http://www.kirklees.nhs.uk/uploads/tx_galileodocuments/Practice_Process_Guidelines_01

Professional Practice Process Policy for Health Visiting and School Nursing Teams

Responsible Directorate

Patient Care and Professions

Responsible Director:

Sheila Dilks

Date Approved

27 January 2009

Committee

NHS Kirklees Governance Committee

Version Control

Document Title Document number Author Contributors Version Date of Production Review date Postholder responsible revision Primary Circulation List

Professional Practice Process Policy for Health Visiting and School Nursing Teams 1 Catherine Smyth 2 June 2008 July 2010 for Professional Development Lead

Web address

Restrictions

Health Visiting and School Nursing teams and their operational managers All ratified policies, strategies, procedures and protocols are published on the Trust Intranet and Public Website.

None

Standard for Better Health Map

Domain Core Standard Reference

Safety, Clinical and Governance C2, C5, C6, C8, C9

Cost

Effectiveness,

Performance Indicators

1. 100% of GP practices have a link Health Visitor 2. 100% of GP practices have a link School Nurse 3. All Kirklees refuges have a named health link

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Contents

Section 1 2 3 4 5 6 7 8 9 10 11 12 13

Introduction Associated policies and procedures Aim and objectives Scope of the policy Accountabilities and responsibilities Vulnerable families Families moving in and out of Kirklees Ineffective home visits Failure to attend for appointment Processing A&E slips Processing hospital letters Processing domestic violence referrals from West Yorkshire Police Force Processing information regarding families residing in a Kirklees Refuge Equality impact assessment Training Needs Analysis Monitoring compliance with this policy References

14 15 16 17 Appendices 1 Stakeholder involvement 2 Confirmation of receipt of clinical record Prompters to consider when attempting engagement with families 3 or individuals with whom there are difficulties in accessing 4 Equality Impact Tool

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Page 3 4 4 4 4 5 5 6 6 7 7 7 7 8 8 9 9 10 11 12 13

Policy Statement NHS Kirklees wish to have a consistent approach to the delivery of services for supporting families. Whilst maintaining flexibility of approach to meet individual and family needs, Health Visitors and School Nurses need to be accountable for their own practice yet at the same time exercise the requirement to make decisions based on professional judgement.

1.

Introduction

The merging of 3 Primary Care Trusts in October 2006 brought many challenges, one being the bringing together of different working practices. Health Visiting and School Nursing (this needs to consistent) teams in Kirklees had, and continue to have, different Child Health Surveillance Programmes, however, together with commissioners work is underway to bring these together under the umbrella of the Child Health Promotion Programme (version April 2008) as described in Standard 1 of the Children’s, Young People and Maternity Services NSF. This should resolve any inconsistencies within the core programme.

There are, however, like in many NHS services, other areas of health visiting and school nursing practice whereby individual circumstance varies from the norm and practitioners need to make decisions based on professional judgement. It is these ‘grey areas’ that can cause anxiety for practitioners, and that can lead to clients perceiving inconsistence or inequality in services. It is acknowledged that whilst professional judgement and decision making are paramount, some general guidelines are needed to inform that professional decision making. It is intended that by providing guidance staff will feel supported in their practice and the risk of complaints and clinical incidents will be reduced in circumstances whereby action is initially unclear.

The practice areas covered within this policy are: o

Vulnerable families

o

Families moving in and out of Kirklees

o

Ineffective home visits

o

Failure to attend for appointment

o

Processing A & E information

o

Processing hospital letters

o

Processing domestic violence referrals from West Yorkshire Police Force

o

Processing information regarding families residing in a local refuge

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2.

Associated policies and procedures

This policy should be read in accordance with the following policies, procedures and guidance. o

Kirklees PCT Guidelines for the Structure and Format of a Clinical Record (2007)

o

Kirklees PCT Supervision Policy (2007)

o

Kirklees PCT Child Protection Policy (2008)

o

Kirklees PCT Domestic Violence Policy (2008)

o

West Yorkshire Consortium Safeguarding Children Procedures 2007

o

Working Together to Safeguard Children (2006)

3.

Aims and objectives

The aim of this policy is to inform professional decision making for Health Visitors and School Nurses in circumstances that require deviation from or are additional to the universal or core Child Health Promotion Programme.

