Interview with Anita Farrant, Head of Service Early Help, Suffolk County Council February 2017
Context and background
The transfer of health visiting staff took place in 2011 under a section 75 agreement with TUPE arrangements - staff were transferred on NHS terms and conditions including protecting existing pension arrangements. All staff which transferred were on NHS Agenda for Change contracts (which link to performance related pay).
HR, contracts and policies
Any newly appointed health visitors or skill mix employed by the Council following the transfer, were appointed on council contracts and pension arrangements.
This has had an impact on recruitment and retention, particularly for experienced NHS health visitors as the surrounding areas are still employing staff on NHS Agenda for Change (AfC) contracts (with performance related pay), which creates additional challenges for the council to attract senior experienced health visiting staff.
Newly qualified health visitors are easier to attract as the council starting salary is more generous than AfC. The council is currently seeking to resolve this issue through considering offering preferential terms and conditions to attract staff. Staff on NHS contracts are working to NHS HR policies, whilst those on council contracts work to council HR policies. It is possible to support both sets of policies but can involve more work/interpretation (i.e. transport policy is one example, where there is a variance at the point at which health visitors are able to access a lease car because of work related travel requirements).
It is important to involve the unions (RCN/UNITE) at an early stage and begin to build new relationships through HR. Having appropriate arrangements in place to support the revalidation of health visiting staff has been well managed.
CQC Registration The Council did seek CQC registration. They were able to reregister with the same Responsible Manager we had pre TUPE but had to nominate a new Accountable Manager. The council also approached NHS Monitor to check if an NHS provider licence was required but they did not meet the criteria and it was not required.
Clinical Governance
Clinical governance arrangements were established at the outset when staff were TUPE’d over. Arrangements included a Chief Nurse with a clear process for how complaints, incidents and risks are dealt with. Provision of mandatory training and safeguarding supervision from named nurses was also continued. There is a separate governance structure for health and children’s social care.
IT
Prior to the transfer, health visiting staff were all working from NHS buildings. At the point of transfer, they continued to work in NHS sites and on NHS kit. It was important for them to be on the same system (SystmOne) as other health staff (such as GPs). New teams have been housed in council accommodation using Council IT.
Transferring staff onto council IT kit has been an ongoing priority to save time, increase productivity and reduce risk.
Health visitors can now also access SystmOne via the Council’s desktop. The council has also introduced wifi in buildings where health visitors work so that they can work remotely with access to council systems (including in some NHS buildings).
The council has also provided health visiting staff with mobile IT equipment (although there was no budget originally allocated for this, the council felt this was an important investment to ensure a good fit between IT and staff needs.
Ease of access through suitable IT kit has had a huge impact on staff morale and it is important to have it in place in advance, so it does not compromise the ability of health visitors to do their job.
Ensuring there are clear detailed agreements around IT and accommodation is essential as both can prove very expensive if they are not water tight.
Integration
Co-location through children’s centres has worked well to date. The council is looking to co-locate the health visiting service with other children’s services.
Other observations
Overall the advantages have outweighed the difficulties and the transfer has reduced duplication.
It is important to maintain contact between health visiting and other NHS health services staff; don’t forget health colleagues and existing relationships that you have, particularly GPs, community paediatricians and therapists. Plugging into existing forums where health colleagues meet up is a good way of doing this.
Be aware of cultural differences which can be difficult for NHS staff new to working in a council, for example council management arrangements can mean nurses are managed by non-nursing staff. In these situations, it is helpful to have a senior nurse overseeing professional and service development. It is important to maintain strong links with training partners.
Strong leadership and quality assurance is key.
Good data sharing agreements need to be in place.