communities
ii.
working together to deliver outcomes
iii.
prioritising prevention, reducing inequalities and
promoting equality
iv.
improving performance and reducing cost
Scottish Government Response
Pillars of Public Service Reform
• Decisive shift towards prevention
• Greater integration of services, better
partnership, collaboration and
effective local delivery
• Greater investment in people who
deliver services
• Focus on improving performance
through greater transparency, innovation
and digital technology
• Assets based approaches
What do Children, Young People, Families,
Carers and NHSS Staff Want?
• Caring and Compassion
• Collaboration
• Continuity
• Confidence
• Clean and Safe Environment
• Clinical Effectiveness
Lack of clarity,
inconsistency in
roles and
specification of
community
nursing services
Underdeveloped
skill mix
Poor data
collection
and feedback
to managers
and staff
Community Nurses Said…….
Disproportionate
amount of
nurses’ time
taken up with
activities not
directly related to
care
Current service models
not managing efficiently
the increasing complexity
and volume of the
workload
Documentation, record
keeping and referral
processes do not take
advantage of
Ways of working not
technology
always consistent
Some
with the emerging
services
evidence base
traditional and
reactive to
demand
NHS Scotland Quality Strategy
is About Three Things:
1.
Listening and Responding to
the Views and Experiences of
People for Improving
Services.
2.
Building on the Values of
NHSS Staff and Contractors
and Their Commitment to
Providing the Best Care
Reliably – for Everyone and
All of the Time by Supporting
Leadership, Creativity and
Innovation.
3.
Making Quality Count –
Measurable Improvement in
the Aspects of Care Which
Children, Young People and
Families see as Important.
Quality Strategy Aims
• Safe - There will be no avoidable injury or harm to
patients from healthcare they receive, and an appropriate
clean and safe environment will be provided for the delivery
of healthcare services at all times.
• Person-centred - Mutually beneficial partnerships
between patients, their families and those delivering
healthcare services which respect individual needs and
values and which demonstrate compassion, continuity,
clear communication and shared decision making.
• Effective - The most appropriate treatments,
interventions, support and services will be provided at the
right time to everyone who will benefit, and wasteful or
harmful variation will be eradicated.
Modernising Nursing in the
Community Programme Board
• Phase 1: Modernising Nursing in the Community
Programme Board in place from September 2009 –
December 2011
AIM
• To provide leadership and vision to support NHS
Boards to develop and deliver:
- High Quality
- Sustainable and
- Person centred community nursing services.
Children, young
people and
families
MNiC
Programme
Board
Nursing for work
and well being
Keeping people
at home
MODERNISING NURSING IN THE COMMUNITY
SAFE, EFFECTIVE & PERSON CENTRED CARE
CHILDREN
YOUNG
PEOPLE,
FAMILIES
Building
workforce
capacity &
capability
Improving
efficiency
ADULTS,
OLDER
ADULTS
Utilising
Telecare &
Telehealth
technology
PEOPLE AT
WORK
Using care
pathways
Working
with clients,
carers &
patients as
partners
Utilising
high quality
clinical
outcomes
Strengthening
leadership &
team
working
Promoting
health &
addressing
inequality
Providing
choice &
care in the
right setting
Working with
other
agencies &
disciplines as
partners
Anticipating
health needs
&
responding
earlier
Enabling
and
supporting
self care
INFORMING
PRACTICE
WITH
POLICY,
RESEARCH AND
EVIDENCE
DEVELOPING
SKILLS
AND
KNOWLEDGE
THROUGH
EDUCATION
The MNiC framework
brings together the elements
required for safe, effective,
person centred care in the
community
Effective
Safe
Person
centred
The 3 Quality Ambitions
provide the focus for
everything NHS Scotland
does to deliver the best
quality healthcare
Community
Nursing
Care
Children Young People and Families Sub
Group
Aim
• To develop a framework for public health
nursing 0-19 years (including preconception)
which will assist NHS Boards in the provision
of high quality, sustainable public health
nursing in the community.
