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Improving services for children through large scale workforce change

Foreword

During 2005/06, NHS Employers’ large scale workforce changeteam ran a national workforce change programme to developand spread new roles and new ways of working in children’sservices, in support of the National Service Framework forchildren, young people and maternity services – standard six.

Every child matters: change for children set an outcomes framework which included ‘be healthy’outcomes, to promote the health and well-being of children and young people. Both documentsemphasise the importance of developing a skilled and effective workforce. Our programme focused onworkforce redesign and integrated and co-ordinated working in this area.

The programme engaged 42 organisational teams across health, social care and education, many ofwhich worked in partnership together to integrate working practices and processes. Building on existingmodels of good practice, teams applied ‘adopt and adapt’ principles to redesign roles and spread goodideas and new ways of working across services for children.

This report illustrates a wide range of approaches to improving services for children and their families,from new ways of working and service redesign, to the implementation of new or amended roles in avariety of staff groups and service areas.

In this report you will find an outline of the methodology used, examples of good practice change ideasfrom the participating teams, an overview of the impact the changes had on service users and on staff,and measures of the productivity and benefits realisation.

I hope you will find some interesting and useful ideas that you can use to assist you in bringing aboutsome of the key improvements you want to achieve within your services for children.

i

Lynda Scott National lead for large scale workforce change NHS Employers

Contents

Foreword i

1. Programme background and aims 2

Programme aims 5

2. Programme design and implementation 6

3. Results 11

Examples of impact and benefits obtained by trusts 15

4. Brief case studies 21

5. Appendices 46

Appendix 1: Large scale workforce change team 47

Appendix 2: Participating trusts by strategic health authority 48

Appendix 3: National Reference Panel 50

Appendix 4: Acronyms explained 51

Appendix 5: Acknowledgements 52

Section 1

Programme background and aims 1

Workforce modernisation is key to the implementation of both the National Service Framework for children, youngpeople and maternity services1 and Every child matters2. At the inception of this programme, the Department forEducation and Skills (DfES) issued the Children’s workforcestrategy consultation3. The subsequent governmentalresponse was published in February 2006.

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1 National Service Framework for children, young people and maternity services: supporting local delivery

2 Every child matters: change for children in health services, DfES 2004

3 Children’s workforce strategy: a strategy to build a world-class workforce for children and young people, April 2005 and the Government’s response to the consultation, February 2006: www.everychildmatters.gov.uk

4 www.cwdcouncil.org.uk

5 www.everychildmatters.gov.uk

Background

Programme backgroundand aims

The projects in this programme reflect many of the key elements of this strategy and itsimplementation, for example:

• seeking local solutions to local issues, with an emphasis on sharing good practice

• more inter-agency and multi-disciplinary working, with a focus on leadership, managementand supervision.

In terms of the response to the strategy, the programme reflects the vision of a world-class children’s workforce that:

• strives to achieve the best possible outcomes for children and young people, and reducesinequalities

• is competent, confident and safe to work with children and young people

• people aspire to be part of and want to remain in

• parents, children and young people trust and respect.

Since April 2005, there have also been many new developments to support the children’s workforce, including:

• establishment of Children’s Workforce Development Council (CWDC)4

• championing children – guidance for leaders/managers of multi-agency teams

• a multi-agency toolkit published by CWDC

• agreed common core of skills and knowledge5

• consultation on sharing information on children and young people

• trials of lead professional and common assessment framework (CAF)

• to support implementation of the common core, Skills for Health has mapped the NationalWorkforce Competence Framework for children, young people and maternity services againstthe common core prospectus

• the Joint Planning and Commissioning Framework for children, young people and maternityservices has been launched by DfES and DH ministers. The framework is a children’s services-wide view of how joint planning and commissioning will develop over the next five to tenyears. If children's trusts can get this right, it has the potential to be one of the main driversto improve outcomes for children and young people and enable children's trusts to makesignificant efficiency gains.

Despite working in a time of great change, both in children’s services and in the NHS, theprojects have sought to deliver change for children and healthy outcomes. While theprogramme evaluation commissioned by the Care Services Improvement Partnership (CSIP) willnot report until autumn 2006, the projects are already demonstrating how to achieve theworkforce change essential to the delivery of the future children’s workforce.

The programme has also been supported at a national level by a reference panel of keystakeholders, including representatives from user groups, government departments andprofessional organisations. This panel provides a conduit for advice, support andcommunication to sustain the approach of integrated team-working.

Janis Stout, senior workforce advisor, change for childrenCare Services Improvement Partnershipwww.csipengland.org.uk/Childrenandfamilies

Improving services for children

Programme aimsThe aims of the programme were:

• to develop and implement a skill mix of roles and new ways of working, which providecapacity and flexibility to care for children and young people at home and in their localcommunities

• to contribute to the development of career frameworks for practitioners working withchildren and young people

• to ensure the most effective use of practitioner and support staff time in delivering servicesfor children

• to spread models of good practice across the NHS and children’s services

• to improve access to services for children, young people and their families

• to support integrated and co-ordinated service delivery

• to improve the working lives of staff.

Section 2

Programme design andimplementation 2

Programme design andimplementation

All large scale workforce change (LSWC) programmes followthe same basic programme design and implementation, asdescribed below.

In May 2005 all strategic health authorities were invited to submit expressions of interest from trustswishing to participate in this ten-month programme. Forty-two teams were selected to take this piece ofwork forward across 19 strategic health authorities. A scoping exercise had identified successful areas ofgood practice that already existed. The LSWC team approach shared and built upon the strengths ofthese models already in operation, to enable a safe and speedy spread programme across England.

Who was involved at each trust?Chief executives at each NHS trust, along with local authority children's leads, signed a memorandum of agreement committing their support to their local teams in delivering the aims of the project. Thishigh-level backing is seen as an essential and integral part of the programme design.

It was important that the initial team comprised senior people from each organisation. Each projectteam nominated a lead, an individual with expertise and credibility among peers who could also workwith board-level colleagues. The role of the team leads was ‘to make things happen’. It was very clearthat for the most part these leads felt empowered, and were driving the initiative forward within theirorganisations. As the teams drew up their detailed action plans, representation from operational staffincreased. These knowledgeable individuals were key to the successful design and implementation ofthe new ways of working.

Training and support frameworkStaff delivering healthcare are equipped with high levels of skills appropriate to their area of work. Skillsto improve their services are often low or absent. The LSWC team methodology supports all participantsin applying the most appropriate modernisation tools and techniques to secure measurableimprovements against local and national priority areas. The bespoke packages delivered by the LSWCteam ensure that trust teams are more favourably positioned to deliver against the key national priorityareas for the NHS and partners. The LSWC team builds participants’ understanding of current policydrivers and balances this against the particular targets that their organisations need to deliver locally.The emphasis of the programme was on rapid, widespread and safe implementation of efficient andsustainable new ways of working.

The programme followed distinct phases. There were set times when all teams came together nationallyfor two major learning and sharing workshops. Two periods were scheduled for trust teams to workwithin their host organisations to develop and strengthen the support framework in readiness forsmooth implementation of the new role and the introduction of new ways of working.

Reporting formats These were designed to enable the LSWC team to monitor progress without addingunnecessary additional demands on clinical teams, who were fully engaged in service delivery.

Finally, the LSWC team provides all teams involved in their programmes with a legacy of basicimprovement skills, to help those who wish to continue making further changes to enhancetheir local services.

The LSWC approachImprovement skills development workshopLSWC spread programmes start with the engagement of up to 60 teams from NHS trusts.Between 250 and 300 service staff are recruited, including staff from human resources,education, and senior managers. The training package itself starts during the first two or threedays, as each programme is launched.

