Opportunities for Safeguarding Children in the New NHS Presentation workshop for London safeguarding Children Board Conference Briony Ladbury Senior Strategic safeguarding Children Advisor NHS LONDON December 2011 Where do the opportunities spring from? вЂў NHS Reforms вЂў Munro Review of Child Protection вЂў Nosgrove Review (of Children in the family Justice System) вЂў Ofsted Review вЂў Big Society Proposed NHS Reforms Funding Accountability Public Health England Parliament Department of Health NHS Commissioning Board/s Local bodies & senates Monitor Economic Regulator Integration Patients interests Competition safeguards Care Quality Commission licencing Local Authorities Local HWB Boards partnership JSNAвЂ™s Public Health Clinical Commissioning Groups contract (Any Willing/Qualified) Provider & Networks Accountability for results Local Health Watch Patients and Public вЂ“ (adults and children) NHS Structure post reforms Main Changes вЂў вЂў вЂў вЂў вЂў вЂў Directly funded Public Health Service Public Health situated in Local Authority National Commissioning Board вЂ“ senates Clinical Commissioning Groups вЂ“ members & networks Health and Wellbeing Boards Healthwatch Much yet to be clarified NHS Reforms Statement вЂў NHS Overall Accountability вЂ“ NHS Commissioning Board and Clinical Commissioning Groups to: вЂў вЂў вЂў вЂў Promote the NHS constitution Core principles and values 18 week waits Duty to promote a comprehensive health service Principle & opportunity вЂў Clinical advice and leadership вЂ“ GP consortia will become Clinical Commissioning Groups вЂ“ Demostrate LA alignment вЂ“ Governing Bodies must have a nurse and specialist doctor as members вЂ“ Commissioners supported by clinical networks and clinical senates вЂ“ Informed by health and social care professionals in discussion with patients, carers, voluntary sector and other partners Principle & opportunity вЂў Choice and competition вЂ“ вЂ“ вЂ“ вЂ“ Promote patient choice Level playing field Best providers (public, private and voluntary sector) вЂ�MonitorвЂ™ to protect and promote interests of patients (not competition вЂ“ Safeguards against cherry picking and privatisation вЂ“ Commissioners and вЂ�MonitorвЂ™ have duty to promote integration вЂў Personal health budgets вЂў Joint health and social care budgets вЂ“ Promote innovative integrated care Principle & Opportunity вЂў Developing the workforce вЂ“ Robust safe transition for training and education вЂ“ Deaneries to oversee training of junior Drs and Dentists вЂ“ Leadership and management training вЂ“ Protected education and training funds вЂў Fairly distributed вЂў Transparent process Timetable for Change вЂ“ Clinical commissioning groups established April 2013 вЂ“ CCGs take control when вЂ�ready and willingвЂ™ вЂў Aligned to LA boundaries вЂ“ Clustered into вЂ�federationsвЂ™ вЂ“ Monitor have powers to 2016 to maintain standards of governance. вЂў вЂў вЂў вЂў вЂў вЂў вЂў вЂў SHAs Clustered from October 3rd 2011 (No change for London) Oct 2011 вЂ“ NHS Commissioning Board Established April 2012 вЂ“ Choice of Any Qualified Provider extended Oct 2012 вЂ“ NHS Commissioning Board established & independent (limited functions) Oct 2012 вЂ“ Monitor takes on regulatory functions Oct 2012 вЂ“ HealthWatch England & local HealthWatch established April 2013вЂ“ SHAвЂ™s & PCTs abolished (NHS Commissioning Board takes over) Public Health England established, CCGs fully established (expected to be вЂ�ready and willingвЂ™) April 2014 вЂ“ Trusts are Foundation Trusts (any outstanding get new management) Public Health вЂў Public Health England will fund services by: вЂ“ Commissioning & providing services from itself, i.e vaccines, campaigns, health protection вЂ“ Asking the NHS Commissioning Board to commission services i.e screening вЂ“ elements of GP contract вЂ“ Granting a ring fenced budget to local government вЂ“ 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 VISITOR PROGRAMME ? Spheres of influence Funding Accountability Parliament Department of Health Public Health England NHS Commissioning Board Monitor Local offices & senates Local Authorities HWB Boards JSNAвЂ™s Care Quality Commission licencing Local partnership Clinical Commissioning Groups contract (Any Qualified) Provider supported вЂ�clinicalвЂ™ networks LSCB Local Health Watch