NHS Cornwall & Isles of Scilly Health Visitor Workforce - March 2010

PCT/Provider / Response
Number of WTE Health visitors* / 78.54 wte health visitors registered on Part 3 of Nursing & Midwifery Council Register (SCPHN). This includes 67.74 wte with HV caseloads (Bands 6 and 7) plus 10.8 wte specialist role hours.
6.05wte Family Health Practitioner Learners placed in band 6 vacancies but being paid at Band 5 with caseloads according to competences during training – who will be qualifying as Band 6 caseload holders.
Plus 1.2 SCPHN HV students that will qualify in Sept 2010 who will apply for vacancies.
Number of headcount Health visitors / 86 with HV caseloads- other qualified HVs with specialist roles that do not hold caseloads
Plus 7 costed at Band 6 completing the Band 5 development pathway and holding caseloads as achieve competences
Number of Health visitors with full time case load / 44 with full time hours of which 18 are Band 7 and 26 band 6.
56 Health visitors who are part-time and job share full time caseloads.
Description of caseload allocation method / Named Health Visitor for each GP practice –cases allocated according to hours and caseload size. Skill mix is also included in allocation of caseload. Emphasis is upon active caseload – focus on 0-2 years and targeted 2- school entry according to need
In Cornwall the caseload in the teams is initially allocated using the following calculation: the total team caseload number ie children under 5 years, divided by the number of days available in the team. Each team leader is responsible for benchmarking that each Band 6 SCPHN has at the most 70 children per day –therefore a full time caseload is in the region of 350 children. It is recognised however that this does not take into account the need of the caseload. We therefore take into account the team Safeguarding numbers and Children In Care to assist the staff allocation per team and the level of skill mix support available as well as Children Centre provision. We are keen to emphasise that caseload numbers should be active caseload and have recently started an exercise with our commissioners to focus on the 0-2 caseload with targeted interventions to those families with children aged 2 years to school entry with needs. It is recognised that many 2-5 year olds do not require the intervention of the Health Visitor, yet these numbers are historically counted which gives a false impression of work load. A family needs profile is currently being undertaken to look at levels of need across caseloads and in geographical patches to ensure appropriate capacity & banding.
Range of Caseload / The HV caseload is predominantly 0-2 years however in families with an identified need provision will continue as required until school entry.
The caseload is universal incorporating universal needs through vulnerable, complex & acute. HV’s have a named nurse role for looked after children and are engaged in child protection plan work.
Number of Health visitors with specialist roles and reduced caseload / All Band 7:
2.4 wte Safeguarding Supervisors (6 posts)
1.6 wte CPT (6 posts)
0.6 wte Infant Feeding Co-ordinator
0.6 Hospital Liaison HV
Number of Health visitors with specialist roles and no caseload / 2 ie 0.4 Safeguarding Supervisor and the combined role of 0.4 Safeguarding Supervisor and 0.6 Hospital Liaison
Number of Health visitors with leadership/management roles and caseload / 4.6 wte Team Leaders (7 posts)
Number of Health visitors with leadership/management roles and no caseload / 3 wte ie 2wte are Team Leaders full time
1wte is 0.4 Safeguarding Supervisor and 0.6 Team Leader
Workforce Information request / PCT response
Do you have access to a workforce plan or strategy for the health visitor workforce? / Yes –this has been submitted to Claire Chivers and Christine Whitehead (attached).
A workforce caseload grid has been developed and a caseload profiling exercise being undertaken this month.Both pieces of work will inform the future model of Health Visiting and subsequent workforce strategy.
Owing to significant vacancies in the past a local programme of training has been developed - the Band 5 development pathway. Up on qualification these practitioners will be called Family Health Practitioners and paid at level 6. Discussions are underway for this training to be recognised to enable successful graduates to be registered on part 3.
Is this part of the response to the Healthy Child Programme? / Yes but also in regard to workforce development in response to recruitment issues and solutions
Has this shown a need for an increase in health visitors? / As identified in Box1 a comprehensive mapping/need exercise is currently underway to identify any capacity requirements.
Is funding available for these posts? / Requirements are unknown until needs exercise completed.
Have you reviewed the workforce demand for safeguarding? / Yes.
What were the outcomes of the review? / The need to increase and redesign the current supervisor structure to 3 wte
If it showed an increase in health visitors is required, is funding available for these posts? / No this is to be provided from the existing investment at present. The 6 part time posts in existence are tightly managed in regard to their supervision remit and not used to develop a ‘wider ‘ safeguarding role.
If you do have access to a workforce plan, does it include use of a wider workforce to deliver services? / The workforce plan is focused on Health Visiting and School Nursing, developing the Cornwall and IOS model to ensure a rolling programme produces competent Band 6 roles and a career continuum for the whole HVSN workforce.
If so, can you provide brief details? / Our Workforce Plan incorporates the Band 5 development pathway to Band 6. Our first learners will be completing in July ready to take up ‘ Health Visitor’ posts but called Family Health Practitioners (See below)
Any additional comments about demand or supply issues, for example have you had any difficulty in recruiting to health visitor posts? / Well documented recruitment issues as nationally-probably compounded by the fact we are a Peninsula and relocation in regard to house prices and jobs for spouses.
18 months ago we had accumulated 9 vacancies which we were unable to fill after national adverts. This resulted in the development of the Family Health and School Health Practitioners. We are supported by the SHA, DH, Skills for Health and PCT and will be going to meet the NMC again on the 24th March 2010 in the hope of influencing the revalidation of the SCPHN training.
Difficulties will be encountered if the DH and Govt strategy continues to only head count SCPHN Health Visitors and not equivalent competent staff such as Family Health and School Health Practitioners
Trainee Places / PCT response
Demand for trainee health visitor places from September 2010 / We currently are pursuing the Band 5 development pathway but await news from the SHA in the allocation of funding when other Trusts will be given backfill for SCPHN students.
We do require our equivalent contribution to maintain the Band 5 pathway as in previous years.
NHS CIoS propose the NHS SHA invest the equivalent so, match fund the costs of 4 full time courses with backfill to support the sustainable programme of development in Cornwall.