The improving services for children programme was launched with project leads from allparticipating organisations attending a three-day improvement skills development workshop(ISDW). The ISDW is designed to equip team leads with the knowledge of change-managementtechniques that can be used to develop new ways of working. These include problem analysis,how to redesign a role, process-mapping of the patient journey and how to conduct small testcycles on their change ideas, to ensure delivery of improvements. The project leads also learnedhow they could measure the results of the changes they intended to make, to show impactagainst the key programme objectives and provide evidence that their activities were deliveringimprovements for service users, staff and their organisations.

Preparation and diagnostic daysThese were held regionally and enabled site leads to convene their full project teams and, withdedicated input from LSWC team facilitators, focus more sharply on their identified problemareas. Teams were also helped to produce more detailed and deliverable action plans.

Identifying local problem(s) and generating solutionsDefining local problems was key to creating new roles, new ways of working or whole serviceredesign that delivered the improvements required by children’s services teams at a local level.Using change-management tools and techniques, the teams accurately identified points in theirrespective patient experiences where changes could secure the greatest improvements topatient care. Gaining a clear understanding of the problems at the start meant that effort was


not wasted on developing solutions to symptoms, rather than the root causes of problems.Teams could then focus their energy on those problem areas that would yield the mostsignificant benefits.

Designing the new role or new way of workingWith clear understanding of the care processes they wanted to improve, teams undertookanalysis of patient pathways and service structures that could yield the greatest improvementsfor children and staff. This helped teams to understand how to sequence the changes and toidentify what skills were most necessary for the local role to have maximum effectiveness.

Engaging service usersInvolving service users is fundamental to modernisation activities and is reflected in the valuesunderpinning the national patient and public involvement (PPI) strategy, which is central tocreating a patient-led NHS. Wherever possible, all teams were asked to include service users tohelp identify the areas of improvement to be worked on.

GovernancePatient safety is paramount. All teams were advised to review their existing local protocols andguidelines to ensure that their improvement activities were held within a firm governanceframework. It was also essential that there was clear communication and understanding at each trust about the remit and boundaries of the new roles or ways of working. Site leads were advised to ensure workforce, trust boards and service users were kept fully apprised oflocal developments.

Measuring the improvementsWith all improvement activity, baseline measurements must be taken before any changes areimplemented. This is important because the effect of change needs to be assessed. Not allchanges yield improvements and, if baseline measures are taken, these subsequent variationscan be identified quickly. In addition, measuring improvements identifies the really positive andpowerful changes early on in the process and can allow teams to build on that success.

A range of measures was provided to cover issues of quality, efficiency and waste. Teamsidentified local measures to support their improvement work and to ensure it delivered thedesired benefits for service users and staff. During the programme, teams also learned how thecollection of simple and informative data could enable them to articulate their business casesand present them in a format that major stakeholders would appreciate.

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Web-based discussion forumThe LSWC team sets up and manages a web-based, virtual discussion forum for each of itsprogrammes. These ‘smartgroups’ help participating teams to share and request information,so that they can make quicker progress with the design and implementation plans for theirnew way of working.

Popular contributions include locally devised job descriptions, protocols and training details,which teams were then able to choose to adapt for their own use. This openness allowedvariations in approach to be freely debated. The LSWC team also ensured major policydocuments and guidelines were readily available for viewing.

External evaluationAn external evaluation of the programme, commissioned by CSIP’s research directorate, is inprogress and will report its findings in autumn 2006. The outcome will be openly available andthe learning from this exercise will be shared to complement the focus and detail of this report.


Section 3

Results 3

Overall resultsOver 150 new ways of working or new roles have been introduced. The roles created arewithin bands two to seven of Agenda for Change. This number will grow significantly as moreteams begin to implement the plans they developed during the programme.

The new roles are spread between the following sectors:

Health 45%

Health, education and social care 23%

Health and social care 18%

Speech and language 9%

Health and education 5%

Results from individual sites are described in good practice case studies in section four of thisreport (from page 21). Examples of some of the impact and benefits from this programme arehighlighted in the following section.

Countess of Chester NHS Foundation Trust: families will have better control over their child’s conditionthrough additional support at home, thanks to the development of a new community nursing team.

East Yorkshire & Yorkshire Wolds and Coasts PCT: CAMHS waiting time reduced from 26 weeks to two weeks by introduction of new ways of working in health visiting.

Central and Greater Derby PCT: 80 per cent of staff trained in the common assessment framework(CAF), resulting in speedier access for patients.

East and North Herts NHS Trust: children with minor injuries are now seen and treated more quickly in the accident and emergency department.

Wolverhampton City PCT: reduction in the number of children being admitted to hospital.

Wolverhampton City PCT: newly integrated working across acute and primary care results in more co-ordinated care for children in the community.

North Hampshire Hospitals NHS Trust: new support worker in the orthotic clinic releases time for thephysiotherapist to see twice as many children in the available time.

Royal Liverpool Children’s NHS Trust: episodes of care completed in one location, reducing the need for repeat visits and duplication of services for children.

Benefits to children and families

Results

North Hampshire Hospitals NHS Trust: 50 per cent of physiotherapist time saved by introducing a newsupport worker role.

North Hampshire Hospitals NHS Trust: 34 per cent of specialist school nurse time saved by introducing a new support worker role.

Oldham PCT: new clerical post releases 12.9 per cent of mental health practitioners’ time.

Bedford PCT: 3.5 hours of community paediatrician time saved per week.

Central and Greater Derby PCT: 50 hours per team per week (projected) saving in health visitors’ time.

Central and Greater Derby PCT: introduced integrated working by redesigning the health visiting andschool nursing service. Time released by new ways of working is redirected to inner city areas ofgreatest need.

Time released

Dacorum PCT: new support workers mean supported parents can take their babies home earlier. Length of stay reduced by 14 days for babies of 30 weeks (each cot day costs £500).

Sandwell & West Birmingham Hospital NHS Trust: reduced length of stay from 23 to 18 days for pre-term babies of 33–35 weeks.

East & North Herts NHS Trust: waiting time for analgesia in A&E is reduced from 45 minutes to tenminutes by introduction of paediatric emergency nurse practitioner role.

Countess of Chester Hospital NHS Foundation Trust: projected that 200 attendances and 50 admissions are avoided by introducing two advanced paediatric nurse practitioners and new community nursing teams.

Bedford PCT: seven community paediatrician slots are made available for children with more complex needs per week.

Poole Children’s Services Partnership: number of contacts with children regarding sexual health andbehaviour has increased from 23 to 87 per month.

Efficiency and productivity

South Birmingham PCT: additional capacity in core specialist and primary care services by introducingcommunity family workers.

South Birmingham PCT: improved recruitment from black and minority ethnic groups, supportingmainstream staff to understand the needs of the local community more.

Sunderland PCT: developed workforce capacity with the introduction of three new staff nurse roles to compliment the public health role of health visiting teams.

Vale of Aylesbury PCT: increase in time available for qualified staff for specialist work by introducing a new paediatric technician post.

Suffolk West PCT: six new roles and 14 new posts created in three localities to serve the new localcommunity cluster arrangements.

Workforce


Case study 1: Sandwell and WestBirmingham Hospitals NHS TrustBackgroundThis NHS trust reviewed the work of their unfunded community neonatal care team service.Established since 1988, it had evolved with no regular audit or service review.

Results• reduction in the number of visits for families who do not need intensive support, and

increased capacity for those who do

• significant reduction in time used unproductively by neonatal unit nurses

• more time can be spent on the neonatal unit, facilitating earlier discharge from the unit withappropriate support.

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The team has released 11 per cent of neonatal unit nurses’ time. This highly skilled time can bebetter used supporting babies who need to remain on the neonatal unit.

ContactJulie Nycyk, consultant [email protected]

Examples of impact andbenefits obtained by trusts


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BackgroundBand seven paediatric emergency nurse practitioner (PENP) was introduced into the A&Edepartment enabling a more appropriate child-centred approach. The role was a combinationof the existing adult ENP role and the paediatric nurse in A&E.

