Health visiting in Wolverhampton: a partnership approach

The challenge

Like many, Wolverhampton's health visiting services faced multifaceted challenges in the public health space - staff retention, service continuity and quality and the ability to efficiently meet diverse and complex community needs. Further, Wolverhampton is the 20th most deprived council area in England; one in four children are living in poverty, significantly higher than the England average of 17.1 per cent.

The solution

In 2019, Wolverhampton moved away from its traditional procured service model arrangement and entered into a 10-year partnership with RWT, transforming the delivery of the Healthy Child Programme. This new arrangement provided health visiting services with a greater sense of stability, flexibility, visible improvement in staff retention and healthier, more open working relationships.

The flexibility of the arrangement allowed Wolverhampton to innovate with its partners and put in place key transformation programmes and priorities. A targeted digital transformation programme was developed to improve data management, data accuracy, service efficiency, and alignment to emerging priorities. Some additional, recurring investment was allocated to new specialist roles, including clinical roles that have supported special educational needs, perinatal mental health and others such as a marketing and communications expert, to target approaches to community engagement and service promotion; this has been very successful.

Programmes such as HENRY and Five to Thrive were successfully introduced and enabled colleagues across health and social services to work collaboratively and embed early help and safeguarding arrangements. The council has also embedded the Solihull Approach in their parenting offer, ensuring a consistent offer for families.

The health visiting team now also has an equalities dashboard - for each KPI they can see the percentage uptake by geography, deprivation, ethnic group and GP practice. They are able to undertake analyses for the KPIs across the deprivation gradient, and there is no statistically significant gradient - the coverage is equitable at city level for deprivation.

The impact

Since 2019, health visitor mandated contacts have shifted from a below regional average to above England average coverage: 

• New birth visits completed within 14 days have increased from 84 per cent in 2020-21 to 93 per cent in 2022-23, above the England average of 80 per cent.
• The proportion of infants receiving a six-to-eight-week review has increased from 86 per cent in 2020-21 to 91 per cent in 2022-23, above the England average of 79 per cent.
• The proportion of infants receiving a 12-month review has increased from 73per cent in 2020-21 to 81 per cent in 2022-23, above the England average of 71 per cent.
• The proportion of children who received a two-two and a half year review was slightly above the England average at 75per cent.  

Despite workforce issues nationally, since 2019, Wolverhampton’s health visiting and public health workforce retention is notably better than in previous years. Investment into communications and marketing has enabled integration of the published Start for Life Offer into the Healthy Child App avoiding unnecessary duplication of information; digital exclusion is also now being actively addressed.

The current approach has led to more timely contact with families and a number of needs have been identified and supported earlier. The data from these reviews has helped further prioritise partnership contributions to other allied service areas such as investment in speech and language assessment tools, pathways, and interventions.

The focus on vulnerable communities, refugees, asylum seekers, more transient populations, and the travelling community has also been greatly enhanced; there is now a dedicated health inclusion team.

Another major benefit of the partnership has been the leadership and support provided to emerging national programmes and local transformation plans which is evident in the Family Hubs and Start for Life Programme and the Families First for Children Pathfinder (FFCP). Wolverhampton is one of three wave one councils for the FFCP. There has also been consistent work on the programme’s safeguarding aspects to embed early help.

Although the challenges of sharing resources, data, staffing have not been fully overcome, all parties have worked hard to rise above challenges; the parental and infant wellbeing posts are employed by the council whilst supervision, training and development posts are overseen by health visitors.

Finally, Wolverhampton has been exploring libraries as a place for delivering health visiting services and are currently testing this prospect. This will introduce and connect families to a safe learning environment, support programmes like Bookstart, play and stays; it will also introduce families to safe social spaces that allow a connection to the offer in Family Hubs.

The partnership approach is contributing to the city's children being ready to learn, being ready for school and developing future generations that will be ready to contribute and benefit from the investment in the city.

How is the new approach being sustained?

The approach is being sustained through:

• a stable, long-term partnership promoting continuous collaboration and unified pathways for efficient health visiting services.
• Quarterly reviewed data ensuring timely and accurate information is available to support decision-making allowing for responsive adjustments to service delivery. 
• Ongoing investment in specialist clinical roles and digital initiatives supporting the evolving nature of the service.

Lessons learned

A key lesson learned is the effectiveness of moving away from traditional procurement models into long-term partnership arrangements as they bring a great sense of security. The new model has improved the commissioner-provider relationship and has been critical in improving workforce retention, service delivery and outcomes.

Contact

Bal Kaur - [email protected]

Public Health Consultant, City of Wolverhampton Council

Louise Sharrod - [email protected]

Principal Public Health Specialist, City of Wolverhampton Council