NHS | Presentation to [XXXX Company] | [Type Date]1

Delivering health visiting service transformation

Denise Thiruchelvam, NHS England

Contact: england.healthvisiting@nhs.net

Webinar 1- 10.00-10.50

14th November 2013

Aim of Webinar 1Define 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

2013-14 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.

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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

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

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Delivery of the Healthy Child Programme

• Universal, progressive, preventive

• Led by HVs but delivered in partnership

• Focus on outcomes

• Address inequalities

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Current commissioning system

NHS | Presentation to [XXXX Company] | [Type Date]6

New Commissioning Landscape

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 Opportunities• Fractured commissioning

• Understanding organisational boundaries

• Changing the current model of work

• Short timeline

• Change fatigue

• Anxiety for the future

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• 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

• 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.

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Transition of responsibilities for PH of 0-5s to local authorities

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

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Potential Use of Health Visiting Transformation Funding

Potential Use of Health Visiting Transformation FundingBring together commissioners and providers and engage

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?

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Potential Use of Health Visiting Transformation Funding

What is the system approach to service transformationTo deliver high 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

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Using the funding to deliver a system-wide approach to service transformation

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 

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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

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Successful Proposal Criteria

Name and contact details of Area Team Health Visiting lead Yes No

Is the proposal in not more than 500 words? Yes No Does the proposal give full details of how funding will be used to support provider and commissioner development and represents value for money?

Yes 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?

Yes No

Does the proposal specify the outputs expected? Yes No Will the outputs improve public health outcomes for young children and their families? Yes 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 No

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Each bid will be evaluated based on the criteria in this table

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.

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• 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.

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NHS England Procurement Rules

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 non-discriminatory 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.

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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

These thresholds will be updated on 31 December 2013.

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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.

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Lower ThresholdsShould 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

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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.

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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.

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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.

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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

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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

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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 accessed29

Key stakeholdersCommissioners

• 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.

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Commissioner and provider partnershipBenefits 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 practice31

Local resources – JSNA and Health and Wellbeing Strategy

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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.

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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?

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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/public-health-england

• RCN (Royal College of Nursing) www.rcn.org.uk

• Local Government Association www.local.gov.uk

• SOLACE www.solace.org.uk

N | Presentation to [XXXX Company] | [Type Date]35

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

•

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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

NHS | Presentation to [XXXX Company] | [Type Date]37

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

NHS | Presentation to [XXXX Company] | [Type Date]38

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

NHS | Presentation to [XXXX Company] | [Type Date]39