Dr Deirdre McCormick

2. Dr Deirdre McCormick

3. NHS Health Scotland Early Year Annual Conference: Getting it Right for Every Child – The Story so Far…. HKAAHKFHA Thursday 1st March 2012 Sterling Management Centre Modernising Nursing in the Community Dr Deirdre McCormick Nursing Officer – Scottish Government

4. 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: • services built around people and communities • working together to deliver outcomes • prioritising prevention, reducing inequalities and promoting equality • improving performance and reducing cost

5. 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 Scottish Government Response Pillars of Public Service Reform

6. What do Children, Young People, Families,Carers and NHSS Staff Want? • Caring and Compassion • Collaboration • Continuity • Confidence • Clean and Safe Environment • Clinical Effectiveness

7. Lack of clarity, inconsistency in roles and specification of community nursing services Community Nurses Said……. Current service models not managing efficiently the increasing complexity and volume of the workload Disproportionate amount of nurses’ time taken up with activities not directly related to care Under-developed skill mix Documentation, record keeping and referral processes do not take advantage of technology Poor data collection and feedback to managers and staff Ways of working not always consistent with the emerging evidence base Some services traditional and reactive to demand

8. NHS Scotland Quality Strategyis About Three Things: • Listening and Responding to the Views and Experiences of People for Improving Services. • 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. • Making Quality Count – Measurable Improvement in the Aspects of Care Which Children, Young People and Families see as Important.

9. 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.

10. 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.

12. MODERNISING NURSING IN THE COMMUNITY SAFE, EFFECTIVE & PERSON CENTRED CARE CHILDREN YOUNG PEOPLE, FAMILIES Building workforce capacity & capability Improving efficiency Using care pathways Working with other agencies & disciplines as partners INFORMING PRACTICE WITH POLICY, RESEARCH AND EVIDENCE ADULTS, OLDER ADULTS Utilising high quality clinical outcomes Working with clients, carers & patients as partners Utilising Telecare & Telehealth technology Anticipating health needs & responding earlier Promoting health & addressing inequality DEVELOPING SKILLS AND KNOWLEDGE THROUGH EDUCATION PEOPLE AT WORK Strengthen-ing leadership & team working Providing choice & care in the right setting Enabling and supporting self care

13. The 3 Quality Ambitions provide the focus for everything NHS Scotland does to deliver the best quality healthcare The MNiC framework brings together the elements required for safe, effective, person centred care in the community

14. 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.

15. 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 • Clinical Skills

17. Evidence Based Summaries • Public Health Interventions to Support Smoking Cessation and Prevention of Uptake • Public Health Interventions to Prevent Unintentional Injuries among the Under 15s • Public Health Interventions to Promote Maternal and Child Nutrition • Pregnancy and Complex Social Factors • Public Health Interventions to Support Mental Health Improvement • Weight Management in Pregnancy/Post Partum • Parenting • Looked After & Accommodated Children and Young People • Community Assets/Capacity Building • Substance Misuse (Drug and Alcohol) • Dental Health • Domestic Abuse • Sexual Health • Immunisation • Physical Activity  • Obesity

18. 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 • Organisational change based on lean methodology

19. MNiC Education Sub Group Three Key Strands • Support and advise on the development of the community component of the new nursing pre-registration 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.

21. Redressing the balance between two approaches to promoting health and tackling health inequality Assets based Narrowing the health gap Deficits based

22. 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, workforce, planning etc

23. Top 4 Priorities • Supervision in MNiC • Sustaining and Maintaining FNP (within MNiC) • Education and Learning Development • Sharing the Knowledge and Learning from FNP

24. 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.

25. What learning can be shared with universal services ? • Skills and knowledge • Workforce roles • Service Delivery • Systems • Materials • Model replication

26. 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 TOMORROWwe 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 BEYONDtomorrow by creating a world class service and world class practitioners Ros Moore, Chief Nursing Officer Scotland

27. 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/

28. John Dickie

29. NHS Health Scotland National Early Years Conference 1st March 2012

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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.

36. 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

37. 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

38. 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

40. Boyd McAdam

41. Getting it right for every child: the journey so farCollaborative 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

42. GIRFEC? + Grrr! Oh Bother! www.scotland.gov.uk/gettingitright

43. What is Getting it right for every 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 benefitsand 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

44. www.scotland.gov.uk/gettingitright

45. GIRFEC provides the shared goal for all to collaborate around Improved life chances for all children and young people www.scotland.gov.uk/gettingitright

46. Well-being www.scotland.gov.uk/gettingitright

47. www.scotland.gov.uk/gettingitright

48. 5 Questions • 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

49. The Universal Pathways resource as a precursor to development of a Pathway of Care for Vulnerable Families (0-3) www.scotland.gov.uk/gettingitright

50. GIRFEC • Appropriate • Proportionate • Timely www.scotland.gov.uk/gettingitright