Results• children with minor injuries seen and treated more quickly

• fewer professionals involved in each care episode

• quicker pain relief for children when required

• doctors’ time saved is redirected to more complex cases

• children spend less time in A&E

• child is cared for in a paediatric environment with paediatric nurses

• opportunity for PENP to provide relevant and timely health promotion to parents and carers

• five roles in place across both hospital sites: two full-time and three part-time

• length of stay reduced from three to two hours (door to door)

• number of people involved in each contact is reduced from six to four

• analgesia given in ten minutes, previously a 45-minute wait

• helps trust to meet four-hour A&E wait target.

Case study 2: East and North Hertfordshire NHS Trust

By introducing the role of paediatric emergency nurse practitioner, the amount of time childrenand their families had to stay in the emergency department was significantly reduced.

Contact Sue Fox, [email protected]

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BackgroundWhen clinically ready for discharge, certain babies can now be cared for in the homeenvironment. This role offers tailored support and advice for families and carers at home.Parents get to know the neonatal team community support worker who works on the unit andwith parents, once discharged.

Results• reduced length of stay (LOS) unit

• parents become independent of NHS care earlier

• earlier discharge means parents learn to recognise normal patterns of infant behaviour anduse universal not specialist services

• staff no longer working over contracted hours to cover community work

• ten days of outreach cover provided by support worker without staff being called away frombusy neonatal unit

• first pre-term baby (30 weeks) discharged home with naso-gastric tube. LOS reduced by 14days for this category of baby

• cost savings of £500 per cot per day = £7,000

• qualified neonatal staff time released and redirected to neonatal unit, to care for babies withmore complex needs.

Case study 3: Dacorum PCT (Bedfordshire &Hertfordshire neonatal network)

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Key: measured by gestational age at admission to the neonatal unit

Target length of stay (LOS) met at 0, across all gestational ages of babies, since theintroduction of the role in January 2006.

Contact Jacquie Kemp, perinatal network [email protected]

BackgroundThe team focused on engaging professional and support staff in paediatric therapy and learningdisability nursing teams, in order to develop a generic role of a cross-professional support workers.The role will be employed in bands two and three of Agenda for Change, with one WTE band twocurrently in place, employed within a special school.

The annual training needs analysis identified the core competencies of professional nursing andtherapy roles and those of the different levels of support workers. The support workers in thelearning disability service have been rostered to work alongside the special school nurses in schoolsfor severe learning disability, in preparation for being able to fulfil delegated tasks to releaseprofessional nursing time.

Results• 34 per cent of special school nurse time is spent on tasks which could now be delegated to a

competent support worker

• a further 24 per cent will be delegated in the future once protocols regarding the administrationof medicines have been agreed and implemented with appropriate training and supervision

• 50 per cent of the activity required by physiotherapists to run a three-hour orthotic clinic can bedelegated to a support worker

• benefits for children of using cross-professional support workers in a flexible way between home,special school and respite, supports both nurses and therapists and means the defined group ofchildren with severe and complex disability will receive integrated and consistent healthcare.

A support worker allocated to a special school one day a week has enabled the nurse to use thetime released to:

• complete complex assessments for the continuing care process

• support the paediatric consultant in a complex neuro-disability clinic in her role as key worker

• be available during school hours to provide counselling and support to parents

• monitor the support worker’s competencies.

Having a support worker in the orthotic clinic released time for the physiotherapist to:

• focus on the clinical assessment process with the orthotist

• see twice as many children in the available time

• reduce waiting times for children requiring assessment or review of their orthoses.

ContactFiona Corkhill, disability services [email protected]

Case study 4: North Hampshire Hospitals NHS Trust

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Section 4

Brief case studies 4

New roles and new ways of working being implementedEach trust was asked to supply a brief description of the new roles and new ways of working they hadimplemented as part of the improving children’s services programme.

This information will help colleagues looking at improving children’s services to identify roles which mostclosely match their own situation and to share good practice.

More detailed case studies can be accessed on the NHS Employers website,www.nhsemployers.org/kb/kb-785.cfm, or by contacting the trust directly, using the contact details inthis report.

Case studies in this section are grouped by the area of work that new roles and new ways of workingwere implemented, to enable colleagues to access information more easily on the work areas they areinterested in. A list of these trusts grouped by SHA areas is also available in Appendix Two.

There is a useful list of acronyms used in this report in Appendix Four.

Brief case studies

Team Work area

East & North Hertfordshire NHS Trust Accident & Emergency

Warrington PCT Autistic Spectrum Disorder

Countess of Chester Hospital NHS Foundation Trust & Ellesmere Port & Nelson / Chester West PCTs

Care closer to home

Barnsley PCT Community

Calderdale & Huddersfield NHS Trust Community

Central Manchester PCT Community

Doncaster Central PCT Community

North Hampshire Hospitals NHS Trust Community

Royal Liverpool Children’s Hospital (Planned care team)

Community

South Birmingham PCT Community

St Helens & Knowsley Hospitals NHS Trust Community

St Helens PCT Community

Vale of Aylesbury PCT Equipment store

Bedford PCT Health visiting

East Yorkshire & Yorkshire Wolds & Coasts PCT Health visiting

Sunderland tPCT Health visiting

Waltham Forest PCT Health visiting

Windsor, Ascot & Maidenhead PCT Health visiting

Central & Greater Derby PCT Integrated children's service

Central Manchester PCT Integrated children's service

Dudley Beacon & Castle PCT Integrated children's service

Poole Children's Services Partnership Integrated children's service

Rotherham Children's & Young People’s Services Integrated children's service

Walsall tPCT Integrated children's service

Waveney PCT Integrated children's service

Wirral Hospitals NHS Trust Integrated children's service

Suffolk West PCT Integrated transition team

Wolverhampton City PCT and RoyalWolverhampton Hospitals NHS Trust

Integration of hospital & community nursing

Oldham PCT Mental health

Bedfordshire & Hertfordshire neonatal network -Dacorum PCT

Neonatal team

Sandwell and West Birmingham Hospital NHS Trust Neonatal team

Royal Orthopaedic Hospital NHS Trust Orthopaedics

Tower Hamlets PCT Respite care

Burntwood, Lichfield & Tamworth PCT Speech & language

Plymouth tPCT Speech & language

South Sefton PCT Speech & language

Royal Liverpool Children’s Hospital (Unplanned care team)

Walk-in centre

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Work area Accident and emergency paediatric emergency nurse practitioner (PENP)

Improvements and benefits• children with minor injuries seen and treated more quickly• fewer professionals involved in each care episode• quicker pain relief when required• doctors’ time saved is redirected to more complex cases.

Impact• length of stay reduced from three to two hours (door to door)• number of people involved down from six to four (risk also down)• analgesia given in ten minutes (previously a 45-minute wait)• helps trust meet four-hour A&E wait target.

Staff / client views“Junior staff are happy to ask advice/information of the PENP.” Ward sister“Parents/carers perceive the PENP as being more accessible and often less daunting to speak to than somedoctors.” Ward sister“Parents/carers are happy to have health education information given to them by PENP – they don’t feel they arewasting a doctor’s time.” Ward sister

Organisation nameEast & North Hertfordshire NHS Trust

Contact nameSue Fox, sister

Contact [email protected]

Work area Autistic spectrum disorder

Improvements and benefits • focus of the improvement work was the development of a designated key worker for children with suspected

diagnosis of autistic spectrum disorder• role has been highlighted as a key priority by parents, following an early support awareness event held in

collaboration with local authority.

Impact• providing support and information in a timely way• enabling children to have access to co-ordinated care through common assessment framework.

Organisation nameWarrington PCT

Contact nameRebecca Flanagan


Work area Acute and community – to reduce inappropriate hospital admissions

Improvements and benefits• treatment at home instead of journey to hospital and time spent waiting• families will have better control over their child’s condition through additional support at home, thanks to the

development of a new community nursing team – one hospital and one community APNP, four staff nurses and seven nursery nurses.

