Community Services benchmarking Deep dive report for Health Visiting
NHS Benchmarking Network June 2020
Raising standards through sharing excellence Community Services benchmarking - Deep dive report for Health Visiting
© NHS Benchmarking Network (NHSBN)
Citation for this document: NHS Benchmarking Network Deep dive report for Health Visiting. June 2020
Raising standards through sharing excellence Community Services benchmarking - Deep dive report for Health Visiting
Contents
Section 1: Introduction Content of this report Page 4 Executive summary Health Visiting Page 5
Section 2: National policy context Community Services Page 6 Health Visiting Page 10
Section 3: Key Findings - Health Visiting Service model Page 12 Access Page 14 Activity Page 14 Workforce Page 18 Finance Page 21 Quality and outcomes Page 24
Section 4: References Page 25
Appendix 1: The Community Services benchmarking project Page 26
3 Community Services benchmarking - Deep dive report for Health Visiting Section 1: Introduction Content of this report
When reviewing this document, please note:
the 2019 Community Services project collected and analysed data for the NHS financial year 2018/19. The “2018 project” refers to 2017/18 data any reference to the “national average” within this document refers to the mean average of 2019 project participants all charts and data in this report refer to the overall UK position. Peer group profiling is available in the online toolkit on bar charts, each blue bar represents an individual service. The orange horizontal line represents the mean average value of all services this report is an overview national report and therefore the charts in this report do not show the position of any one organisation in particular. Member organisations who participated in the Community Services project can check their individual positions in the online toolkit, which is issued to members once the dataset has been finalised. This allows individual comparison of every metric collected against the sample position.
NHSBN Community Services 2019 - Health Visiting
14,791 731 338
Face to face contacts per Face to face contacts First visits per 100,000 100,000 population per clinical WTE in post registered population
319 23 55%
Percentage of visits Unique service users Clinical WTE per carried out within 28 per clinical WTE in post 100,000 population weeks pregnant 2.5 42 3,263 mins
Face to face contacts per Average length of a Referrals received per service user contact 100,000 population
4 Section 1: Introduction Community Services benchmarking - Deep dive report for Health Visiting
Executive summary Health Visiting
Health Visiting is high on the national agenda with Department of Health and Social Care welcoming plans to update the Healthy Child Programme due to the importance of early intervention in healthcare. (Institute of Health Visiting - Health Visiting in England: A Vision for the Future)
The Healthy Child Programme includes five mandated visits to monitor and address any needs of the child. In 2019, the percentage of visits delivered in the timeframe increased for the majority of visits. Second visits (14 days after birth) had the highest proportion of visits carried out within the agreed time period increasing from 86% in 2018 to 91% in 2019.
First visits (28 weeks) were least likely to be provided on time suggesting meeting this target is providing a challenge for services with just over half (55%) being delivered within the agreed timeframe. This was a reduction on 2018 in which 62% of first visits were delivered in the time frame.
Percentage of visits completed Service users, on average, within the time period received 2.5 face to face contacts
Fifth visit from a health visitor. This is in line (2.5 years) with the five mandated visits which Fourth visit (12 months) take place over a period of nearly Third visit three years. (8 weeks) Second visit (14 days after birth) As well as the five mandated visits, First visit services also provide several high (28 weeks) impact programmes to help infant
0% and families outcomes. 97% of 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% services offer breast/ infant feeding 2018 2019 and 94% offer Maternal Mental Health.
Health Visitors are a highly skilled workforce with Band 6 staff making up the majority of the skill mix (59%) in 2019.
The NHS Long Term Plan mentions the importance of mothers and infants receiving seamless care including when moving from maternity to other services such as Health Visiting. Although this is hard to measure, the average number of complaints being only 2 per 100,000 registered population suggested there is a high quality service in Health Visiting.
