Rapid Appraisal Health Visiting Services – Consultancy

Widescale and intense appraisal project of Health Visiting Services across East Anglia, East and West Midlands.


Health Visiting services nationally were required to increase the number of Front Line Health Visitors by approx. 50% (8,000 to 12,000) over 4 years.
Each HV is a registered nurse already and has a year long university/practice based course that they must complete.
Providers were also expected to transform their service to be consistent with a nationally set framework (The Healthy Child Programme).
This initiative was driven by Downing Street but managed by regional SHAs.

The challenges facing the providers and the service included:
Ensuring commitment and the investment from their PCT.
Recruitment, retention and integration of the new cohort.
Design and development of services and implementation.
External and internal engagement at all levels.
Managing significant change within the service alongside major upheaval in the rest of the NHS.

Key Challenges

The original intention was to implement this process across the East of England – 13 providers It was eventually decided that it was required to be delivered for the East and West Midlands as well – another 20 organisations.
The procurement process required us to contract and engage with each provider/commissioner combination.
Cultures and Health Visiting Project management differed across the regions and to some degree the  buy in to the overall process.
The integration and use of the peer review process was poorly communicated in the additional regions and required some degree of management to ensure consistency and reliability.
The clinical associates we were using had little experience of the intensity and criticality of the delivery timelines and this took some while to embed.
The output reports initially required significant personal oversight to ensure they  remained consistent and concise.

Main Actions

We had developed a skill and some processes to rapidly appraise business etc. in the past. We had used these within other NHS assignments to get under the skin of Mental Health PBR etc.
We took this application and developed an output report and dashboard which through a series of broad topics and meetings would be able to assess the progress of each provider towards the full implementation required of them by 2015.
Having sold the concept to one SHA we were commissioned to co-develop the core areas that we wished to measure and the questions that we would be asking and of whom.
We developed the whole process from initial communication with providers and commissioning, briefing packs, diagnostic system, output report templates and project management processes.
Trained clinical associates in writing a particular style of report and to trust their judgement to assess and then cross validate their assumptions.

Main Results And Achievements

A replicable and objective report and process that delivers an output to the service and its commissioners within three weeks of starting on site.
A process that engaged with all levels in the organisation and laterally with core stakeholders.
A process that has been widely complimented as supportive and non- confrontational
A factual, punchy but objective report that recognises good practice, potential support required as well as areas of note and concern.
A report and outputs that can be referenced in future to gauge on-going progress and developments.
A process that has by its nature delivered an understanding, recognition and engagement of/with the Health Visiting services
A wealth of quantitative and comparative data and general themes
A process that integrated working NHS clinicians into an external consultancy project to provide an expert peer review content.