Impact• reduction in hospital attendance and admission. Predicted that between 100 and 200 attendances and

50 admissions may be prevented with the staffing levels available• reduced waiting times – children will not need to be seen by a doctor• no travel costs and parking charges• easier access to treatment and reduced handoffs, as 70 per cent of attendances are referred directly by the GPs • one community-based APNP could be ensuring support for 200 or more children in an area• less time off school for children• better patient experience• improved staff job satisfaction through enhancing their skills and knowledge and providing clear career

progression.

Staff / client views“It’s good not to have to answer the same questions over and over to different people.” Parent“The nurse has reassured me that I don’t need to worry and I’m happier that I can cope at home and telephone if I’m worried later.” Parent

Organisation nameCountess of Chester Hospital NHSFoundation Trust and Ellesmere Portand Nelson/Chester West PCTs

Contact nameAnne Murphy, lead children’s nurse


Work area • obesity and poor nutrition in deprived areas of the community• one WTE community family food and health worker, based within the dietetics service and working across

hospital and community settings and cross-agency.

Improvements and benefits• taster sessions at school and in parent and child groups to provide guidance on healthy eating and healthy

lunch boxes• interactive sessions, including competitions, advice, literature and useful information• cook-and-eat sessions in the community to encourage healthy eating and the balance of good health• planning to provide healthy eating input at after-school clubs with more interactive sessions.

Impact• 72 families engaged in three taster sessions• has engendered interest and enthusiasm for healthy eating in parents and their children• sustained increase in fruit and vegetable consumption• greater confidence in cooking healthy food• increased awareness of the importance of healthy eating and how to prepare, cook and maintain a healthy diet.

Staff / client views“I enjoyed discussing the labelling on food packaging – now I know what to look out for when trying to shopmore healthily.” Parent“I made beef and vegetable burgers and the kids all enjoyed them.” Parent“My children loved the fresh fruit salad I made.” Parent

Organisation nameBarnsley PCT

Contact nameAnita McCrum, community practice educator project lead



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Work area Children's community nursing team

Improvements and benefits • development of services and capacity to allow a seven-day nursing service that is child focused and provides

care in the children’s home• assessment and re-allocation of non-nursing duties, with some now being undertaken by volunteer workers.

For example, volunteer drivers delivering equipment.

Organisation nameCalderdale and Huddersfield NHS Trust

Contact nameJanet Powell, matron – paediatric services


Work area Paediatric advanced nurse practitioner

Improvements and benefits• the team looked at how to reduce the number of unnecessary GP referrals to A&E for children with acute

paediatric conditions• this will be achieved by identifying tasks and interventions that can be dealt with by a paediatric advanced

nurse practitioner and other roles• an experienced community children's nurse has been identified to undertake advanced practitioner master’s

degree programme and a GP practice has been identified for a pilot to be undertaken• a monitoring system is being developed• once in place, the paediatric advanced nurse practitioner will be able to offer services closer to home in

familiar surroundings and encourage parent/carer confidence in services and their own caring abilities• this should reduce the number of inappropriate attendances at A&E and should reduce the number of

GP referrals (for some conditions) to secondary care.

Impact• community children’s nurse has commenced the advanced practitioner master’s programme• monitoring system still being developed.

Staff / client views“Enthusiasm amongst CCN team that new role is developing and that this will eventually enhance serviceprovision.”“Commitment evident to progress the work, but other commitments currently a higher priority.”

Organisation nameCentral Manchester PCT

Contact namePeggy Keating, children's community nurse manager


Work area Community intensive low-level family support worker

Improvements and benefits• works in parent’s environment to establish rapport and gain consent to work on specific aspects of the

child’s needs• giving intensive support/ teaching/ supervision on a range of parenting matters such as bed-time routines,

hygiene, morning routines to ensure children ready for school.

Impact• in a three-month pilot period the worker saw five families = 25 different contact episodes• assistance to attend groups run at the children’s centre• families found it impossible to engage without this additional support• taking care to those who are hardest to reach. Children can benefit from a range of services provided by the

children’s centre• boost parents’ confidence as carers• improve levels of basic skills in parents, to position them better as potential returners to employment.

Staff / client views“They are very helpful, sorting me out so I can do loads of great stuff in the week.” Parent“They have helped me to join in and get involved.” Parent

Organisation nameDoncaster Central PCT

Contact nameCaroline Hill, head of community services



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Work area • community – paediatric therapy and learning disability nursing teams• cross-professional support workers at bands two and three with the potential to develop to assistant

practitioner role at band four.

Improvements and benefits• special school nurses identified on a typical day – 34 per cent of their time is spent on tasks that could now be

delegated to a competent support worker• a further 24 per cent of time will be delegated in the future once protocols regarding the administration of

medicines have been agreed and implemented with appropriate training and supervision• 50 per cent of a physiotherapist’s time to run a three-hour orthotic clinic can be delegated to a support worker• measurement of a typical shift in respite is in progress to identify when and for which elements of a child’s care

plan the skills of a nurse are required• benefits to children of using cross-professional support workers in a flexible way between home, special school

and respite, supporting both nurses and therapists, means the defined group of children with severe and complex disabilities will receive integrated and consistent healthcare.

ImpactA support worker allocated to a special school one day a week has enabled the nurse to use the time released to:• complete complex assessments for the continuing care process• support the paediatric consultant in a complex neuro-disability clinic in her role as key worker• be available during school hours to provide counselling and support to parents• monitor the support worker’s competencies.

Having a support worker in the orthotic clinic released time for the physiotherapist to:• focus on the clinical assessment process with the orthotist• see twice as many children in the available time• reduce waiting times for children requiring assessment or review of their orthoses.

Staff / client views“As a family we find the special school nurse the most useful person to communicate through about the needs ofour son and would want to use her as our key worker.” Parents“I've really enjoyed the chance to work with the therapists and understand more about the needs of the childrencoming into respite.” Learning disability support worker“I will be able to offer more support to parents if I'm not spending my day giving gastrostomy feeds.” Specialschool nurse“A support worker in our orthotic clinic enables me to concentrate on the clinical needs of the children and liaisemore effectively with the orthotist.” Physiotherapist

Organisation nameNorth Hampshire Hospitals NHS Trust

Contact nameFiona Corkhill, disability services manager


Work area Healthcare assistant in a community setting

Improvements and benefits• established outpatient clinics in Bootle community centre• weekly clinic for ophthalmology running for past two months and two-weekly clinic for general paediatrics

running for past month• patient-centred questionnaires used to investigate differences in patient journey in local community setting

compared to that of the hospital setting.

ImpactAttendance at community clinic resulted in the following reductions, compared to attendance at hospitaloutpatient department:• average length of travelling time reduced by 18 minutes• average length of time child had to take off school to attend appointment reduced by one and a half hours• number of interventions (hand-offs) reduced by an average of two to three.

Staff / client views“Attending the local clinic is much better. It has meant that my daughter has only had to miss the last lesson inschool today.” Parent“This is a really exciting opportunity. I have enjoyed being part of the team setting up the external clinics. I feelthat I have made a big contribution to this work.” Senior nurse“As an experienced HCA, I think this new role will allow me to develop my skills further and stretch myself more.”Healthcare assistant

Organisation nameRoyal Liverpool Children’s NHS Trust

Contact nameJackie Buls, lead nurse outpatients


Work area Community family workers

Improvements and benefits • to establish a pilot project using three different settings to employ and train staff, using a para-professional

model to create community family workers focusing on special schools, child development centres and health visiting services.

Impact• creating additional capacity in core specialist and primary care mainstream services, freeing up practitioner time• improved recruitment from black and minority ethnic groups.