Section 1: Introduction 5 Community Services benchmarking - Deep dive report for Health Visiting National policy context Community Services
England
The NHS Long Term Plan, published in January 2019, highlights the importance of community services in supporting service users in the community and reducing unnecessary hospital admissions. The Long Term Plan sets out to:
boost ‘out-of-hospital’ care, and dissolve the historic divide between primary and community health services increase investment in primary medical and community health services, which will equate to an extra £4.5 billion a year by 2023/24. Extra money will start to flow to community via Sustainability and Transformation Partnership (STP)/ Integrated Care Systems (ICS) and Primary Care Networks (PCN) via Directed Enhanced Service (DES) contracts in 2020/21. The Long Term Plan Implementation Framework outlines funding allocations, with funding for Primary Care flowing more quickly than funding for Community Services increase the capacity and responsiveness of community and intermediate care services via a new offer of urgent community response and recovery support. These services will aim to prevent unnecessary admissions to hospitals and residential care, as well as ensure a timely transfer from hospital to community expand community multidisciplinary teams aligned with new Primary Care Networks based on neighbouring GP practices. Expanded neighbourhood teams will comprise a range of staff such as GPs, Pharmacists, District Nurses, Community Geriatricians, Dementia workers and AHPs.
Does your organisation operate with any Primary Care Networks (PCNs)?
Yes 69% 31% No
0% 20% 40% 60% 80% 100%
6 Section 2: National Policy Context Community Services benchmarking - Deep dive report for Health Visiting
Although the focus of community services within the NHS Long Term Plan is on adult services, wider children’s services and providing a strong start in life for children and young people is also highlighted in the plan. The Long Term Plan sets out to:
bring together the NHS, Local Authorities and other local partners through local maternity systems, with the aim of ensuring women and their families receive seamless care, including when moving between maternity or neonatal services or to other services such as primary care or Health Visiting expand and invest in mental health services for children and young people design and implement models of care that are age appropriate, closer to home and bring together physical and mental health services. These models will support health development by providing holistic care across Local Authority and NHS services, including primary care, community services, speech and language therapy, school nursing, oral health, acute and specialised services roll out clinical networks to ensure improvement in the quality of care for children with long-term conditions such as asthma, epilepsy and diabetes.
Wales
Community services strategy in Wales is contained within the document A Healthier Wales: Our Plan for Health and Social Care and sets a clear ambition to bring health and social care services together for the benefit of service users. This is not a new vision, but is supported by clear expectations, milestones and design principles to establish new models of care in every part of Wales.
The overall aim is to provide services that are designed and delivered around the needs and preferences of individuals, with greater emphasis on sustaining a healthy population and preventing ill health. To achieve this ambition, Wales must continue to break down the barriers that prevent health and social care services and their wider partners from operating across the whole system, delivering seamless care to the people of Wales.
Good planning arrangements are critical to bring together multiple providers and allow the system to be pre-emptive and anticipatory, ensuring that the right level of care is provided at the right time, from the right source and in the right setting.
Section 2: National Policy Context 7 Community Services benchmarking - Deep dive report for Health Visiting
A Healthier Wales outlines the following strategies, all of which relate to the provision of community services:
services which support people to stay well, not just treat them when they become ill when people need help, health and social care services will work with them and their loved ones to find out what is best for them and agree how to make those things happen. This is the basis of the ‘person-centred approach’ more services will be provided outside of hospitals, closer to home, or at home, and people will only go into hospital for treatment that cannot be provided safely anywhere else. This ‘community- based approach’ will help take pressure off the Welsh hospitals, reduce the time people have to wait to be treated, and the time they spend in hospital when they have to go there health and social care services will use the latest technology and medicines to help people get better, or to live the best life possible if they aren’t able to get better.
Northern Ireland
Northern Ireland have a strategy which, in tandem with the modernisation of acute hospitals, seeks to expand the range of services that can be delivered in the community and is described in A Healthier Future. This encompasses the following:
the key aim is to support an increasing number of people to live independent lives, preferably in their own homes to do this, the Health and Social Care Board and the Public Health Agency in Northern Ireland need to develop effective alternatives to hospital care, which are designed to reduce inappropriate admissions and unnecessary lengths of stay there also needs to be a strong focus on rehabilitation in tandem with assessment of long term care needs to avoid unnecessary reliance on residential and nursing home care.