Accountability for results Patients and Public вЂ“ (adults and children) Reforms - NHS London Where are we now in London? вЂў Transition? PCT Clustering TCS and vertical integration FT pipeline Performance вЂў Commissioning Commissioning support Clinical Commissioning Groups / Federations? & authorisation вЂў Clinical [Safeguarding] Networking Designated Professionals, Named Nurses Acute, Named Nurses Community Named Midwives вЂў Health Visitor Project Munro 4 themes 1. A system that values professional expertise MUNRO REVIEW Less beurocracy вЂ“ remove assessment timescales etc Improve quality of assessment and services вЂ“ locally determined Rewrite Working Together Remove constraints to local innovation (national - forms, KPIs, IT systems) Involving health in Joint unannounced Inspection Process Data set agreed 2. PRACTICAL APPLICATION IN NHS Less practice guidance вЂ“ local interpretation More [health] professional discretion in assessments and care planning вЂ“ 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 Sharing responsibility for the provision of early help MUNRO REVIEW Impact of NHS Reforms Shared understanding of NHS roles & responsibilities Retention of professional expertise Relationship of LSCB & HWB Board CCG development NHS (CQC) inspection Coordinated effective early help assessment processes and services (JSNA) PRACTICAL APPLICATION IN NHS Health Visitor Programme, MASH Projects School Nurse Development Family Nurse Partnerships Integrated Early Help Teams Working in the community and other partners вЂ“ Vol Sector & Social Care Peer Review and audit Sharing good practice Munro 4 themes 3. Developing [Social Work] Expertise and Supporting Practice MUNRO REVIEW NOT NHS SPECIFIC BUT SHOULD ALSO BE REFLECTED BY NHS High quality practice placements Professional capability framework CPD framework & performance appraisal Career pathways Leadership Recognition of specialism PRACTICAL APPLICATION IN NHS Good NHS initial training in HEIs Good post graduate вЂ“ in-service training Appraisals to reflect safeguarding competency performance and training needs Developing a career pathway вЂ“ succession planning Leadership Courses 4. Clarifying accountabilities and creating a learning system. MUNRO REVIEW PRACTICAL APPLICATION IN NHS NOT NHS SPECIFIC BUT SHOULD ALSO BE REFLECTED BY NHS Training for health staff on systems approaches including RCA LSCB annual reports to CE & Leader of Council, Police & Crime Commissioner, Chair of HWB LSCBs to monitor effectiveness of CHILDRENS services and senior managers Researching options for using a systems methodology for SCRs NPSA assisting development with methodology and accountability Ensuring lessons are learned and applying performance management to ensure improvement Ofsted Review вЂў Unannounced inspections вЂў Ofsted and CQC combined вЂ“ no longer parallel processes вЂў Pilots already underway вЂў Will review 50 not 20 cases вЂ“ thoroughly!!!!! вЂў Map the childвЂ™s journey and experience of services вЂў Includes practice observation in the field вЂў 4 judgment areas вЂ“ Effectiveness of service вЂ“ Effectiveness of interventions (including early help) вЂ“ Quality of practice вЂў Effectiveness of leadership and governance вЂў Regular peer review and audit will help you to prepare! Nosgrove Review вЂў Review of children in family justice system вЂў Quicker timescales вЂў Less delays (expert witnesses) вЂў More emphasis on childвЂ™s wishes and feelings вЂў More reliance on good Social Work assessment вЂў Health Professionals able to be more involved in providing Social care colleagues with health aspects of assessment вЂў Multi-agency training Big Society & localism вЂў Fits public health agenda well вЂў Working with communities вЂ“ Meets needs of the most vulnerable вЂ“ Enables community participation вЂ“ ChildrenвЂ™s voice heard in design and evaluation вЂў Health Visitor Programme Strands вЂ“ вЂ“ вЂ“ вЂ“ Community Universal Universal Plus Universal Partnership Plus вЂў Enables other skilled professionals to support community health system eg ChildrenвЂ™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 вЂў What do YOU have to do as a childrenвЂ™s safeguarding professional (in any professional context) to ensure that the new NHS grasps the opportunities and improves safeguarding children services ?