Re: Number of visits

[Guest guest]

Hi Cheryl,

I suspect there’s something more interesting going on here that begs a different question.

There’s the basic core pattern of engagement, 1. Universal, 2. Universal Plus (UP), then 3. Universal Partnership Plus (UPP).

Since input is always much easier to measure than impact, from a commissioning point of view it strikes me as much easier to define, monitor and audit these three spheres of activity in that order.

If this is the case then the priorities will be set in the same order. (In WW1 no one was demoted for firing shells at the German lines only for asking if the effort was worth it.)

On paper the work/activity and priorities derives from delivering the Universal service.

From delivering this service at a local level, the needs of the child/family/community will be identified and this will set the visiting pattern and priorities of the individual Health Visitor, the Team and the Team’s engagement with allied services. In this way you would have Health Visiting services delivering the same results in quite different ways in townships just a few miles apart and to different sub-groups within the same Township.

Here’s what I think is the really interesting dynamic.

On paper, the individual HV will allocate the resource she has at her command (her time) in a way that will best meet the needs of the child, the family and the community.

In practice, she will prioritise what’s most measurable whilst the potentially more impactful but less easily measured will, given the scarce resource (her time), remain an aspiration. Other outfits with more autonomy will be quick off the mark and will be in a position to deliver boutique services.

Confident Providers that can harvest the soft intelligence of those delivering core/universal services and translate this information into a rationale for the way in which they deliver Universal Plus and Universal Partnership Plus will prosper. Those Providers that simply allow their HVs to run on a treadmill of delivering the core service that doesn’t have a direct feed into how they deliver UP & UPP services will see their work given piecemeal to boutique providers. The upshot will be a plethora of unconnected and uncoordinated services.

The answer as to what sort of kit and software will depend on what you want it to do. There’s a fourteen year old next door who could fashion you a system that will record and measure inputs. Given a couple of days he could knock up a programme that would classify those inputs in as many ways as you would wish. This would seem like a tyranny to the user.

Using a system that would capture inputs but also information that HVs would need to know that would help them define the UP & UPP needs of the community they serve would feel like a useful tool. This would derive from HVs interactions with families whilst delivering the Universal core programme. That data may confirm their perceptions or surprise them and challenge their assumptions. Such a system wouldn’t be a tyranny.

Such a system is not beyond the wit of woman and the conversation as to what you would want in the drop-down menus would give people belief that they are in the change and transformation business.

Best wishes

Terry McGinn

From: Cheryll

Sent: Sunday, June 24, 2012 11:37 AM

Subject: Number of visits

Thanks to everyone who has shared their local figures on this with me. These will help to inform some policy work I have been engaged in with respect to early intervention to promote infant mental health, a role health visitors need to have the capacity to lead on.

Your figures do suggest that there is considerable variation up and down the country. Clearly there are a variety of reasons for that, but one seems to be that sometimes the systems are driving the professionals, rather than the professionals driving the systems. Clearly to have more professional time freed up for client contacts must be aspirational. One way of course would be for all health visitors to be issued with the resource to be able to enter data remotely. I wonder how long it will be before this happens universally. Clearly this approach is working well for some of you.

Kind regards

Cheryll

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