Improving service delivery in school health services for vulnerable children and their families, working with Birmingham Community Healthcare NHS Trust

This project, funded by the Department of Health (England) and led by our workforce and service design experts, was tasked with demonstrating competences for the role of the community support nurse (CSN).

The new role, working across health and education, would provide services to vulnerable children and their families, particularly non-attendees and those that live in hard to reach communities.

The role was created through funding from the Birmingham Children’s Fund. Since then, the CSN role has evolved, therefore managers needed to evaluate and clarify the role function. They decided to reassess how the role was working across the education and health sectors and to demonstrate how Skills for Health competences could be used in role definition and service design.

Managers at South Birmingham Primary Care Trust (now part of Birmingham Community Healthcare NHS Trust), were keen to evaluate the achievements of the role and to underpin the service with competences for greater transferability to other roles within Community Nursing Services. Due to the sensitive nature of the work, managers recognised a need to consider competences relating to empathy, people skills and emotional intelligence for the role.

At its essence was the desire to create a role that could deliver a service to families who would feel they could trust their community support nurse, and with whom they could open up and discuss their real problems and concerns.

When South Birmingham Primary Care Trust (PCT) was invited to become part of a School Health Demonstrator project, managers recognised an opportunity to assess and evaluate the effectiveness of a new role in school nursing.

“The project has highlighted the real benefits a structured competency-based approach can offer for service induction and training planning for service redesign. South Birmingham PCT have been able to use Skills for Health competences to underpin the community support nurse role and training programme to improve services for children most in need.”

Pam Truman, Project Manager School Health Demonstrator Site, South Birmingham PCT

As the leading authority on healthcare workforce skills, we developed a bank of national workforce competences (NWCs) and National Occupational Standards (NOS) which describe the skills and knowledge required to carry out a task or function effectively. Competences are designed to underpin and be integral to accredited and non-accredited education and training programmes.

A Steering Group, including stakeholders from the PCT, local schools’ leadership, health bodies and allied agencies, came together to identify the skills in the existing community support nurse workforce and to define what additional skills were required. Next, they identified any gaps between current and required role profiles.

After much refinement, and with help from the Steering Group, eighteen competences were matched to the required CSN profile, to ensure future role holders have the required skills. Managers then redefined the job description using the identified suite of competences and developed a Knowledge and Skills Framework outline for the CSN with Steering Group consultation and previous role holders providing an input of current experience.

From this work, managers have been able to develop and put in place a structured competency-based training package; so that both current and new post holders will have a much clearer idea of what is required of them in the CSN role.

This will be a comprehensive needs-based induction programme so that learning is appropriate to the individual. The training and development programme will help support CSNs personally and in their professional development and career pathway, as well as enable clinical mentors and supervisors to use a standardised approach to professional development.

Example role-based competences identified and used:

• Make use of supervision
• Develop relationships with children and young people
• Communicate with children and young people and those involved in their care
• Work with children and young people to assess their health and well-being
• Plan the inter-disciplinary assessment of the health and wellbeing of children and young people
• Develop individualised care plans with children and young people.
• Recognise and respond to possible abuse of children and young people
• Respond to crisis situations

Benefits

• CSN’s have been successful at identifying the needs of young people and families and signposting them to relevant services
• Increased CSN involvement has led to improved school attendance
• Service improvement supported by effective recruitment, induction, and training planning
• Successful use of competence-based role design that reflects needs of school nursing team and local community
• Increased operational flexibility within the school nurse team
• Role offers the ability to deal with health issues within a multi-agency context enabling other health staff to tackle other family problems

The Competences are part of a range of online tools which can help managers design roles, services, education, and training and forecast future needs. They are a powerful tool for those who want to structure their teams’ and individuals’ learning and development around service user needs, and they can all be linked to the Knowledge and Skills Framework.

South Birmingham PCT managers have been pleased with the way competences have been allocated to the role. South Birmingham’s school nursing team welcome the CSN as an asset to the school nursing service.

Use of competences and related tools are still in their early stages at South Birmingham PCT. However, managers have been greatly interested in the Skills for Health framework, and they are considering extending its use to other roles within the school nurse service, across other Community Nursing Services and wider to other services within the PCT. Competences describe what individuals need to know and do, whoever is performing the task, which means they have many and varied uses.

“This role has been proved to be invaluable in identifying and intervening in the lives of some of our most invisible and vulnerable children and families. The holistic assessment and face to face working that the role offers lies at the heart of practice in relation to the safeguarding of children.”

Clare Edwards, Lead Nurse Safeguarding, South Birmingham PCT

“The application of Skills for Health competences has demonstrated how they were an effective tool to underpin the consolidation and progression of school health development within South Birmingham PCT. The benefits of the project have been seen with the implementation of competences to support the role of the community support nurse. This work has enabled us to reflect on what we needed to support and improve services provided to vulnerable children within South Birmingham.”

Pat Hackett, Associate Director of Community Services (Children), South Birmingham PCT

South Birmingham PCT commissions services for a population of 383,000 as well as providing primary care services for the local population and specialist services for a wider population.

The Children’s Directorate brings together all the specialist community services for youngsters across Birmingham and offers a co-coordinated approach for child health care. It works closely with local acute paediatric services and other local providers of care for children including Primary Care Trusts, Health and Social Care, Education, and voluntary agencies.