Key Outputs from the CYP&F Sub Group
Development of a Career Framework for
Public Health Nursing and Community
Children's
Nursing Supported by NES
Based on the 4 pillars used for advanced
practice
• Leadership
• Facilitation of Learning
• Evidence Research and Development
Evidence Based Summaries
1. Public Health Interventions to Support Smoking Cessation and
Prevention of Uptake
2. Public Health Interventions to Prevent Unintentional Injuries
among the Under 15s
3. Public Health Interventions to Promote Maternal and Child
Nutrition
4. Pregnancy and Complex Social Factors
5. Public Health Interventions to Support Mental Health Improvement
6. Weight Management in Pregnancy/Post Partum
7. Parenting
8. Looked After & Accommodated Children and Young People
9. Community Assets/Capacity Building
10. Substance Misuse (Drug and Alcohol)
11. Dental Health
12. Domestic Abuse
13. Sexual Health
14. Immunisation
15. Physical Activity
16. Obesity
Community Nursing Workload Assessment
Tool
Available in May 2012
Leadership Development – Leading Better
Care
Phase 2
–
–
–
–
–
Safe and effective clinical practice
Contributing to the organisation’s objectives
Managing and developing the performance of the team.
Enhancing the patient experience
Outcome Measures/Clinical Quality Indicators
Releasing Time to Care in the Community
MNiC Education Sub Group
Three Key Strands
–
Support and advise on the development of the
community component of the new nursing preregistration programmes.
–
Influence the modernisation of community
nursing education programmes and the support
for the wider workforce in line with NHS Board
requirements.
–
Supervise the development of career frameworks
to support community nursing.
Where We Are Now?
The Deficit Approach
Where an Asset Way of
Thinking Takes Us
Start with deficiencies ad
needs in the community
Start with the assets in the community
Respond to problems
Identify opportunities and strengths
Provides services to users
Invest in people as citizens
Emphasise the role of
agencies
Emphasise the role of civil society
Focus on individuals
Focus on communities/ neighbourhoods and
the common good
See people as clients
and consumers receiving
services
See people as citizens and co-producers
with something to offer
Treat people as passive and
done-to
Help people to take control of their lives
‘Fix people’
Support people to develop their potential
Implement programmes as
the answer
See people as the answer
Assets based
Narrowing
the health
gap
Deficits based
Redressing the
balance
between two
approaches to
promoting
health and
tackling
health
inequality
Thinking Through the FNP
Programme
• To identify and examine the factors that
are contributing to the success of the FNP
Programme
• To discuss how these could be sustained,
supported, developed and transferred
across nursing and related services in
future terms
• Consider the future of FNP in terms of its
place within the wider nursing and
midwifery family, career pathways,
Top 4 Priorities
• Supervision in MNiC
• Sustaining and Maintaining FNP (within
MNiC)
• Education and Learning Development
• Sharing the Knowledge and Learning from
FNP
Why share FNP Learning ?
• FNP approach has potential to interrupt
cycle of deprivation for this client group
and maximise their life chances.
• Approach has potential to transform wider
services.
• Manifesto commitment.
What learning can be shared with
universal services ?
•
•
•
•
•
•
Skills and knowledge
Workforce roles
Service Delivery
Systems
Materials
Model replication
Ambitions for Community Nursing
Ambition 1: That TODAY community nursing across all
Scotland delivers the best quality, safe, effective
and person centred care every time
Ambition 2: That TOMORROW we maximise the potential
of community nursing channelling resources
and energies where it makes the most difference
Ambition 3: That we secure the future of community
nursing in Scotland BEYOND tomorrow by
creating a world class service and world class
practitioners
Ros Moore, Chief Nursing Officer Scotland
MNiC Website Launched 24th January 2012
Provides Users
Evidence base
Policy Drivers
Practice exemplars
Education and training opportunities
Relevant resources
MNiC Website address:
www.mnic.nes.scot.nhs.uk/
John Dickie
NHS Health Scotland
National Early Years
Conference
1st March 2012
www.cpag.org.uk/scotland
Child poverty
•
Scale, extent and nature of child
poverty in Scotland
•
Impact of that poverty – why it matters
•
What needs to be done?