To deliver on this vision, the following strategies are being pursued in relation to community services provision in Northern Ireland:
secure an appropriate balance between hospital and community based services within local health economies continue the expansion and evaluation of intermediate care as a way of working that is designed to prevent unnecessary hospital admission, promote faster recovery from illness, support timely discharge, maximise independent living and improve the quality of assessment of long-term health and social care needs
8 Section 2: National Policy Context Community Services benchmarking - Deep dive report for Health Visiting
in co-operation with the independent sector, expand the use of supported living, domiciliary care, day care and assistive technologies as alternatives to residential accommodation, focusing on rehabilitation and independent living develop a range of housing and care options for different levels of support, offering a continuum of care as people’s needs change contribute to the development of a region-wide single assessment process, focused upon the person and designed to streamline and improve decision making about long-term health and social care needs and simplify access to services expand the range of flexible and responsive respite and support services for carers increase the take up of Direct Payments engage actively with users and the voluntary and community sector in the design and delivery of services.
Scotland
The newly created Public Health Scotland’s strategy around community services is embodied in A Fairer Healthier Scotland 2017-22. There are five strategic priorities that have been developed in partnership with stakeholders, including providers of community services. These are as follows:
Fairer and healthier policy - ensure that knowledge and evidence is used by policy and decision makers. This is so that strategies focus on fairness and influence the social determinants of health and wellbeing. Children, young people and families - ensure the knowledge and evidence provided is used to implement strategies focused on improving the health and wellbeing of children, young people and families. A fair and inclusive economy - providing knowledge and evidence on socio-economic factors and their impact on health inequalities. This is to contribute to more informed and evidence-based social and economic policy reform. Healthy and sustainable places - ensure the knowledge and evidence provided is used to improve the quality and sustainability of places. This will increase their positive effect on health and wellbeing. Transforming public services - working in partnership with and support public sector organisations to design and deliver services that have fairer health improvement and the protection of human rights at their core.
Section 2: National Policy Context 9 Community Services benchmarking - Deep dive report for Health Visiting
Health Visiting
Health Visitors are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness. They are registered nurses/midwives who have additional training in community public health nursing. They work with families to give pre-school-age children the best possible start in life. Health Visitors work mainly with children from birth to five years and their families. They also work with at-risk or deprived groups such as the homeless, addicts or travellers. Health Visitors have a crucial role in making sure that children and young people have the best start in life. In partnership with parents, Health Visitors assess: What is the age group served by parenting skills this service? the family and home situation 0% the development needs of young children. 0% 0% All Health Visiting Services provide Universal Service 17.1% Provision which include the five mandated visits (28 weeks pregnant, 14 days after birth, 17.1% 8 weeks after birth, 12 months 65.7% and 2.5 years) to examine development and needs in young children.
Health Visitors offer and agree with parents any further support Adults - aged 18+ Children - aged 0-19 that may be needed, and arrange to meet with them in their own Children - aged 0-18 All ages - no restriction home, clinic or community Children - aged 5-19 Other setting. Health Visitors work together with a range of different health care professionals including community nursing staff, school nurses, nursery nurses, GPs, social workers and allied health professionals.
Local Authorities, in addition to their wider responsibilities, have also become responsible for commissioning and funding preventative health services, including Health Visiting services. However, the Long Term Plan states that as these services are funded directly by central government from the public health grant, and funding and availability of these services directly affects demand for NHS services, the Government and the NHS will consider whether there is a stronger role for the NHS
10 Section 2: National Policy Context Community Services benchmarking - Deep dive report for Health Visiting
in commissioning Health Visiting services (and other services), and what might therefore be best future commissioning arrangements.
Health Visiting services are well placed to provide an important part of the solution to key governmental priorities. These include, but are not limited to, reducing pressures on GPs, paediatricians and A&E, mental health and safeguarding services, and improving immunisation rates.
Are the following provisions provided?