Staff / client views“The role has proved to be beneficial to the health visitors in the community teams. The role is enabling thetrained staff to focus their skills on more specialist activity, such as clinical interventions and assessment of needs,while the community support role is supporting families in the home, providing a better quality service within the community.”“The perspective of the workers is clearly closer to the needs of people in communities and is increasing ourknowledge of how better to meet those needs.”

Organisation nameSouth Birmingham PCT

Contact nameVicki Fitzgerald, para-professional development manager



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Work area Children's hospital at home

Improvements and benefits • the two PCTs of St Helens and Knowsley have committed themselves in the new financial year of 2006/07 to

fund two WTE band five registered children’s nurses posts to enable us to expand the remit of our existing children’s hospital at home team

• the team will take referrals from the walk-in centres, the children’s and neonatal wards and the short-term GP assessment unit / children’s observation unit at Whiston hospital.

Impact• children of St Helens and Knowsley will have access to a children’s community nursing team, whereas at

present there is no service except the adult district nursing team, the paediatric nurse specialists and individualised care packages set up jointly with social services for children with complex needs

• this will reduce inappropriate hospital attendances• the service has already broadened its remit awaiting the arrival of the posts, which will increase capacity• the service is now offered (prior to the posts commencing) to babies discharged from the special care baby

unit who continue to need follow-up and support with feeding and growth, or are on home oxygen and tube feeds, to Home Start newly diagnosed diabetics who are not too ill at diagnosis, and to palliative-care children nursed at home, together with tertiary colleagues.

Organisation nameSt Helens & Knowsley HospitalsNHS Trust

Contact nameSally Duce, lead nurse & directorate manager, paediatrics


Work area Community respite unit

Improvements and benefits• the project focus for this team was to work with local authority partners to enable the transition of children

with complex health needs into a local authority community respite unit.

Impact • health adviser now working with the local authority (LA) decision-making panel for respite, to provide advice• developed clinical protocols and pathways of care, ensuring accountability and safety with monitoring and

supervision plans• two new roles being recruited to disability / complex health team.

Staff / client views“I have learnt a great deal from my participation on the project team and from the opportunity provided fornetworking by attending the cluster group meetings.’’ Specialist nurse CYP disability“This project will have a positive impact on future inter-agency working practice and takes forward the NSFprinciples of care for children with complex health needs.’’ LA operational team manager“When we have this service in place it will make a huge impact on parents like me who are struggling with out-of-borough respite care that only adds additional stress to the family.’’ Parent

Organisation nameSt Helens Primary Care Trust

Contact nameJanet McDonald, director of child & family health


Work area Children's equipment store

Improvements and benefits • integrate agencies and systems to enable efficient and cost-effective provision of equipment for children, within

a new equipment store• establish a new role for a dedicated paediatric technician to maintain the equipment.

ImpactPredicted impact only, as targets set for when store is opened and roles in post:• financial saving on equipment by recycling and repairing existing equipment – target to recycle nine items

per month (from four at present)• increased access to equipment for children with disabilities, by decreasing number of months from request to

delivery – from five to target of two • increased integrated working across health and social care• increase in time available for qualified staff (occupational therapist) for specialist work (from time freed up

from repairing and setting up equipment and administration).

Staff / client views“We have still got a standing frame in the garage that we don’t use it at the moment – this new system shouldhelp.” Parent“We need a local, timely one-stop shop for the maintenance of our good-quality complex equipment.” Paediatricoccupational therapist “We are looking forward to building a good working relationship with the technician, who will understand bothchildren’s and families’ needs, as well as supporting the therapists.” Paediatric occupational therapist

Organisation nameVale of Aylesbury PCT

Contact nameElizabeth Geldard, therapy services manager



Work area Health visiting

Improvements and benefits• preventing chronic constipation in the under-fives, identifying potential problems as early as possible• at the outset of the project all children in need of referral for constipation were seen in secondary care in a

variety of clinics led by doctors. In a three-month period to March 2006, children were then seen by health visitors, who gave advice and information on diet, water intake and exercise, resulting in fewer referrals to secondary clinics.

Impact• improved referral pathway• care and advice available to parents closer to home• promotes prevention and reduces expectations of medication • more confident parents• health visitors proactively giving dietary advice at child health clinics and also targeted to children known to be

using laxatives. Average time on laxatives for a child aged 30 months was two years. This is now prevented in many cases

• medication prescribed less frequently and for reduced length of time• seven referrals to bowel clinic prevented• seven x 30 minutes community paediatrician time saved • clinic slots available for children with more complex needs.

Staff / client views“Life is so much easier.” Parent“It’s given me the confidence to work with parents.” CCA“This is fantastic! After what I’ve seen while working in adult gastroenterology I know it’s so important.” Student health visitor

Organisation nameBedford PCT

Contact nameAnn Fewtrell, children’s services modernisation manager


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Work area New ways of working in health visitor teams

Improvements and benefits • introduction of new ways of configuring caseloads to facilitate delivery of services to families with complex needs• focusing on referrals to CAMHS• engaging with families at tiers one and two to deliver packages of care using brief intervention techniques.

Impact • 42 children now seen in behaviour clinic rather than being referred to CAMHS• waiting time reduced from 26 weeks to two weeks• three parenting courses held with average of 14 parents attending• parenting course for adolescents held with eight parents attending.

Staff / client views One mother commented that she cried every day before she and her child came to the behaviour clinic and thatshe had not cried since.

Organisation nameEast Yorkshire & Yorkshire Woldsand Coast PCTs

Contact nameAngela Lewis


Work area Health visiting service

Improvements and benefits • project developed the public health role of the staff nurse in the health visiting team, to reduce the impact of

adult behaviours on children’s health, such as nutrition, smoking and the impact of maternal depression.

Impact • developed workforce capacity by the introduction of three rotation public health staff nurses• establishment of clearly defined public health role for the staff nurse.

Organisation nameSunderland tPCT

Contact nameChris Winter, modern matron / clinical lead


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Work area Health visiting and school nursing

Improvements and benefits • developed new and existing roles and new ways of working in health visiting and school nursing, to build

capacity and capability to meet public health roles, improve quality of access, enhance early intervention and ease life transitions.

Impact • moving from GP attachment to corporate caseloads• two new assistant practitioners to be in post by June 2006• three new community staff nurses to be in post by June 2006 • developing team leader roles• career development at all levels.

Staff / client views“This programme is important for the PCT to take forward children’s services with the local authority. It hasturned around staff attitudes to change towards feeling positive, enthusiastic and taking control.”“It creates pressure for an already depleted workforce to work within pre-designed frameworks, but is also animpetus to do the work we have to do.”“It is exciting but scary, and the pace is quite daunting.”“Drivers are national and local but what can help is training to help support new roles.”“It helps us to do what we know is needed to make things better for children and families.”

Organisation nameWaltham Forest PCT

Contact nameMarylin Claydon, nurse manager


Work area Health visiting and school nursing

Improvements and benefits• the team has increased the workforce capacity by increasing the number of staff nurses and nursery nurses• in total five staff nurses and two nursery nurses have been employed• improved joint working by staff nurses working across two school nursing teams has led to an increase in the

number of open-door clinics in schools, provided by school nurses • communication has improved between staff by defining roles and competencies from the skill mix team

specifically for health visiting team• they have improved local access to the health visiting team by having joint baby clinics and central locations,

along with supporting parenting by providing a Webster Stratton course, which is done in partnership. The course is provided at various community settings.

ImpactAchieving choosing health priorities in the following areas for school nursing team: • provide information and support through more drop-in sessions and be more readily available to provide

one-to-one support at other times to young people and families with their health needs in secondary and primary schools

• provide early identification of problems and intervention in association with other professionals and by improving access to the service

• increase the contribution to high-quality personal, social and health education and sex and relationships education in the primary and secondary curriculum, aiming to reduce teenage pregnancy and sexually transmitted diseases

• lead healthy schools initiatives.

