Chris Tully
Lead Officer for Children's NSF,
Central and Greater Derby PCTs
Tel: 01332 224000
Email: chris.tully@centralderby-PCT.nhs.uk
Summary:
Local parents in a Sure Start programme in Derby City were trained as 'Community Researchers' by Leicester De Montfort University and employed by the Primary Care Trust to find the views of over 100 parents in Derby City as part of a 'Large Scale Workforce Programme' to Improve Services for Children. This was one of the modernisation methods that were used to re-design the shape of health visiting and school nursing services to ensure this provision will meet the needs of parents, children and young people supporting recent Government policy for integration.
Abstract:
The overall aim of Government's policy is to improve outcomes for parents, children and young people and reduce inequalities in health. The latest policy drivers, The Children Act 2004, Every Child Matters, The Children's National Service Framework and Creating a Patient led NHS have been developed to support this aim and enable this change to take place. Government policy is ensuring the emphasis and importance of multi-agency working and the participation with the public including young children to help support service re-development and improvement.
In Derby City a Modernisation Change Project was set-up by a multi-agency team to re-design Health Visiting and School Nursing services. These professionals are highly qualified degree nurses who specialize in public health. The aim of this project was to re-design and introduce new roles so that the service could become more specialist and outcome focussed. This health provision is a vital contribution to the Government’s agenda to ensure parents; children and young people receive preventive health advice, support and information to enable them to function to their maximum potential. However these services have not been examined critically for many years. Over the last few years a Government initiative such as Sure Start has shown impact and positive change for families and children when agencies work differently and together. The overall objective is to ensure children’s services of the future will ensure a locality focus, team working, linkage with all agencies and partnership working with parents.
The modernisation agency now called NHS Employers has supported the project with Change management tools such as the 'Toolkit for Local Change'. A project board was set-up with our multi-agency partners including as education, social services, local university, GPs and front line workers to ensure involvement by partner agencies and strategic influence. Local parents have been involved as Community Researchers. Health Visiting and School Nursing teams have been fully engaged in the change process by filling out time logs, questionnaires and being part of visioning days to inform the changes. This has ensured a base-line of information at the beginning of the project. The re-named Child and Family Teams (Health Visiting and School Nursing services) elected local ‘Champions’ to ensure they are fully involved with this Change Programme.
As part of the Integration Programme parents, children and young people have been fully engaged with the process through involvement in focus groups, participation in consultation and being interviewed by Community Researchers reaching over 500 children, young people and parents. Their views reflected the Every Child Matters Outcomes Framework-to Be Healthy, Stay Safe, Enjoy and Achieve, Provide a Positive Contribution and Achieve Economic Well-being. All these findings have been fed back to managers and staff in all agencies and used to design the Children’s Strategic plan for Derby. This information has also been vital in shaping questionnaires that were used to interview parents by the Community Researchers.
The parents' views and expectations have helped to shape the re-design of services. By being involved with designing services parents feel empowered in their role, sharing their expertise and providing local knowledge and this is being incorporated into service re-design thereby making a more patient focussed National Health Service.
From our community research, local parents have told us they value the services we provide however they need more intense support at specific times, more seamless service and more information about local services for families. Jobs such as family support workers and link workers have been designed to ensure an early intervention and prevention focus.
The tools designed by the Modernisation Agency ensure impact measures on such things as number of staff working in new ways and time released or created due to the change. Reports about the progress made are sent regularly and are compared and shared with other PCTS. The data has proved that Derby PCTs have made good progress. Training local parents in Community Research is unique and has demonstrated a powerful model and partnership approach in re-shaping services. The later evaluation has shown improvement not only by the effectiveness of new service delivery to families but also has improved work force issues such as improved recruitment and retention of staff and enhanced career and succession opportunities.
Community Researchers are patients of the NHS and live in one of the most deprived areas in Derby City, they hope to achieve an accreditation through their training. For a number of them it was their first paid work they had after years of homemaking. Full evaluation was done after their initial research. Some of the comments were:
“I had not worked for ten years and realised I can still use the things I learnt at college”
“ I feel boosted up after so long at home with the kids-I know I can go and get a job now, I know I can do things”
Training in diversity was an important element of the Community Research course undertaken by parents to ensure understanding of different cultures. One of the Community researchers is Asian and is able to speak Punjabi and was useful for this population. Services are designed specifically to meet the needs of diverse populations
As part of the National Modernisation programme 45 other Primary Care Trusts across the Country have been involved in various learning events across the Country. A story-board has been produced by Derby PCTs to demonstrate what changes and learning has been made and is shown at all the ‘Integration Learning Events’. Articles have also been written in the local Integration newsletter so colleagues know about the project.
This Change Programme has been a whole systems approach involving all agencies and also local people. By using the Community Researchers it has demonstrated the value of involving and empowering local people to enhance and re-shape services. This way of working should be integral for the Health Service to ensure services are delivered to ensure best outcomes for parents, children and young people.