UPP 97% 3%
UPPP 100%
Other 55% 45%
0% 20% 40% 60% 80% 100%
UPP = Universal Plus Provision Yes No UPPP = Universal Partnership Plus Provision
Health Visitors lead the delivery of the Healthy Child Programme (a universal prevention, health promotion and early intervention programme available to all families), and are a highly skilled workforce who are equipped to work in partnership with parents and communities to address a multitude of key government priorities for children and their families. The Department of Health and Social Care has recently announced plans to update the Healthy Child Programme and the 4,5,6 Health Visiting model for England (4 levels of service, 5 health reviews and 6 high impact areas, delivered in conjunction with School Nursing services).
The NHS Long Term Plan for England offers a commitment to redesign services for children and young people, through the creation of a Children and Young People’s Transformation programme, concentrating on delivering improvements in key health outcomes, including infant mortality, breastfeeding, obesity and uptake of childhood immunisations.
Section 2: National Policy Context 11 Community Services benchmarking - Deep dive report for Health Visiting
Key findings Health Visiting - service model
Health Visiting services are generally responsible for supporting children from birth to five years and their families, providing antenatal and postnatal support including assessing growth and development needs. (Royal College of Nursing) Health Visiting Services all provide Universal Service Provision which include the five mandated visits (28 weeks pregnant, 14 days after birth, 8 weeks after birth, 12 months and 2.5 years) to examine development and needs in young children. In addition to Universal Provision, 100% of organisations also provide Universal Partnership Plus Provision, in which Health Visitors provide ongoing support and bring together relevant services to help families with continuing complex needs. 97.1% of organisations providing Universal Plus Provision which allows families to access expert advice from a Health Visitor when they need it on specific issues such as postnatal depression. Some Health Visiting services provide high impact programmes which can be seen below:
Does your Health Visiting Service provide any of the high impact programmes?
Breastfeeding/ 97% 3% Infant feeding
Maternal Mental 91% 9% Health
Healthy 2 year olds & 80% 20% school readiness Yes
Managing minor illness 71% 29% No & accident prevention
Healthy weight 71% 29%
Transition to 69% 31% parenthood
Other 35% 65%
0% 20% 40% 60% 80% 100% 12 Section 3: Key Findings - Health Visiting Community Services benchmarking - Deep dive report for Health Visiting
Health Visiting services are most likely to occur in service user’s own homes and in clinics and health centres with 100% of participating organisations providing the service in these locations. 94% of services are located within children’s centres and 78% in community facilities whereas only 3% of services are located in day hospitals out of the organisations who participated in the project, only 19% provide an in-reach service into acute services. 9% of the services are managerially and functionally integrated with acute services, which can be seen below 17% of organisations reported that there are no age restrictions on the services whereas 17% only provide the service for children aged 0-19. The majority of services involved in projects fall into the ‘other’ category (66%) for the age group which is served by the service.
Does your Health Visiting Service have links with acute services?
Does this service provide in-reach into the acute 19% 81% services? Is this service managerially and functionally integrated 9% 91% with acute services?
0% 20% 40% 60% 80% 100%
Yes No
As discussed on the previous page, as well as the five mandated visits, Health Visitors often run different high impact programmes. The high impact areas are where Health Visitors have the greatest impact on child and family health and well being. They also allow for Health Visitors to work in partnership with other services.
The most common programmes run by the services who took part in the project were Breastfeeding/infant feeding (97%) and Maternal mental health (91%).
Section 3: Key Findings - Health Visiting 13 Community Services benchmarking - Deep dive report for Health Visiting
Health Visiting - Access
DNA rate (%) 18% DNAs are known to cost the NHS a significant amount of 16% money. Keeping a low DNA 14% rate is an aim for many services 12% across all NHS organisations. 10% The chart to the left shows the 8% DNA rate for the Health Visiting 6% services who participated in the 4% project. The blue bars represent the individual service with the 2% orange bar showing the mean 0% average.