•
(Context: progress to date, challenges,
opportunities in Scotland, GIRFEC)
•
The role of early years services
What do we mean by child poverty
•
Peter Townsend (Poverty in the UK, 1979)
in poverty when “lack the resources to obtain
the types of diet, participate in the activities
and have the living conditions which are
customary, or at least widely encouraged and
approved, in the societies in which they
belong”
•
not ‘just’ about income, but income central
•
relative to society you are in
•
not just survival, but social participation
Scale and nature of child poverty
•
250 000 (25%) children living in poverty
(2009/10)
•
some children at particular risk
− families affected by disability
- one parent families
- families without paid work
•
affects families across Scotland, but
concentration and nature varies
− ECP child poverty map of Scotland
www.endchildpoverty.org.uk
Impact of child poverty
•
poverty damages health – poverty kills
− health compromised from birth – average birth weight 200g lower
− 2 ½ times more likely to have chronic illness as toddlers
− 3 times more likely to suffer mental disorders
•
poverty undermines learning
− nine months behind by age three
− gap widens as go through school
•
poverty undermines life chances
− More likely to be unemployed as adult
− More likely to be the parents facing poverty in the future
•
•
•
poverty damages childhoods
poverty in Scotland may be “relative” but its impact on
children is absolute
Child poverty costs us all – est. £1.5billion a year
What needs to be done?
Context:
Nothing inevitable about this poverty
•
Need to eradicate it, not just reduce it’s impact
Not starting from scratch…..
•
Real progress: since 1997 100 000 fewer children
in poverty
•
Policy worked: at UK and Scotland level
•
Political consensus: UK Child Poverty Act 2010
•
Scottish government: Solidarity target, poverty
framework and new Child Poverty strategy
What needs to be done?
Context cont.
…..but huge challenges
•
progress had stalled even before recession/cuts
•
Over £18billion welfare cuts, hitting poorest hardest
•
IFS predict massive rise in child poverty
•
Scotland: little evidence that spending decisions
being proofed for impact on child poverty despite
national anti-poverty frameworks.
Opportunities in Scotland?
•
•
Getting it right for every child….
Access to advice and information
− build on Healthier Wealthier Children
•
Preventative spend and early intervention
− prioritise spending and delivery that prevent child poverty
•
•
•
Proposed legislation on children’s rights and services
Commitment to supporting parents
Existing commitments
− Extend early years nursery provision
− Free school meals and school clothing grant recommendations
•
Use of new welfare powers to protect poorest families?
− social fund and council tax benefit replacements
− revisit criteria for passported benefits
•
Build on commitments to Scottish Living Wage
Role of early years providers?
•
Be aware, and promote awareness, of context
of children’s lives and the barriers families face
as incomes squeezed and prices rise
•
Support and promote practical solutions e.g.
maximising family incomes, accessing services,
reducing costs and removing barriers
•
Collectively advocate
− Use knowledge and experience as tools in
advocating for local, and national, policy proofing and
structural changes needed
Support from CPAG in Scotland
Information, training and advice on:
• Healthy Start Vouchers
• Statutory Maternity Pay/Maternity Allowance
• Sure Start Maternity Grant
• Child Benefit
• Child Tax Credit
• Working Tax Credit – help with childcare costs
• Other financial help for families
• Making effective referrals for local advice
• The new Universal Credit
• www.cpag.org.uk/scotland/taxcredits/early_years.htm
www.cpag.org.uk/scotland
Boyd McAdam
getting
it right
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for e ery child
Getting it right for every child:
the journey so far
Collaborative working/ coordinated approach
Boyd McAdam
Head of Better Life Chances Unit
Children’s Rights and Wellbeing Division
Children and Families Directorate
Health and Social Care
Scottish Government
www.scotland.gov.uk/gettingitright
GIRFEC?
getting
it right
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for e ery child
+
Grrr!
www.scotland.gov.uk/gettingitright
Oh Bother!
What is Getting it right for every child? getting
it right
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for e ery child
Evidenced best practice for children and young people that:
• applies to all children and young people.