Achieving choosing health priorities in the following area for health visiting:• increase in breastfeeding data• smoking cessation• increased uptake of immunisation• provide targeted services for vulnerable children and young people• early intervention and identification of vulnerable children and young people.

Organisation nameWindsor, Ascot & MaidenheadPCT

Contact nameAnshu Varma, children’s service manager



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Work area Implementing integrated children’s service with Derby City and partners

Improvements and benefits• new role of health co-ordinator helps to clarify the governance arrangements and so reduce risk• complete redesign of health visiting and school nursing provision • redesign of roles of health visitors, school nurses, nursery nurses, community staff nurses• redesign of Child Health Promotion Programme • health visitors released from doing routine three-year child health checks.

Improvements expected for children and staff• caseload weighting system for deprivation now ensures resources go where most needed • 80 per cent staff trained in CAF, giving speedier access to targeted services and ensuring that referrals made

are entirely appropriate• staff involved in developing lead professional role• services are now child-focused and needs-led• strengthened R&R, as new way of working is more attractive.

Impact• projected 50 hours of health visiting time saved per week across the team• time redirected to inner city area where health needs are greatest.

Staff / client views“Fantastic to receive a CAF – I don’t have to repeat the assessment for this child.” Community paediatrician

Organisation nameCentral and Greater Derby PCT

Contact nameChris Tully, lead officer for children's NSF


Work area Implementing children and young people’s multi-agency team in Manchester

Improvements and benefits• workers from health, social care and education working in multi-disciplinary, singly managed, co-located teams• children will then have access to the right workers with the right skills at the right time• the team will use CAF, the lead professional role and the child index as tools to support multi-agency planning.

Impact• two teams planned to be in place by December 2006 and remaining ten teams by December 2007• this strategy will complement national guidance in Every child matters• refocus service to prevention and earlier intervention• provide an improved response to the needs of children and young people.

Organisation nameCentral Manchester PCT

Contact nameAlison Jackson, associate director, children's service development


Work area Early support programme

Improvements and benefits• this year has been used to ensure a sound framework for delivery• engagement of all stakeholders with a particular emphasis on the engagement of families.

Working towards: • appointment of programme manager• accredited key worker training • engaging with parents and carers in a meaningful way in the development of the programme• integrating and testing the development of the early support programme and the common assessment

framework, particularly in relation to ensuring synergy in the development of the lead professional/key worker• project being overseen by a multi-agency steering group that includes parent representation.

Impact• 20 families have been identified to participate in the pilot• seven Dudley professionals (education, social services, health and voluntary sector) have received training to be

key worker trainers• parental/carer questionnaire highlighted difficulty in accessing appropriate information to enable informed

choice and decision-making in relation to support services. 71 per cent of respondents found this aspect distressing or not satisfactory. 100 per cent of families taking part in the pilot now have access to information

• 67 delegates attended the conference in March 2006 from health, education, social care and private and voluntary sector.

Organisation nameDudley Beacon & Castle PCT

Contact nameAnne-Marie Morris, children’s services commissioning lead


Work area School nursing and teenage pregnancy

Improvements and benefits • the team used the programme to develop a strategy to provide locally based preventative and support services

to reduce unintended pregnancies in under-18s and reduce social exclusion• developed new ways of working in school nursing to increase the number of young people contacts.

Impact• increased the number of contacts from 23 per month to 87• recorded second highest reduction in teenage pregnancy in the country between 1998 and 2004• daily confidential drop-in session in school• health drop-in at youth centre• youth advisory clinic at local library• teenage parents’ support groups• significant change in type of contact – now more specific to sexual health and behaviour.

Staff / client views‘‘Gave someone safe to talk to.’’ Young person‘‘Gail’s not so scary as a doctor…she listens to me and doesn’t make me feel silly.’’ Young person‘‘Gail helped me talk to my mum.’’ Young person‘‘I feel safe talking to the nurse down the club – she explains stuff.’’ Young person‘‘Speedy referral.’’ Staff‘‘Safe place in school.’’ Staff

Organisation namePoole Children's ServicesPartnership

Contact nameTina Collinson, service development manager



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Work area Integrated health and family support

Improvements and benefits • better integration of health and family support services across organisations with increased capacity in

mainstream professional health services, to provide increased depth and breadth of service to meet increasingcomplexity of need.

ImpactNew role not in post yet – more tangible impacts will be evident over next 12 months.• improved cross-organisational working with partners in education, social care and Sure Start• better clarity for children and families about what care is offered to them by a variety of services at children’s

centres• enhanced general knowledge about health services for all stakeholders.

Staff / client views“It’s given me an overview of what could be achieved.”“Quality relationships must be at the hub of health input.”“Involvement and consultation with fieldworkers every step of the way.”

Organisation nameWalsall tPCT

Contact nameMary Griffiths, head of nursing children & families


Work area Family support in multi-agency community team

Improvements and benefits • a family support worker was in post from September 2004 to November 2005• the family support worker worked with nine families, which consisted of 28 children in total• examples of the tasks carried out by the worker include: accompanying parents and children to local toddler

groups and appointments, promoting physical activity and healthy lifestyles.

Staff / client views“She has been a great encouragement in helping me to become more independent, taking me to town,supporting me at my appointments … speaking to different people on my behalf, such as school. Having her hasgiven me great confidence to go out, something I would not do on my own … she put in lots of support for meand the children.” Parent

Organisation nameRotherham Children and YoungPeople’s Services

Contact nameJane Bruce, multi-agency development co-ordinator


Work area Children’s services team leader

Improvements and benefits• each children’s team leader is proactive in their cluster and is promoting health as a committed partner to

integration and innovative practice• post-holders are championing the pace of change, promoting the integration of services and seeking to show

evidence of outcomes against the ECM outcomes framework.

Impact• defined mixture of management, development and clinical practice• career progression to advanced clinical practice• progressing skill mix, such as staff nurses in YOS and Connexions.

Staff / client views“Making a real difference. Excellent work.” Young person“A really good start – we can build on this work.”

Organisation nameWaveney PCT

Contact nameSue Mummery, head of children's & family services


Work area Unplanned care

Improvements and benefits• development of an ‘unplanned care area’ specifically for children. Development of closer working

relationships with social services and other youth organisations.

Impact• reduced admissions through triage by children’s nurse and improved signposting to appropriate services• active management of young people who ingest alcohol, with social services• improved management using child concern model.

Staff / client views• We know from discussions with the children and their parents that they want dedicated facilities, audiologically

as well as visually separate from adults.• Patients and parents using the present children’s A&E area who have experienced the main department have

highlighted the positive benefits.

Organisation nameWirral Hospitals NHS Trust

Contact namePauline Riding, children’s matron / assistant directorate manager



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Work area Multi-agency transition team

Improvements and benefits• the aim of the project was to develop an effective co-located multi-agency transition team in each locality in

Suffolk, to provide a planned progression from childhood to adulthood for young people with additional needs• the team has created six new job roles and 14 new posts, based in three localities, to serve the new local

community cluster arrangements as part of the Suffolk Children’s Trust• interventions take place in the home/education setting or in the local office, which is also a drop-in centre for

young people• transition teams are the first fully integrated co-located teams in Suffolk and provide a mix of skills, experience

and abilities• frontline posts such as the transition support worker and broker provide a generic support role for young

people and families, allowing the social workers and nurses to concentrate on specialist interventions.

Impact• young people with a learning disability (LD) are now able to access a service from the transition learning

disability nurse, where previously the LD service for children and young people ended at age 13• transition team are able to provide a co-ordinated service to young people with complex needs in the

transition to adulthood• carrying out joint assessment visits and joint care planning is ensuring that young people and their families do

not have to repeat their stories and also that action planning is jointly agreed. A lead contact is also agreed at the referral meeting.

