Re: operating framework 09-10

December 16, 2008

and all,

A spontaneous reflective response:

Interesting to see that any notion of 'tackling social exclusion' has disappeared off the radar of health planning for the next year.

It is understandable in that it it so difficult to do. It has been the prime motivation for my work over the last few years and I feel I have little that is measurable to show for it (not that I have tried very hard to measure anything). That is, unless yesterday's multi-agency meeting to discuss the area, which reported less crime, fewer complaints about drug dealing and nuisance, could have any relationship with groups/activities to promote community spirit we have held - very tenuous. All I can say is that some people know each other and look out for each other in ways they might not have otherwise done, and Community Learning activities have been possible because I fondled people in to a group where they would engage and kept things going between sessions. Stop Smoking people have been effective. The community seems to know and value our activities. I have continuing

good working relationships with all the men who were involved with the fathers art group - they are still vulnerable, at home etc but at least they will talk to me about difficult things.

It is disappointing because it is no less important because it is hard to do. Unlike Surestart we do actually manage to engage the very vulnerable without coercing them through child protection threats. But it is hard and often not very rewarding but the learning processes as workers are generative even though slow. I feel the relationships needed to do this work are learnable by mainstream workers but it will take time in the same way that 'children's rights' and 'advocacy' has done. Abandoning the thrust to tackle social exclusion means the work force will feel safe again to return to the default position of focussing resources with those who do turn up with little more than monitoring and coecive action for those who do not - called safeguarding.

This may not make much sense but it was useful to do it!

Father Christmas is coming to day and I need to go and buy the mince pies.

Robyn

From: Cowley, SARAH <sarah.cowley@...>Subject: operating framework 09-10 Date: Monday, December 15, 2008, 4:52 PM

Dear all

Following on from the priorities document, the 'operational framework,' which informs all NHS spending and planning, is now out for 09-10; on the NHS website. As promised, children do feature, but as far as I can see there is still no 'must-do' requirement around their services. I suppose we should be pleased that they feature quite explicitly, along with a reminder that PCTs must have a local workforce plans and SHAs a workforce strategy. The Child Health Plan is promised 'shortly' and looks set to change the name of child health promotion programme (or perhaps it is just acknowledging that as one part of what s needed overall). Key paragraphs below.

best wishes

Page 17 Children

45. Combating child obesity remains a major challenge for us all, and the objective remains to reduce the proportion of overweight and obese children to 2000 levels by 2020. PCTs should lead this with their local authority and regional partners to support parents and families to make healthier choices.

In particular, PCTs should deliver the Change4Life social marketing programme and could include sharing results from the National Child Measurement Programme with parents.

46. Breastfeeding is a vital part of a healthy start for babies and also reduces child obesity. All PCTs should be developing effective approaches to promote breastfeeding initiation and support mothers to continue to breastfeed for longer, including implementing the principles of the UNICEF Baby Friendly Initiative in hospitals and community settings. In 2008/09, the Department of Health doubled its support to PCTs to promote this initiative to £4 million.

47. PCTs will want to review the transparency of their service offer in line with the Child Health Strategy, to be published shortly, and local priorities. These may include:

• delivering a high quality Healthy Child Programme (formerly the Child Health Promotion Programme);

• implementation of the adolescent-friendly ‘You’re Welcome’ standards;

• improving the experience of services for children with a disability and their families, including palliative care;

• reviewing and evaluating the effectiveness of Child and Adolescent Mental Health Services to ensure that vulnerable children have swift and easy access to services; and

• services to reduce teenage pregnancy rates, including provision of a full range of contraceptive services.

48. All NHS organisations have statutory responsibilities in relation to safeguarding and promoting the welfare of children. All SHAs, PCTs and trusts will be expected to keep under review their arrangements to make sure that they have the policies, skills, competencies, partnership arrangements with other agencies, monitoring and assurance procedures to ensure that their statutory responsibilities are being met.