The mean average DNA rate for participants in 2019 was 7.3% which was similar to the mean average in 2018 (7.2%). Health Visiting - Activity
Total referrals received per 100,000 population The total number of referrals 9,000 shows the demand for Health 8,000 Visiting services. The mean 7,000 average for total referrals received per 100,000 population 6,000 in 2019 was 3,263. 5,000 The referral values range from 4,000 1,700 to 7,811 per annum. 3,000 2,000 Referrals have increased from 1,000 2,769 in 2018 which suggests demand for Health Visiting 0 services is increasing. Even though the national birth rate is dropping, demand for Health Visiting services is rising almost certainly because of the rise in austerity.
14 Section 3: Key Findings - Health Visiting Community Services benchmarking - Deep dive report for Health Visiting
Health Visiting - Activity
Face to face contacts per 100,000 registered population 30,000 Health Visitors, on average spend 45% of their time facing 25,000 patients. The mean number of face to face contacts per 20,000 100,000 registered population reported in 2019 was 14,790. 15,000 This compares with 13,232 face to face contacts reported 10,000 in 2018.
5,000 In 2018/19, there were 2.5 face to face contacts per service 0 user.
As well as face to face contacts, Health Visitors offer 3,583 non-face to face contacts, on average, per 100,000 registered population. The average length of contact for Health Visitors is 42 minutes.
Number of first visits per 100,000 registered population 800
700 Mean average 600
500 First visits 338
400 Second visits 970 959 300 Third visits Fourth visits 911 200 Fifth visits 908 100
0
The chart above shows the number of first visits that took place per 100,000 registered population in 2019. The table summarises the average number of visits that took place per 100,000 registered population, for all five mandated visits.
Section 3: Key Findings - Health Visiting 15 Community Services benchmarking - Deep dive report for Health Visiting
Health Visiting - Activity
Percentage of visits completed within the time period
First visit Second visit Third visit Fourth visit Fifth visit Year (28 weeks) (14 days) (8 weeks) (12 months) (2.5 years)
2019 55% 91% 87% 76% 78%
2018 62% 86% 84% 79% 78%
Health Visiting services are commissioned to deliver five mandated visits. Metrics measuring compliance with delivering these five mandated visits within agreed timeframes were first introduced into the project in 2017. The above compares the percentage of visits completed in 2019 and 2018 project.
The highest proportion of visits carried out within the agreed time period was for second visits, with 91% of visits carried out by 14 days post birth. Carrying out first visits within the agreed timeframe is proving a challenge for some services with only 55% of visits being delivered at 28 weeks pregnant.
Unique service users per 100,000 population 16,000 The number of unique 14,000 service users per 100,000 registered population gives 12,000 an indication of caseload.
10,000 The mean average for 8,000 unique service users per 6,000 100,000 population is 6,108.
4,000 On average, there are 2,000 279 unique service users per clinical WTE in 0 establishment.
16 Section 3: Key Findings - Health Visiting Community Services benchmarking - Deep dive report for Health Visiting
Health Visiting - Activity
Average caseload per clinical WTE in establishment The average caseload allows 1,200 us to see the demand on the services, by seeing how many 1,000 service users are actively being seen by clinical staff. The mean 800 average is a caseload of 472 per clinical WTE in establishment. 600 Most community services will 400 have a higher figure for unique service users per clinical WTE 200 than for caseload per clinical WTE. Health visiting, however, 0 is different due to the nature of their caseloads (for example, children who are older than 1 year but younger than 2.5 years will still be counted on a Health Visitor caseload, but may not be actively seen if they do not require intervention beyond the 5 mandated contacts).
The average time a unique service user spends on the caseload is 1,156 days.
Section 3: Key Findings - Health Visiting 17 Community Services benchmarking - Deep dive report for Health Visiting
Health Visiting - Workforce
Clinical staff skill mix
The pie charts show the skill mix for Health Visiting 10% over the last three years. 18%
The proportion of Band 7 staff has reduced from 16% 9% in 2017 to 10% in 2019. This coincides with the slight 2019 increase in Band 5 staff from 5% in 2017 to 9% in 2019. Band 6 staff make up the highest proportion 59% of the Health Visiting workforce, making up 59% in 2019.