• expects all relevant agencies (including adult services) to adapt and
streamline their practices and systems around the National Practice
Model
• determines the national approach to improving outcomes for
children and young people in Scotland, whatever their needs/risks
• is based on research and evidence of best practice and proven
benefits and will be backed up by legislation
• leads to all relevant planning activity being brought together into a
Child’s Plan for use by a single agency or several agencies working
together to support the child.
www.scotland.gov.uk/gettingitright
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www.scotland.gov.uk/gettingitright
getting
it right
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GIRFEC provides the shared goal for
all to collaborate around
Improved life chances for all children
and young people
www.scotland.gov.uk/gettingitright
Well-being
getting
it right
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for e ery child
www.scotland.gov.uk/gettingitright
getting
it right
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www.scotland.gov.uk/gettingitright
5 Questions
getting
it right
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• What is getting in the way of this child or young person’s
well-being?
• Do I have all the information I need to help this child or
young person?
• What can I do now to help this child or young person?
• What can my agency do to help this child or young
person?
• What additional help – if any – may be needed from
others?
www.scotland.gov.uk/gettingitright
The Universal Pathways resource as a precursor to
development of a Pathway of Care for Vulnerable Families (03)
getting
it right
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for e ery child
www.scotland.gov.uk/gettingitright
GIRFEC
getting
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• Appropriate
• Proportionate
• Timely
www.scotland.gov.uk/gettingitright
Culture, Systems, Practice change getting
it right
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•
•
•
•
•
•
•
Workforce
Outcomes: understanding and measurement
Leadership – at all levels
Governance and accountability
Common language and shared understanding
Business process redesign
Views and engagement of the child/ family
www.scotland.gov.uk/gettingitright
The 10 Core Components
getting
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1. Focus on improving outcomes for young people, based on shared
understanding of well-being
2. Common approach to gaining consent and sharing information
where appropriate
3. Integral role for children, young people and families
4. Co-ordinated approach to assessing needs, agreeing actions and
outcomes, based on the Well-being Indicators
5. Streamlined planning, assessment and decision making leading to
the right help at the right time
www.scotland.gov.uk/gettingitright
The 10 Core Components (continued) getting
it right
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6. High standards of co-operative working and
communication
7. A Named Person for all children and a Lead
Professional to co-ordinate multi-agency activity
8. Maximising the skilled workforce within universal
services
9. A confident and competent workforce across all
services
10. Capacity to share demographic, assessment, and
planning information electronically
www.scotland.gov.uk/gettingitright
How is it being implemented? - 1 getting
it right
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•
•
•
•
•
Pathfinder – Highland
Learning partners – West Lothian, Lanarkshire,
Edinburgh – Domestic Abuse Pathfinders - Dumfries and
Galloway, Falkirk, West Dunbartonshire
Established CPP formations – Grampian, Tayside, Forth
Valley, South East Scotland. Chief officer buy-in.
Future formations? – Clyde Valley, Ayrshires, Glasgow,
West, Islands
Also links Highland, Fife, D&G
www.scotland.gov.uk/gettingitright
How is it being implemented? - 2 getting
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•
•
•
•
A programme approach under the governance of the GIRFEC
Programme Board (SG; COSLA; Health Chief Execs; ADES; ADSW;
ACPOS; Third sector (Chair); SCCYP, SOLACE)
Specific sector support
- NHS CEL 29/ 2010;
- ACPOS (endorsement; national management of concerns; IM)
Cross party support (Dec 09); Children’s Summit pledge (June
2010); SNP manifesto commitment to legislation:
Scrutiny/ Performance Improvement: Care Inspectorate embedding
GIRFEC in inspection regime, working with Education Scotland and HIS.
www.scotland.gov.uk/gettingitright
GIRFEC Programme Board Five
Key Implementation Priorities
getting
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• Identifying a Named Person for every child and young person in the
universal services.
• Identifying protocols and governance for Lead Professional.
• Supporting partnerships to take a proportionate approach to
managing all concerns and risks.
• Redesign business processes to secure a single planning process for
all children and young people supporting a single plan.
• Ensuring the use of the National Practice Model.
www.scotland.gov.uk/gettingitright
How the maturity model works
Level 1 – initial
Level 2 – established
Level 3 – business enabling
Level 4 – quantitatively managed
Level 5 – optimised
www.scotland.gov.uk/gettingitright
getting
it right
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getting
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Proce
ss
1.