Detail: Family Health Practitioners

Band 5 learners with a nursing background who are not SCPHN but developing competences and caseloads and placed in HV Band 6 vacancies

Information has been submitted to PlymouthUniversity in regard to commissioning modules for the Band 5 development pathway. We are not commissioning the traditional SCPHN course as it does not meet service requirements. We cannot provide backfill for SCPHN students without freezing vacancies and this will increase risk in our teams.

Cornwall and the IOS Community Health Services will continue with SHA support the Band 5 development pathway. We require funding allocation equal to other Trusts (as in year 2009/10).

We are meeting with the NMC on the 24th March with the SHA and DH to progress talks in regards the 3 rd part of the SCPHN register. 2 areas of contention are 1) Supernumary status of students 2) CPT Band 7’s only able to have 1 full time student SCPHN according to the NMC. Both points are not realistic in today’s financial climate and have to be more realistic to meet the workforce pressures of service.

Conclusion

Although early into the pathways inception, the concept is proving to be making a difference to the Children’s workforce. NHS CIoS wish to continue embedding this flexible and localised mode of education delivery across the workforce. The remodelling of the service will continue with an emphasis of developing band 3s, 4s, and a continuum of competency development across the bands. NHS CIoS propose the NHS SHA invest the equivalent so, match fund the costs of 4 full time courses with backfill to support the sustainable programme of development in Cornwall.

As previously mentioned Rebecca Ryder Education and Development Lead and Anne Hall Lead Health Visitor and School Nurse have already developed a solution to our workforce issues and are continuing to work to progress our model further with the SHA,DH and NMC.

Please see Workforce Plans attached.

Kirsty Edlin, Senior Commissioning Manager.