49. SHAs, PCTs and trusts are statutory partners in Local Safeguarding Children Boards (LSCBs). Other health agencies may also be involved in the LSCB. The individual members have a duty to contribute to the effective work of the LSCB.

50. SHA strategic workforce plans will need to be developed which deliver improved health outcomes in maternity, neonatal and children’s services and help tackle inequalities. The plans should support the delivery of high quality services as close to home as possible and in a range of settings, for example children’s centres. PCTs will want to consider how their local workforce plans support the local services offer.

Page .28

The Pricing Framework for Community Services (to be published in December 2008) will inform contracting for 2009/10. PCTs should have community service portfolios that are described in terms other than professional groups, initially:

• health and well-being;

• children and families;

• acute care provided in the community;

• long-term conditions;

• rehabilitation; and

• end-of-life care.

Further information about standard classifications will be published early in 2009.

page.30

High Quality Care for All committed to developing a quality framework for community services. This will be piloted from June 2009, prior to national roll out from April 2010. We shall publish compendiums of best practice to support transformation of community services across six key clinical areas: children and families; public health; long-term care; end-of-life care; acute services; and specific treatments in the community and rehabilitation.

Professor Cowley

Professor of Community Practice Development

Florence Nightingale School of Nursing and Midwifery

King's College London

5th floor, WBW, lin Wilkins Building

150 Stamford Street

London SE1 9NH

T: 020 7848 3030 (p.a. Caroline, 3023)

F: 020 7848 3764

E: sarah.cowley@...