2017 2018 2019
Band 2 2.1 1.6 0.4 14% 17% Band 3 4.0 2.6 2.8 Band 4 13.9 17.3 17.5 2018 7% Band 5 5.3 6.6 8.7 Band 6 57.6 56.9 59.1 Band 7 15.6 14.0 10.5 57% Band 8 1.4 1.0 0.9 Band 8b/c/d & 9 0.1 0.05 0.03
16% Band 2 Band 3 Band 4 14% Band 5 Band 6 Band 7 5% 2017 Band 8a Band 8b / 8c / 8d / 9
58%
18 Section 3: Key Findings - Health Visiting Community Services benchmarking - Deep dive report for Health Visiting
Health Visiting - Workforce
Clinical WTE in establishment per 100,000 registered population 50 Mean 45 average 40 2019 23 35 2018 22 30 2017 27 25 2016 25 20 2015 28 15 2014 26 10 2013 25 5 0
The chart shows the number of Clinical WTE in establishment per 100,000 registered population. From the services who took part in the project, on average, there are 23 clinical WTE. To the right of the chart, the table demonstrates the mean average of clinical WTE per 100,000 registered population across the years the project has run.
Clinical staff vacancy rate 16% Vacancies are an issue across the 14% NHS with staff shortages having an effect on the way services are 12% run. As a result, Health Visitors potentially carry larger caseloads 10% than normal, or do not offer 8% mandated visits in line with the required schedule (see page 16 6% illustrating the percentage of visits achieved within the required time 4% period), as well as increasing 2% reliance on bank and agency staff (see page 23). 0%
The vacancy rate for clinical staff in Health Visiting services is, on average, 6% ranging from 0% to 15%. This is a slight reduction from the 2018 rate of 8%.
Section 3: Key Findings - Health Visiting 19 Community Services benchmarking - Deep dive report for Health Visiting
Health Visiting - Workforce
Staff sickness rate
12%
10% Sickness and absence rates can also have a big effect on staff shortages within 8% different services across the community. 6% Staff sickness/absence for Health Visiting is on average 4% is 5%, ranging from 2% to 9%, and is consistent with 2% 2018 reporting.
0%
20 Section 3: Key Findings - Health Visiting Community Services benchmarking - Deep dive report for Health Visiting
Health Visiting - Finance
Total costs - Budget per 100,000 registered population
The bar chart compares £1,000,000 the budget for Health £800,000 Visiting in 2018/19 (the blue bar) and 2019/20 £600,000 (orange), per 100,000 £400,000 registered population. £200,000 Pay costs represent £0 the highest percentage Clinical staff Non-clinical Non-pay Indirect costs pay cost staff pay cost cost & overheads of total budget costs in both years making up 62% of total budget in Budget 2018/19 Budget 2019/20 2018/19.
There is little variation in budget between 2018/19 and 2019/20 with non-clinical staff pay costs showing no difference. On average, 2.4% of total pay budget is used on bank spend and 2.4% on agency spend.
Clinical staff pay Non-clinical staff Indirect costs and Non-pay cost (£) Year/Cost cost (£) pay cost (£) overheads (£)
Budget 2018/19 867,443 66,689 51,974 370,009 Budget 2019/20 883,465 76,358 47,032 385,818
Section 3: Key Findings - Health Visiting 21 Community Services benchmarking - Deep dive report for Health Visiting
Health Visiting - Finance
Budget vs Spend per 100,000 registered population
£1,000,000 The chart shows the £800,000 difference between the budget 18/19 (blue bar) and £600,000 the spend 18/19 (orange £400,000 bar) per 100,000 registered population. £200,000
£0 2019 was the first year Indirect costs Clinical staff Non-clinical Non-pay the project asked for both pay cost staff pay cost cost & overheads the budget and spend for Budget 2018/19 Spend 2018/19 services.
Clinical staff pay costs makes up the highest proportion of all costs. On average, there is a underspend on the budget by £32k on clinical staff pay costs.
