This case study delves into Doncaster’s innovative approach to public health for families, highlighting the strategic integration of services and the adoption of digital solutions to enhance health visiting services.
The challenge
Doncaster has had to steer through various complexities in funding arrangements and health visiting services have had to appropriately balance and allocate a number of short-term funding streams. While incredibly valuable, time-limited monetary provisions can be a challenge to distribute within given parameters. Certain roles or services, which have a notable benefit within the service and meet specific needs, can only be maintained for a short period of time and this can lead to inconsistent service offerings.
More sustained funding increases, or longer-term provisions, would allow for more effective future planning. In addition, an absence of clarity and precedent on funding responsibilities, particularly for health-specific posts within multi-agency safeguarding hubs, has led to periods of uncertainty regarding long term service planning.
The solution
During the pandemic, the council successfully modelled and piloted perinatal mental health visiting roles which had been evaluated with positive outcomes. Additional funding through the Start for Life programme allowed for the continuation of roles such as parent infant relationship workers and a specialist team lead, further expanding the perinatal parent infant relationship specialism.
An integrated early years pathway model was also piloted during the pandemic in an area of central Doncaster with high levels of migration, ethnic diversity and asylum seekers. As part of this pilot, those at community nurse or family support worker level also operated as early days workers providing support and advice to non-English speaking families on a host of issues outside health. The Start for Life funding has helped sustain these roles.
Another unique feature in Doncaster’s offer is a dedicated smoke-free pregnancy service which is wrapped up within their health visiting pathway. Merged into the pathway in 2015, the goal has been to prolong smoking cessation beyond birth through pre- and post-delivery dialogue and support. This has been facilitated further through a team of specialist smoking cessation advisors who provide consistent support alongside health visiting.
As health visitors struggle with capacity, asking teams to undertake additional tasks has previously led to overwhelm. The council found that funding specific, existing posts to champion new programmes was substantially more successful. One example is a dedicated “Supporting Families” health visitor, who liaises directly with health visiting teams to recognise eligible families for the programme.
During the pandemic, Doncaster’s health visiting provider extended services through digitised contact options and flexible arrangements from online antenatal classes to online video calls are still offered where preferred. The service provider has also created a successful health visiting social media presence through a dedicated Facebook page which boasts a large audience. They have been able to reach and engage a wider community online to address important topics and issues. The service has a single point of contact team to handle community calls and monitor and respond to Facebook comments.
The impact
Prior to the smoking cessation programme’s integration into the health visiting pathway, Doncaster had a persistently high rate of smoking amongst mothers at time of delivery. Since its implementation, the numbers have been substantially lower and have not returned to their original rates.
Doncaster has built a sense of trust with its providers and created a space for flexible, customised service delivery which has been particularly crucial in maintaining the quality and efficiency of new birth visits.
Due to capacity strains and recognising that not all families required the visit within 14 days, Doncaster’s service provider suggested an alternative approach. As some families were better supported, competent and were dealing with a third or fourth birth, an agreement was reached that if health visitors had seen a family in person during the antenatal visit and believed a maximum 21-day new birth visit could be conducted with no risk to the family or child, the 14-day targets could be lowered. This ensured relevant families were seen no later than 21 days following a birth and families needing more support were covered within the 14-day window.
This agreement had a profoundly positive impact across teams and recipients. Health visitors fed back on the benefits of having an extra week or days to provide targeted support and attention to families needing it most. The ability to suggest, discuss and agree on alternative modes of delivery has been immensely constructive.
Social media presence has enhanced contract meetings where alongside discussing main performance indicators and assessment outcomes, social media insights are analysed for additional insight. Key themes, case studies, areas of concerns, footfall and engagement now play a part in review meetings and this input has been useful for future planning.
How is the new approach being sustained?
The approach is being sustained through remaining responsive to changing situations and maintaining an open, honest dialogue with providers. Trusting a partner’s judgement on important aspects of the delivery is key, especially as they are the experts in delivery.
The council proactively measures performance both qualitatively and quantitatively to find ways to continually improve the service and understand changing local needs. Integrating insights from social media engagement through the provider has been an innovative way to capture these needs and areas of focus.
There has also been much effort to optimise current roles and service structures to maintain services. Appointing health visitors as programme champions has given them a sense of ownership of specific provisions and capitalises on current skill sets. Extending active roles to support the wider service such as broadening roles in smoking cessation and as early days workers allows the referrals families need to get wider support across the system.
Lessons learned
- Pivoting and modifying service delivery is crucial in a constantly evolving public health landscape.
- Integrating services can provide more holistic support for families, particularly families who need it most.
- Trust-based relationships with service providers enable flexible service agreements.
- A digital presence can enhance delivery of services.
Contact
Carrie Wardle
Public Health Specialist, City of Doncaster Council