Identi
fying
a
Name
d
Perso
n for
every
child
and
youn
g
perso
n in
the
unive
rsal
servic
es
Level 1 – Initial
Awareness that GIRFEC is
critical to Business and Legal
Requirements
Level 2 – Awareness
GIRFEC is widely understood
and processes are in place
Level 3 – Business Enabling
GIRFEC process are
implemented in critical areas
of the business
Level 4 – Quantitatively
Managed
The number of corporate
exceptions to implementing
GIRFEC processes are known
and reported
Level 5 – Optimised
Responsive GIRFEC
processes are integrated as
part of normal business
1.1.1 Chief Officer recognition
that identification of Named
Person in Universal Services is
essential to the
implementation of GIRFEC.
1.1.2 Commitment to having a
Named Person is clearly set
out in messages from the top
of the organisation.
1.1.3 Inter-agency agreement
on who within Universal
Services is appropriate to take
on Named Person role.
1.1.4 Senior Officers within
each organisation are
responsible for taking the
process forward.
1.1. 5 There is a GIRFEC
policy and it has been signed
off at senior level.
1.1.6 Chief Officers have a
clear vision of what
transformed services for
children, young people and
families will look like.
1.1.7 There is a commitment
from Chief Officers to
consulting and engaging with
children and families.
1.2.1 Senior Officers with
delegated responsibility
understand and accept their
responsibility for the effective
implementation of the Named
Person within Universal
Services.
1.2.2 Senior Officers have in
place an effective
management system, a plan
and realistic timescale for
implementation.
1.2.3 Chief Officers endorse
organisational strategies and
standard operating procedures
for implementation of Named
Person.
1.2.4 Clear guidance on
information sharing in support
of GIRFEC has been
published, guidance and
training is available.
1.2.5 A strategy that identifies
and measures the benefits to
organisations of implementing
GIRFEC is in place.
1.2.6 Children and families
have been consulted and are
aware of the role of Named
Person.
1.3.1 Appropriate business
processes are designed and
developed to support role of
Named Person.
1.3.2 Staff identified as
suitable to undertake Named
Person role have been
consulted.
1.3.3 A training strategy is in
place for those staff taking on
the Named Person role.
1.3.4 Effective monitoring and
evaluation systems to assess
the implementation process
have been developed and
agreed.
1.3.5 There is evidence that
the views and opinions of
children and families have
informed the design and
development of all business
processes.
1.4.1 Monitoring and
evaluation processes have
been implemented, data has
been collected and analysed.
1.4.2 Blockages and delays to
implementation are identified.
1.4.3 Areas of best practice
are identified.
1.4.4 Progress reports have
been submitted to Chief
Officers for review.
1.4.5 Chief Officer views and
comments have been noted
and shared.
1.4.6 Senior Officers have in
place plans to address
blockages and delays that are
endorsed by Chief Officers.
1.4.7 Systems are in place to
monitor that the views and
opinions of children and
families have been actively
sought.
1.5.1 Each child has a Named
Person in Universal Services.
1.5.2 Systems and processes
to support this role are in
general use throughout
organisations.
1.5.3 Procedures to manage
concerns are in place.
1.5.4 There is broad
community awareness and
understanding of the role of
the Named Person.
1.5.5 Systems and processes
to consult and engage with
children and families are in
general use throughout
organisations.
www.scotland.gov.uk/gettingitright
getting
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Process
Level 1 – Executive
Sponsorship
Commitment at the most
senior level
Level 2 – Corporate
Strategy
GIRFEC is widely
understood across the
organisation
Level 3 – Service
Development
GIRFEC process are
implemented in critical
areas of the business
Level 4 – Implementation
Corporate exceptions to
implementing GIRFEC
processes are known and
reported
Level 5 – Embedded
Responsive GIRFEC
processes are integrated
as part of normal business
1. Identifying a Named
Person for every child
and young person in the
universal services
1.1.1 Commitment to
having a Named Person is
clearly set out in messages
from the top of the
organisation.
1.1.2 There is inter-agency
agreement on who within
Universal Services is
appropriate to take on
Named Person role.
1.2.1 A strategy that
identifies and measures
the benefits of
implementing a Named
Person is in place.