Organisation nameSuffolk West PCT

Contact nameTracey Cogan, children’s commissioning manager


Work area Integration of hospital and community nursing teams

Improvements and benefits• integration of the nursing teams from the hospital and the community• sharing of skills and services to utilise resources from the community nursing service in the acute and

community trust.

Impact• major restructuring process in acute trust• integrated working between both acute trust and PCT• integration of all children’s services into a new children’s resource centre, allowing treatment to be provided

closer to home• holistic treatment for children• reduced admissions through co-ordinated care in the community.

Organisation nameWolverhampton City PCT andRoyal Wolverhampton HospitalsNHS Trust

Contact nameMargaret Grizzell, strategic health co-ordinator


Work area Specialist mental health practitioner role / caseload weighting tool

Improvements and benefitsSpecialist mental health practitioner role:• specialist practitioner now working within the Youth Offending Service (YOS)• undertook a cost/benefit analysis of the role to provide evidence for the development of future emerging roles

within children’s services • demonstrated cost-effectiveness of nurse specialist roles within a primary care setting, compared with

traditional medical roles• demonstrated the need and cost-effectiveness of clerical support for specialist roles.

Universal caseload weighting tool:• developed a universal caseload-weighting tool. This will clearly identify workforce resource issues prior to

committing to emerging agendas.

ImpactMental health practitioner role:• access was improved to tiers two and three of mental health services within a primary care setting for

vulnerable young people• introduction of clerical support would free up 12.9 per cent of the practitioner’s time to undertake increased

clinical activity for young people and also would cost less• the cost/benefit analysis identified that a specialist mental health practitioner based at the YOS had benefits,

including reduced DNA rates, greater cost-effectiveness and increased access to young people• on average about 13 new initial assessments are carried out each month• from January 2006, the mental health practitioner also took on responsibility as clinical lead for adolescent sex

offenders and strategic lead within the YOS for operational risk assessment.

Organisation nameOldham PCT

Contact nameJacqui O’Reilly / Jill Beaumont


Work area Neonatal team community support worker

Improvements and benefits• reduced LOS on unit • parents become independent of NHS care earlier• earlier discharge means parents learn to recognise normal patterns of infant behaviour and use universal not

specialist services• staff no longer working over contracted hours to cover community work• ten days of outreach cover provided by support worker without staff being called away from busy neonatal unit.

Impact• first pre-term baby (30 weeks) discharged home with naso-gastric tube. LOS reduced by 14 days for this

category of baby• cost savings of £500 per cot per day = £7,000• qualified neonatal staff time released and redirected to neonatal unit, where it is more appropriately used for

cases that are more complex.

Staff / client views“Before discharge I was nervous about letting someone from the hospital into my house. My anxiety about thisand my baby was relieved. It was a lovely visit - thank you.” Parent“I have valued these visits so much. I would be happy to continue seeing you in my home.” Parent“I feel very supported and much more able to cope with my baby at home because of the support and advice thatI received before discharge and once at home with my baby.” Parent

Organisation nameBedfordshire And Hertfordshireneonatal network – Dacorum PCT

Contact nameJacquie Kemp, perinatal network manager



Work area Community neonatal team

Improvements and benefits • released qualified neonatal nurse time to work on the unit• operational policy reviewed and new ways of working introduced.

Impact • reduced number of DNA home visits from six per cent to one per cent• parents’ resuscitation training, prior to discharge facilitates earlier discharge of baby• average length of stay reduced from 23 days in October 2005 to 18 days in March 2006 for pre-term babies of

33–35 weeks• new ways of working introduced to allow nursery nurse to take a more active role.

Organisation nameSandwell & West BirminghamHospital NHS Trust

Contact nameJulie Nycyk, consultant neonatal paediatrician


Work area Nursing pre-operative assessment in conjunction with spinal consultant clinic

Improvements and benefits• small team of paediatric pre-admission leads from different trusts have come together to set up a paediatric

learning set• agreement for the development of the nurse practitioner role within paediatric outpatient clinic (redesign of

the clinic sister role)• role will include a variety of nurse-led and multi-disciplinary activities benefiting not only children undergoing

spinal surgery, but also those with other complex needs.

Impact• the development of nurse-led pre-operative assessment will ensure children undergo appropriate assessment

(medically and socially) in advance of undergoing major spinal surgery. The benefits for the child will beappropriate

• investigation carried out in timely fashion• assessment by relevant clinicians, which in turn can help to ensure that children have their operations at the

appropriate hospital• discharge planning commences at earliest opportunity, to ensure discharge in timely fashion.

Organisation nameRoyal Orthopaedic Hospital NHS Trust

Contact nameChristina McCaugherty, paediatric clinic manager


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Work area Speech and language therapy

Improvements and benefits • improved early development of speech and language skills of pre-school children in areas of deprivation to

reduce waiting times for children• improved the skills of health visitors and community nursery nurses in speech and language promotion • reduced the number of referrals being made to the SALT services.

Impact• community nursery nurses delivering parent and child group activities• health visiting teams focus on speech and language development with an intervention pathway beginning in

antenatal period• more comprehensive referral form completed• reduction in waiting time for those children who require therapy.

Staff / client views“Really exciting opportunity to use our skills in child development and to show the value of play.” CNN“Chance to demonstrate and measure the impact of early intervention.” Health visitor“Great to have health visitors and speech therapists building on the work they do together.” SALT

Organisation nameBurntwood, Lichfield andTamworth PCT

Contact nameDeborah Futers, nurse consultant, children’s services


Work area Multi-agency respite care

Improvements and benefits • project has developed a generic support worker working across health, social care and education to provide

respite to families with children who have complex health needs.

Impact• consistency of care for children with complex needs• improved communication• ability to support more families and children• consistency in staffing• opportunity for staff to develop their careers.

Staff / client views“Provide continuity of care for children and families by staff who have the competency to provide theappropriate care in the home and other appropriate settings.”“Reduce the need to train new staff regularly (weekly).”“Able to offer the level of support the family requires i.e. three to four hour shift, currently offering 12 hour shiftwhich is excessive for the family.”“Opportunities for staff for development.”

Organisation nameTower Hamlets PCT

Contact nameSam Varley


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Improvements and benefits • the multi-agency team directed their project at providing a consistent message from all services regarding early

interaction skills and the importance of face-to-face communication with children.

Impact• childcare settings reinforcing face-to-face message• new ‘talking tips’ leaflet produced• all health visitors now use leaflet at first post-birth appointment.

Organisation namePlymouth tPCT

Contact nameGaye Powell, head of speech and language services



Improvements and benefits• the team directed their project at addressing the inequitable access and long waiting time for speech and

language therapy across city community clinics through workforce re-configuration and skill mix.

Impact• pilot intervention packages established• time-limited intervention options based on skill mix• change in skill mix based on evidence from the caseload review• moved from nine clinics to two teams.

Organisation namePlymouth tPCT

Contact nameGaye Powell, head of speech and language services



Work area • school classroom assistants with additional health advisory training• school speech and language therapy service support worker role.

Improvements and benefits• two-year fixed-term funding for speech and language post secured• four mainstream primary schools identified to engage in pilot project• identified criteria for selecting schools for speech and language therapy• job description, person specification and advertisement for speech and language therapy support worker post

agreed and now with human resources for recruitment.

Impact• anticipated that children will receive better quality of service as they will not have to be removed from school

to attend review appointments• programmes delivered by same person, ensuring continuity of care• closer liaison with school staff and parents, providing regular feedback on progress• more complex children will receive more timely intervention, as qualified staff are freed up for increased

capacity and flexibility• anticipated result is increased job satisfaction amongst the speech and language therapy workforce and raised

profile of the service within schools.