Clinical staff pay Non-clinical staff Indirect costs and Non-pay cost (£) Year/Cost cost (£) pay cost (£) overheads (£)
Budget 2018/19 867,443 66,689 51,974 370,009 Spend 2018/19 835,362 58,024 49,999 377,029
22 Section 3: Key Findings - Health Visiting Community Services benchmarking - Deep dive report for Health Visiting
Health Visiting - Finance
Bank spend as % of Agency spend as % of total budget total budget 12% 14%
12% 10% 10% 8% 8% 6% 6% 4% 4%
2% 2%
0% 0%
Bank and agency spend can have a big impact on overall costs, particularly due to the high vacancy rate a lot of services experience.
On average, bank spend and agency spend each make up 2.4% of the total pay budget.
Section 3: Key Findings - Health Visiting 23 Community Services benchmarking - Deep dive report for Health Visiting
Health Visiting - Quality and outcomes
Number of complaints per The Community Services annum per 100 WTE staff project collects data on a number of different quality 6 and outcome aspects of the service. The online toolkit 5 hosts the full range of data. Here are some examples of 4 the data reported.
3 The chart on the left shows the number of complaints 2 Health Visiting services have received per 100 WTE 1 staff. The mean average for complaints is 2 complaints, 0 ranging from 0 to 5.
In 2019, organisations reported on average 87 compliments per 100 WTE staff.
Friends & Family Test results - average score
100% 98% 96% Friends and Family Test looks at how many people 94% would recommend the 92% service to others. The 90% average score is 96% for 88% Health Visiting services. 86% 84% 82% 80%
24 Section 3: Key Findings - Health Visiting Community Services benchmarking - Deep dive report for Health Visiting References Department of Health (Northern Ireland). A Healthier Future: a Twenty Year Vision for Health and Wellbeing in Northern Ireland 2005-2025. 2004 Department of Health & Social Care. Early years high impact area 6: Health, wellbeing and development of child aged 2: Ready to learn, narrowing the ‘word gap;. Health Visitors leading the Healthy Child Programme. November 2018 Institute of Health Visiting. Health Visiting in England: A Vision for the Future. October 2019 NHS England. Next Steps on the NHS Five Year Forward View. March 2017 NHS England. The NHS Long Term Plan. January 2019 NHS England. NHS Long Term Plan Implementation Framework. June 2019 NHS Health Scotland. A Fairer Healthier Scotland. A strategic framework for action 2017 – 2022. 2017 Royal College of Nursing. https://www.rcn.org.uk/clinical-topics/children-and-young-people/ health-visiting (accessed on 24/04/2020) The Health Foundation/Nuffield Trust. Community Services. What do we know about quality? November 2017 Welsh Government. A Healthier Wales: Our Plan for Health and Social Care. June 2018
Section 4: References 25 Community Services benchmarking - Deep dive report for Health Visiting Appendix 1 Community Services benchmarking project
The Community Services project is one of the Cardiac Community Team NHS Benchmarking Network’s longest standing Children’s Community Nursing Team projects, being a key area for members to want to benchmark, given the lack of national data available Community / District Nursing in this area. Community services represent over £10 Community Dental billion of NHS expenditure and they play a key role in supporting service users at home and reducing Community Integrated Care Teams unnecessary hospital admissions. The Next Steps Community Matrons on the NHS Five Year Forward View highlights Community Paediatrics the importance of close working with community services, with an aim to free up capacity in 2,000- Continence Community Team 3,000 hospital beds over the next two years. Despite Diabetes Community Team (Adult) this policy intention, The Nuffield Trust reports that funding given to NHS Trusts for community services Dietetics (Adult) fell by 4% last year. An NHS priority over the next Dietetics (Child) 10 years is to help older people stay healthy and End of Life Community Team live independently in their communities, with a move towards more integrated care for this cohort. Health Visiting Community services provision is expected to play Integrated Sexual Health Service an important part in the NHS Long Term Plan. MSK
National data on community services is currently Occupational Therapy (Adult) limited and the Network’s Community Services project aims to fill this information gap, taking a view Occupational Therapy (Child) across all aspects of service provision including Physiotherapy (Adult) access, activity, workforce, finance and quality Physiotherapy (Child) metrics. The project provides a detailed view of 25 different community Podiatry services, and there Respiratory Community Team is a series of case study reports for School Nursing every single service Speech & Language Therapy (Adult) benchmarked. Speech & Language Therapy (Child)
Wheelchairs
26 Appendix 1 Community Services benchmarking - Deep dive report for Health Visiting
The Community Services benchmarking project runs on an annual cycle; project scoping taking place with the Community Reference Group from January through to April; data collection from May through to June; data analysis and validation in September and October, with the national event and other outputs being made available in November and December. There may be some changes to the community services where data is collected between the years the project has been operating.
