derby city and derbyshire family nurse partnership david stephenson
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Derby City and Derbyshire Family Nurse Partnership David Stephenson Taking over delivery of services for young parent and their children 29th June 2012. An ex-NHS service that has operated since 2007 Social Enterprise since Jan 2011 – staff transferred out of the NHS 31 March 2011. - PowerPoint PPT PresentationTRANSCRIPT
Derby City and DerbyshireFamily Nurse Partnership
David StephensonTaking over delivery of services for young parent and their children
29th June 2012
Who we are Ripplez?
• An ex-NHS service that has operated since 2007
• Social Enterprise since Jan 2011 – staff transferred out of the NHS 31 March 2011.
• Owned and run by staff for the benefit of young families in Derby and the surrounding areas
• Deliver Family Nursing Partnership in Derby, Derbyshire and Burton
What Ripplez do?
• Preventive, intensive, structured home visiting programme.
• Offered to first time mothers 19 and under • Recruited in early pregnancy no later than
28weeks gestation and remain with the family nurse until child is 2.
• Licensed programme with fidelity measures to ensure replication of original research.
Objectives of the FNP Programme
• Improve pregnancy outcomes;
• Improve child health and development and future school readiness and achievement;
• Improve parents’ economic self-sufficiency.
Why we left?• Creating a focussed organisation with less management
layers and bureaucracy • Empowering staff through direct control of the organisation;• Enabling access to more funding streams not currently
available to PCTs to increase sustainability and reduce overheads;
• Developing more services for existing service users such as volunteer programmes, housing support and greater access to employment or training;
• Expanding services to other geographical areas;• Creating community ownership that has formal links with
service users and key partners;• Ensuring surpluses are reinvested into the communities we
work to further develop and improve services.
History – Before leaving NHS
• Service setup as a national pilot in 2007;• Right to Request process in late 2009;• FNP became part of DoH Operating Framework –
early 2010; • Approved by the PCT Board in April 2010 and started
working as a Shadow Organisation;• Won contract to provide Family Nursing in Burton• 5 Yr Contract & Transfer Agreement Agreed March
2011 (11 staff transferred);• Commenced trading 1 April 2011
Actions required to leaving NHS
• Business Plan, due diligence and approvals;• Agreeing contracts;• Staff consultation and training;• Setting up Company;• Appointing board and organisational
structure;• Setting up bank account, tax status and
accounting system;• Setting up policies & procedures.
History – After leaving NHS
• June 2011 - won contract to deliver FNP to Derbyshire;
• August 2011 – signed contract with Impetus Trust;• Set up Footsteps – Young Families Group in Derby• Won Big Venture Challenge 1 of 25 out 800
organisation;• Strategic review – Nov 11 to May 12;• Extention to Derby Contract – Jan 12• First year end completed March 2012 (25 staff). • Extention to Derbyshire Contract – Jun 12
Our Plan to Scale Up• Settling down in a new organisational form.• Achieve a three/six months cash buffer.• Maintain and develop our workforce.• Be aware of competition.• Secure additional funding to develop the business.• Develop specifications for new services.• Improve tendering and contractual skills (capability
and capacity).• Ensure young parent involvement in the running and
development of the business.
• This was uncharted territory for the whole team!
Lessons learnt (1)
• Understanding the level of commitment, time and effort required to run a company;
• Creating an identity & ethos;• Communication – keep staff involved;• Staff are your greatest asset – knowledge &
ideas;• Recruiting is expensive in resources so it is
important to get it right;• Managing relatonships – commissioners,
clients, funders and partnership organisations;
Lessons learnt (2)
• Get on top of your finances;• Going for realistic funding opportunities;• Managing multiple locations;• Maintaining staff training;• Managing the Board of Directors;• There is still bureaucracy to manage;• Get your self noticed in a good way; • You can not wait for thing to happen for you.
Summary
• The experience has energised staff;• Have increased our Family Nursing capacity
from 130 to 390 clients;• Ripplez has grown from 11 to 27 staff,
maintaining financial stability.• Staff are now more focussed on service and
financial issues;• Staff are empowered and feel more
comfortable with service development and growth;
Family Nursing
More About the Programme
Theoretical Basis
• Human ecology theory (client’s social and material context)
• Attachment theory (client as a ‘safe base’ from which her child can grow and learn).
• Self efficacy theory (ability to change behaviour by learning to draw on strengths and successes – building skills and confidence).
What do Parents Receive?
• Voluntary programme.
• Frequency of visits in pregnancy weekly first 4weeks then fortnightly.
• Infancy weekly first 6 weeks then fortnightly to 21 months.
• Monthly preparing for ending of programme.
• Each visit has structure and planned content.
The ‘6 domains’
• Personal Health
• Environmental Health
• Life Course Development
• Maternal (and Paternal)
role
• Family and Friends
• Health and Human
Services
Guidelines for Nurses
• Pregnancy
• Infancy
• Toddlerhood
• Supported by PIPE, Ages
and Stages and DANCE
Approach
• Therapeutic alliance
• Focus on bonding,
attachment and emotional
availability of caregivers
• Utilises client’s primary
motivation
• Strength based, positive
and hopeful
• Using motivational
interviewing skills
• Respectful agenda
• Setting goals
Communication Styles Used to Engage
• Self Efficacy – “Well done, what a great achievement cutting down to 15 cigarettes per day”
• Guiding/MI – “Sounds like you already had a knowledge of risks of smoking in pregnancy”
• “What motivated you to cut down?”
• “It sounds like your baby’s health is very important to you”
Case Studies - Burton
‘Making a Positive Difference to the Lives of Young Families’ RippleZ Mission Statement
Case Study 1
Before FNP• Involved with Social Care• 20 a day smoking habit and
cannabis• Unemployed and homeless• Poor diet• Low self esteem• Unplanned pregnancy• No parental support
With FNP• Social Care no longer involved• Smoking reduced and not using
cannabis• Living in rented accommodation• Eating more healthy meals• Aspires to entire education in
future years• Using contraceptives• Improved relationships with
family
2121/04/23
Case Study 2
Before FNP• Involved with a “bad
crowd”, social involved• Abusive ex-partner• Poor diet and smoker• Father spent time in prison• Low self esteem• Unplanned pregnancy• No parental support
With FNP• Social Care no longer
involved• Partner in prison• Quit smoking and eating
healthy meals• Taking A-levels• No GP visits• Using contraceptives• Supported by the family
2221/04/23
Financial outcomes and benefits
Individual• Stopping a 20 a day habit
saves £1971.00• Breast feeding saves
mothers £435 each year• Mothers qualified to A-level
standard can earn £3.07 per hour more than unqualified
Public sector• Obesity costs NHS £950 per
person per year• Costs saved of placing child
into care £2500 per week• Social care saving £400 per
week • Domestic Violence £240 per
incident• Council hostel £484 per
week
23
Health & Social outcomes and benefits
Individual• Stronger family
relationships• More interaction with the
fathers for mother and baby• Healthier lifestyles• Preventing of infections
acquired by babies• Increased self esteem• Stable accommodation
Public sector• Reduced crime• Reduced levels of obesity
and smoking related illness• Reduced demand on hostel
accommodation
24
Public sector savings (Years 1 & 2)
25
Ripplez!
Ripplez CICDerby City Family Nurse
Partnership
Revive Healthy Living CentreRoe Farm Lane
DerbyDE21 6ET
T: 01332 888091E: [email protected]
www.ripplez.co.uk
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