View my profile at http://myprofile.cos.com/S124021COn

December 16, 2008

Robyn, as always, your reflections are valuable. I suspect those who write NHS management documents would be hard pressed to distinguish between social exclusion and the health inequalities targets (sorry for the sniffy academic comment; much less measured than you response!)best wishesOn 16 Dec 2008, at 11:08, Robyn Pound wrote: and all,A spontaneous reflective response:Interesting to see that any notion of 'tackling social exclusion' has disappeared off the radar of health planning for the next year. It is understandable in that it it so difficult to do. It has been the prime motivation for my work over the last few years and I feel I have little that is measurable to show for it (not that I have tried very hard to measure anything). That is, unless yesterday's multi-agency meeting to discuss the area, which reported less crime, fewer complaints about drug dealing and nuisance, could have any relationship with groups/activities to promote community spirit we have held - very tenuous. All I can say is that some people know each other and look out for each other in ways they might not have otherwise done, and Community Learning activities have been possible because I fondled people in to a group where they would engage and kept things going between sessions. Stop Smoking people have been effective. The community seems to know and value our activities. I have continuing good working relationships with all the men who were involved with the fathers art group - they are still vulnerable, at home etc but at least they will talk to me about difficult things. It is disappointing because it is no less important because it is hard to do. Unlike Surestart we do actually manage to engage the very vulnerable without coercing them through child protection threats. But it is hard and often not very rewarding but the learning processes as workers are generative even though slow. I feel the relationships needed to do this work are learnable by mainstream workers but it will take time in the same way that 'children's rights' and 'advocacy' has done. Abandoning the thrust to tackle social exclusion means the work force will feel safe again to return to the default position of focussing resources with those who do turn up with little more than monitoring and coecive action for those who do not - called safeguarding. This may not make much sense but it was useful to do it!Father Christmas is coming to day and I need to go and buy the mince pies. Robyn From: Cowley, SARAH <sarah.cowleykcl (DOT) ac.uk>Subject: operating framework 09-10 Date: Monday, December 15, 2008, 4:52 PMDear allFollowing on from the priorities document, the 'operational framework,' which informs all NHS spending and planning, is now out for 09-10; on the NHS website. As promised, children do feature, but as far as I can see there is still no 'must-do' requirement around their services. I suppose we should be pleased that they feature quite explicitly, along with a reminder that PCTs must have a local workforce plans and SHAs a workforce strategy. The Child Health Plan is promised 'shortly' and looks set to change the name of child health promotion programme (or perhaps it is just acknowledging that as one part of what s needed overall). Key paragraphs below.best wishesPage 17 Children45. Combating child obesity remains a major challenge for us all, and the objective remains to reduce the proportion of overweight and obese children to 2000 levels by 2020. PCTs should lead this with their local authority and regional partners to support parents and families to make healthier choices.In particular, PCTs should deliver the Change4Life social marketing programme and could include sharing results from the National Child Measurement Programme with parents.46. Breastfeeding is a vital part of a healthy start for babies and also reduces child obesity. All PCTs should be developing effective approaches to promote breastfeeding initiation and support mothers to continue to breastfeed for longer, including implementing the principles of the UNICEF Baby Friendly Initiative in hospitals and community settings. In 2008/09, the Department of Health doubled its support to PCTs to promote this initiative to £4 million.47. PCTs will want to review the transparency of their service offer in line with the Child Health Strategy, to be published shortly, and local priorities. These may include:• delivering a high quality Healthy Child Programme (formerly the Child Health Promotion Programme);• implementation of the adolescent-friendly ‘You’re Welcome’ standards;• improving the experience of services for children with a disability and their families, including palliative care;• reviewing and evaluating the effectiveness of Child and Adolescent Mental Health Services to ensure that vulnerable children have swift and easy access to services; and• services to reduce teenage pregnancy rates, including provision of a full range of contraceptive services.48. All NHS organisations have statutory responsibilities in relation to safeguarding and promoting the welfare of children. All SHAs, PCTs and trusts will be expected to keep under review their arrangements to make sure that they have the policies, skills, competencies, partnership arrangements with other agencies, monitoring and assurance procedures to ensure that their statutory responsibilities are being met.49. SHAs, PCTs and trusts are statutory partners in Local Safeguarding Children Boards (LSCBs). Other health agencies may also be involved in the LSCB. The individual members have a duty to contribute to the effective work of the LSCB.50. SHA strategic workforce plans will need to be developed which deliver improved health outcomes in maternity, neonatal and children’s services and help tackle inequalities. The plans should support the delivery of high quality services as close to home as possible and in a range of settings, for example children’s centres. PCTs will want to consider how their local workforce plans support the local services offer.Page .28 The Pricing Framework for Community Services (to be published in December 2008) will inform contracting for 2009/10. PCTs should have community service portfolios that are described in terms other than professional groups, initially:• health and well-being;• children and families;• acute care provided in the community;• long-term conditions;• rehabilitation; and• end-of-life care. Further information about standard classifications will be published early in 2009. page.30High Quality Care for All committed to developing a quality framework for community services. This will be piloted from June 2009, prior to national roll out from April 2010. We shall publish compendiums of best practice to support transformation of community services across six key clinical areas: children and families; public health; long-term care; end-of-life care; acute services; and specific treatments in the community and rehabilitation. Professor CowleyProfessor of Community Practice DevelopmentFlorence Nightingale School of Nursing and MidwiferyKing's College London5th floor, WBW, lin Wilkins Building150 Stamford StreetLondon SE1 9NHT: 020 7848 3030 (p.a. Caroline, 3023)F: 020 7848 3764E: sarah.cowleykcl (DOT) ac.ukView my profile at http://myprofile.cos.com/S124021COn sarahcowley183@...http://myprofile.cos.com/S124021COn

December 16, 2008

,

Yes I agree! When I looked again I spotted 'health inequalities' which I had missed at the first read. But I still stand by my comments which may be compounded by a get tough backlash after Mathews and urgent intent to increase personal responsibility - which of course is not all bad.

Robyn

From: Cowley, SARAH <sarah.cowleykcl (DOT) ac.uk>Subject: operating framework 09-10 Date: Monday, December 15, 2008, 4:52

PM