The Community Services benchmarking project collects provider level data on access, activity, workforce, finance and quality and outcomes at aggregated organisational level for the whole year. Some organisations may chose to make multiple submissions, often where service models differ between different geographic areas or their service covers multiple CCG areas. The metrics are agreed with the Network’s Community Reference Group and definitions are provided for every metric to ensure consistency of interpretation of metrics. The Network provides a Helpline to help with interpretation and give advice on data collection. Metrics are reviewed at the end of each cycle, with a view to refining data collection, and ensure that metrics and definitions utilised are relevant and up-to-date. Metrics with a poor response rate tend to be discarded for the next year’s benchmarking. Within the membership, participants take part in the Community Services benchmarking project from all four UK countries. The project provides the most comprehensive dataset available in the NHS on Community Services.
Data is collected via an online data collection tool, input via the online data collection pages in the Network website members’ area. The project collects data for subsequent NHS financial years, running from 1st April to 31st March, so the 2019 iteration of the Community Services project collected data from 1st April 2018 to 31st March 2019. As the project has run for many iterations, time series analysis is available, through toggling between the years on the online toolkit.
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Validation Other Project scoping Data collection Validation & Draft Event outputs toolkit published
During the data validation phase, all submissions are reviewed and participants are given the opportunity to amend or update their data where any outlier positions are identified. These are checked following the production of a draft online benchmarking toolkit, which shows the draft benchmarked findings for the whole sample against every metric collected. All outputs are anonymised, and provider organisations can see their own position(s) only.
Appendix 1 27 Community Services benchmarking - Deep dive report for Health Visiting
Next cycle The Community Services project will feature in the Network’s 2020/21 work programme, collecting 2019/20 outturn data. In response to member requests, the data specifications have been cut down and the number of community services being benchmarked in this year’s cycle has been reduced, to enable members to have the capacity to complete the benchmarking, following the coronavirus pandemic.
NEW Community Services Covid-19 tracker The Network is also offering aNEW Community Services Covid-19 tracker dashboard project which reports on a monthly basis on a limited set of metrics to track the impact of the pandemic upon community services provision. Project outputs Every participant in the Community Services benchmarking project receives a suite of outputs. All of the outputs from the Community Services project are available via the members’ area of the NHS Benchmarking Network’s website. Log-in details are required to access the member’s area. To request new, or to be sent a reminder of existing log-in details, please email enquiries@ nhsbenchmarking.nhs.uk.
Once logged-in to the members’ area, each of the Network’s projects is listed on the home page. The following outputs can be accessed: Online toolkit Project reports Good Practice Compendium Presentations from the Network’s 2019 Community Services national conference
In addition to the project outputs, organisations who participated in the project are still able to view their data submission via the online data collection pages in a read-only format. Please contact Lucy Atherton if you need any assistance accessing the project outputs.
Networking and sharing good practice The Network is keen to facilitate networking and sharing good practice examples between project participants. If your organisation is interested in contacting other project participations, please email Lucy Atherton and, providing consent is granted, the relevant project lead contact details can be passed on. Please note, although some organisations choose to share their organisation’s identifier codes between each other, the Network keeps all data supplied to the benchmarking projects anonymous. The Network will never pass on identifier codes to colleagues outside your organisation.
28 Appendix 1