Staff / client views“The introduction of this role within our team will undoubtedly increase capacity for the delivery of appropriateprogrammes to children with more complex speech and language needs.” Speech and language therapist“Joint working in respect of this project has resulted in true partnership working between health and education,the breaking down of professional boundaries and additional flexibility to develop new roles.” Education staff member

Organisation nameSouth Sefton Primary Care Trust

Contact nameSandra Black, manager & development lead, school health service


Work area Paediatric NHS walk-in centre developing nurse practitioners

Improvements and benefits• 12-week course developed and delivered over four months to six staff from SCMIU and two from A&E

department by medical consultants, specialist registrars, nurse clinicians and specialist nurses• 11 patient group directives developed, supporting the treatment of common presenting illnesses• more children able to have their episode of care completed in one location, reducing the need for duplication

of services• service-level agreement established, providing ongoing support and continued professional development for

staff at SCMIU from Royal Liverpool Children’s NHS Trust.

Impact• the project has supported development of the service and we hope the care patients receive at Smithdown will

be consistent and of similar standard to that experienced at the A&E department• more patients will therefore use the services, reducing reliance on A&E and providing care more locally to

patients• there has been a 22 per cent increase in the number of patients attending Smithdown.

Staff / client views“Enjoyable. It’s a positive thing.”“Closer links mean better understanding.”“Improves services for patients.”

Organisation nameRoyal Liverpool Children’s NHS Trust

Contact nameRachel Greer, assistant care group manager


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Section 5

Appendices 5

Appendix 1

Large scale workforce change teamWho we areNHS Employers supports the NHS through the implementation of workforcesolutions by delivering large scale workforce change programmes that build anddevelop a more adaptable and flexible workforce. We support employers inmeeting key national priorities and improving efficiency and productivity, bydesigning and delivering wide-ranging workforce solutions.

Supporting employersWe provide support, guidance, advice and tools and techniques for the service,to help employers find local workforce solutions and, in turn, provide benefitsfor service users and NHS staff. Additionally, our national learning and sharingnetworks help speed up the spread of good practice across the service. Wecontinue to advise and guide SHAs and trusts and to provide a national resourceof workforce and service modernisation tools, together with training andguidance on how to use them, to ensure continuous improvements for serviceusers and NHS staff.

Aims and objectives • to design and deliver large scale national programmes that support clinical and

support staff in the delivery of local healthcare services

• to spread new roles, new ways of working and improvements in retention andrecruitment systems known to have impact on key service improvement areas

• to build capacity in human resources (HR) within the NHS to deliver the fourpillars of HR

• to deliver programmes that reflect national priorities, take account of serviceneeds and that are based on the ‘adopt and adapt’ principle.

Find out moreFor more information on the large scale workforce change team and theirprogrammes of work, visit www.nhsemployers.org/workforce or contact LyndaScott, national lead for large scale workforce change on 07789 653 308 or JulieAyo, events and business support co-ordinator on 020 7074 3337.


Appendix 2

Participating trusts by strategichealth authorityTrusts are listed by new strategic health authority area (according to theGovernment’s announcement on SHA reconfiguration under Commissioning a patient-led NHS in April 2006).

East Midlands Strategic Health Authority

Central & Greater Derby PCT

East of England Strategic Health Authority

Bedford PCT

Bedfordshire & Hertfordshire Neonatal Network - Dacorum PCT

East & North Hertfordshire NHS Trust

Suffolk West PCT

Waveney PCT

London Strategic Health Authority

Tower Hamlets PCT

Waltham Forest PCT

North East Strategic Health Authority

Sunderland tPCT

North West Strategic Health Authority

Countess of Chester Hospital NHS Foundation Trust & Ellesmere Port & Nelson / Chester West PCTs

Royal Liverpool Children’s Hospital (Planned care team)

Royal Liverpool Children’s Hospital (Unplanned care team)

South Sefton PCT

St Helens & Knowsley Hospitals NHS Trust

St Helens PCT

Warrington PCT

Wirral Hospitals NHS Trust

Central Manchester PCT

Oldham PCT

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South Central Strategic Health Authority

North Hampshire Hospitals NHS Trust

Vale of Aylesbury PCT

Windsor, Ascot & Maidenhead PCT

Plymouth tPCT

Poole Children's Services Partnership

West Midlands Strategic Health Authority

Dudley Beacon & Castle PCT

Royal Orthopaedic Hospital NHS Trust

Sandwell and West Birmingham Hospital NHS Trust

South Birmingham PCT

Walsall tPCT

Wolverhampton City PCT and Royal Wolverhampton Hospitals NHS Trust

Burntwood, Lichfield & Tamworth PCT

Yorkshire & The Humber Strategic Health Authority

East Yorkshire & Yorkshire Wolds & Coasts PCT

Barnsley PCT

Doncaster Central PCT

Rotherham Children's & Young People’s Services

Calderdale & Huddersfield NHS Trust

Appendix 3

National Reference Panel


Janis Stout Senior workforce advisorchange for children

Care Services ImprovementPartnership

Sue Hobbins Officer for workforce planning Royal College of Paediatricsand Child Health

Catherine Powell Nurse advisor for children &young people

Department for Education &Skills

Caroline Simpson Professional advisor onmaternity

Department of Health

Fiona Smith RCN lead for children Royal College of Nursing

Robert Standfield Lead workforce designer National PractitionerProgramme

Frances Evesham Director of children’s services Skills for Health

Belle Connell Workforce designer & ECPlead

Skills for Health

Charlotte Croffie Regional skills & capacityadvisor (London)

Local Government Association

Hilary Samson-Barry Head child health & maternitybranch (Policy)

Department of Health

Gail Adams Lead – nursing UNISON

Nick Clarke Head of health & social careregulation

Workforce directorateDepartment of Health

Richard Leigh Project manager rapid roll outschool nurse

Cumbria & LancashireStrategic Health Authority

Simon Lenton Vice president (health services) Royal College of Paediatricsand Child Health

Martin McColgan Workforce information officer Royal College of Paediatricsand Child Health

Ian Pritchard Programme lead Large scale workforce changeteam

Jon Richards Senior national officer UNISON

Michelle Singleton UNISON

Jane Scott Royal College of Anaesthetists

Appendix 4

Acronyms explained

Page 51

APNP Advanced paediatric nurse practitioner

CAF Common Assessment Framework

CAMHS Child and adolescent mental health service

CCA Childcare assistant

CCN Community children’s nurse

CNN Certified nephrology nurse

CYP Children and young people

DNA Did not attend

ECM Every Child Matters

LOS Length of stay

NSF National Service Framework

PENP Paediatric emergency nurse practitioner

R&R Recruitment and retention

RCA Royal College of Anaesthetists

RCN Royal College of Nursing

RCPA Royal College of Paediatrics and Child Health

SALT Speech and language therapy

WTE Whole time equivalent

YOS Youth offending service


Appendix 5

AcknowledgementsThe large scale workforce change team would like to thank all theparticipating teams for all their enthusiasm, tenacity and hard workthroughout the programme.

We would also like to thank all parents, children and volunteers for theirsupport of the teams throughout the programme.

Thanks to Janis Stout and other members of the reference panel for theirsupport and enthusiasm.

Finally, thanks to all the presenters who took time out of their schedules toassist the programme.

Contact uswww.nhsemployers.orgEmail [email protected]

NHS Employers29 Bressenden Place 2 Brewery WharfLondon Kendell StreetSW1E 5DD Leeds LS10 1JR

This document is available in pdf format at www.nhsemployers.org/publications© NHS Employers 2006

NHS EmployersNHS Employers is the employers’ organisation for the NHS in England. Our aim is to help employers improve the working lives of staff who work in the NHS and,through them, to provide better care for patients. NHS Employers is part of theNHS Confederation but we have our own director, policy board and assembly. In striving to make the NHS an employer of excellence, we have four key roles:

• negotiating on behalf of employers

• representing employers

• supporting employers

• promoting the NHS as an employer.

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