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Opportunities for Safeguarding Children
in the New NHS
Presentation workshop for London safeguarding Children Board Conference
Briony LadburySenior 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
FundingAccountability
Local Health Watch
Local AuthoritiesHWB Boards
JSNA’sPublic Health
Parliament
Department of Health
NHSCommissioning
Board/sLocal bodies & senates
ClinicalCommissioning
Groups& Networks
Patients and Public – (adults and children)
Monitor Economic Regulator
IntegrationPatients interests
Competition safeguards
Care Quality Commission
(Any Willing/Qualified)Provider
Proposed NHS Reforms
Accountability for results
licencing
contract
Local partnership
Public Health England
NHS Structure post reforms
Main Changes
• 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:
• 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
– 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.
• 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 VISITORPROGRAMME ?
Funding Accountability
Local Health Watch
Parliament
NHSCommissioning
BoardLocal offices & senates
ClinicalCommissioning
Groupssupported ‘clinical’ networks
Monitor Care Quality Commission
(Any Qualified)Provider
Spheres of influence
Accountability for results
licencing
contract
Local partnership
Public Health England
LSCB
Department of Health
Patients and Public – (adults and children)
Reforms - NHS London
Where are we now in London?• Transition?
PCT Clustering
TCS and vertical integrationFT pipeline
Performance
• Commissioning Commissioning support
Clinical Commissioning Groups / Federations? & authorisation
• Clinical [Safeguarding] NetworkingDesignated Professionals, Named Nurses Acute, Named Nurses CommunityNamed Midwives
• Health Visitor Project
Munro 4 themes1. A system that values professional expertise
2. Sharing responsibility for the provision of early help
PRACTICAL APPLICATION IN NHSHealth Visitor Programme,MASH ProjectsSchool Nurse DevelopmentFamily Nurse PartnershipsIntegrated Early Help TeamsWorking in the community and other partners – Vol Sector & Social CarePeer Review and auditSharing good practice
MUNRO REVIEWImpact of NHS Reforms
Shared understanding of NHS roles & responsibilities Retention of professional expertise Relationship of LSCB & HWB Board
CCG development NHS (CQC) inspectionCoordinated effective early help assessment processes and services (JSNA)
MUNRO REVIEWLess beurocracy – remove assessment timescales etc Improve quality of assessment and services – locally determinedRewrite Working TogetherRemove constraints to local innovation (national - forms, KPIs, IT systems) Involving health in Joint unannounced Inspection ProcessData set agreed
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
Munro 4 themes3. Developing [Social Work] Expertise and Supporting Practice
4. Clarifying accountabilities and creating a learning system. MUNRO REVIEW
NOT NHS SPECIFIC BUT SHOULD ALSO BE REFLECTED BY NHS
LSCB annual reports to CE & Leader of Council, Police & Crime Commissioner, Chair of HWBLSCBs to monitor effectiveness of CHILDRENS services and senior managersResearching options for using a systems methodology for SCRs
MUNRO REVIEW
NOT NHS SPECIFIC BUT SHOULD ALSO BE REFLECTED BY NHS
High quality practice placementsProfessional capability frameworkCPD framework & performance appraisalCareer pathwaysLeadershipRecognition 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
PRACTICAL APPLICATION IN NHS
Training for health staff on systems approaches including RCA 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– 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 ?