1.3.1 Appropriate business
processes are designed
and developed to support
role of Named Person.
1.3.2 Senior Officers within
each organisation are
responsible for taking the
process forward.
1.3.3 Delivery of multi
agency awareness raising
sessions to appropriate
staff
1.4.1 Monitoring and
evaluation processes have
been implemented, data
has been collected and
analysed.
1.4.2 Blockages and
delays to implementation
are identified.
1.5.1 There is broad
community awareness and
understanding of the role of
the Named Person.
1.5.2 Areas of best practice
are identified.
www.scotland.gov.uk/gettingitright
Purpose
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By embedding best practice approach:
• supports better information sharing: more better quality, more
appropriate information, common language/shared understanding
• increased trust among professionals
• children and families more engaged + understand better the who,
the what and the why – and their respective roles
• encourages early, effective intervention leading to prevention
•better involvement of children and young people in decisionmaking
• information sharing: appropriate with consent
• ensure children don’t fall out of our radar (national + local need)
• reduced bureaucracy for children and families/ releases
resources
• outcomes focused
www.scotland.gov.uk/gettingitright
Sir Harry Burns
Hilary Third
National Parenting Strategy
Hilary Third
Team Leader: Parenting
Early Years: Children & Families
Hilary.Third@scotland.gsi.gov.uk
Background/context
• Early Years Framework
• Joining The Dots
• GIRFEC
• SNP Manifesto 2011
Why the focus on parenting?
• Supporting parents key to improving lives
and futures of children and young people
• Building resilience, capacity, confidence
and skills of parents
• Fundamental to early
intervention/preventative spend
• Relevance to a wide range of outcomes
child and maternal health; modernising nursing in the
community; maternity services; social work; early
learning and childcare; play; youth justice; children
affected by parental substance misuse; looked after
children; child protection; GIRFEC; children’s
legislation; children’s rights; disabled children;
curriculum for excellence; parental involvement in
schools; nutrition; domestic abuse; violence reduction;
reducing crime; third sector; reducing reoffending; family
law; drugs; tobacco, alcohol use; sexual health; poverty;
employability; skills and literacy; equality; healthy
working lives; positive behaviour in schools; housing
management’ homelessness; antisocial behaviour;
carers/young carers; social services workforce; health
inequalities; mental health; planning……..
Why a national parenting strategy?
• Articulate the contribution parenting makes
to a better Scotland
• Ensure the importance of
parenting/parenting support is embedded
in policy and delivery
• Make the case/create the right conditions
for improving support to parents at
national and local level
• Place a higher value on parenting (and
C&YP) in wider society
• Improve the lives of children and young
people growing up in Scotland
Scope of the strategy
• All parents (not just vulnerable families)
• All those in parental role (including the
corporate parent)
• Parenting of children of all ages (not
just new parents, not just early years)
• Encouraging a broader community
responsibility to support parenting
• Specific focus on fathers
• Address issues which interfere with
parenting
Links with GIRFEC
• A child’s network of support starts with
family and community
• Same principles – child-centred, using the
right approach to support every family
• Parent’s role in protecting/ensuring their
child’s wellbeing (SHANARRI)
• Getting it right for every family
A Phased Approach
Phase I
National overarching strategy
Phase II??
Parenting in the early years
Parenting older children through to
adulthood
Preparing our children and young people to
be the parents of the future
Phase III??
Improving practical support available to
National Overarching Strategy (phase I)
• ‘Set out our stall’ on parenting
• Draw links with other policy areas and
outcomes
• Define our aspirations (link with evidence)
• Provide an overview of current activity
(building on what works)
• Articulate views of parents (and C&YP and
practitioners)
• Set out plans for more detailed work in
phase II and III
Aligning policy and delivery throughout
• National strategy needs to complement
good work already underway locally
• National approach must have credibility
and coherence from delivery perspective
• Focusing on approaches/interventions that
make a difference (evidence)
• Importance of working together with
delivery partners to agree a national
approach and to align local activity
• Key role for services – what are the
• Activity must make a difference to
parents and parenting in Scotland.
• It must make a difference to
children and young people
growing up in Scotland.
Tam Baillie