This will be achieved by meeting the following objectives:

4.

o

To improve current systems and processes

o

To ensure consistency of approach

o

To supplement the universal programme

o

To improve both written and verbal communication regarding to children and families across Kirklees

o

To increase opportunities for identifying unmet need Scope of the policy

This policy must be followed by all Trust employees and staff on temporary or honorary contracts as well as bank staff and students.

A full list of stakeholders consulted in the development of this policy can be found in Appendix 1 5.

Accountabilities & responsibilities

5.1

Lead director

The Director for Patient Care and Professions is lead director at Board level responsible for Safeguarding. Overall day to day responsibility for all aspects of Safeguarding both adults and children is the Assistant Director for Safeguarding Children and Vulnerable Adults. The lead director and assistant director are responsible for ensuring all staff are aware of and conform to this policy. The Director of Kirklees Community Healthcare Services has ultimate management responsibility for staff working towards this policy.

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5.2

Named Nurses for Child Protection

The role of the Named Nurses is to provide support and advice to NHS Kirklees staff where safeguarding issues arise, and to provide child protection training. Individual child protection supervision with the named nurses is available to all staff, and can be arranged according to staff requirements. Minimum attendance at group supervision and individual supervision is outlined in the Child Protection policy 2007. The named nurses are available to provide telephone advice to staff as required.

5.3

Team Leaders

Team leaders are responsible for ensuring that practitioners access supervision and appropriate training. They are also responsible for monitoring and supporting the implementation of this policy and highlighting any difficulty practitioners have following them and risks to service delivery.

5.4

Practitioners

School Nurses and Health Visitors are responsible for following this policy and highlighting to team leaders difficulty in doing so.

6.

Vulnerable families

Health Visitors and School Nurses should establish clear systems within GP practice and schools whereby information about individuals or families of concern is communicated, documented and acted upon. Each GP practice should have an identified Health Visitor and School Nurse link.

There is no agreed definition of what is meant by ‘vulnerable’. Checklists and formulas are discouraged (Hall, 2003) because they do not measure resilience. Both GP and practitioners should exercise professional judgement in terms of what information on which individuals or families need to be communicated. All new referrals require holistic assessment by either a Health Visitor or School Nurse. All conversations should be documented. If there is any indication or suspicion that a child or adult is at risk of significant harm, child protection or vulnerable adult procedures must be followed.

7.

Families moving in and out of Kirklees

Health Visitors GP link Health Visitors must establish a local system of communicating when families move onto and off the practice list.

New to the area families must be visited at home by a Health Visitor within 2 weeks of being made known to the service and an holistic assessment carried out.

In cases whereby previous clinical records are initially unavailable, the Health Visitor will contact the previous Health Visitor to establish the history.

The clinical records of children moving within Kirklees but across teams must be sent from Health Visitor to Health Visitor rather than via clerical assistants. A confirmation of receipt (Appendix 2) must be sent. For children of concern or on the child protection register there should also be a documented verbal handover. Where the child or children are on the child protection register, the child protection administrator should be informed of the change of worker. Child protection records should always

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be attached and stored with other paper based clinical records relating to a particular child.

School Nurses School Nurses should establish links with GP surgeries and set up communication links when families move on and off practice lists.

As above, the clinical records of children moving within Kirklees but across teams must be sent from School Nurse to School Nurse rather than via clerical assistants. A confirmation of receipt (Appendix 2) must be sent. For children of concern or on the child protection register there should also be a documented verbal handover. Where the child or children are on the child protection register, the child protection administrator should be informed of the change of worker. Child protection records should always be attached and stored with other paper based clinical records relating to a particular child.

In cases whereby previous clinical records are initially unavailable, the School Nurse will contact the previous School Nurse to establish the history.

School Nurses should develop a system of generating an offer of holistic assessment of the child and an information leaflet about the school nursing service. This could form part of the school’s registration pack. The response to the offer should be documented.

There must be a swift transfer of health visiting and school nurse records, to the team which will be assuming responsibility for a family’s care, when families move either internally within NHS Kirklees, or externally to another primary care trust. Records must be transferred within 2 weeks, of receiving information about their changed circumstances. Transfer of records must be supported by verbal communication between professionals.

8.

Ineffective home visits

Consider the prompters in Appendix 3. Document all actions and their outcomes. If still unable to locate the family discuss with team leader or named nurse and document any agreed action.

For children on the child protection register, discuss with the case or duty social worker. Document accordingly.

9.

Failure to attend for appointment (DNA)

Appointments generated by the school nursing or health visiting team Re-appoint If a further DNA occurs consider the prompters in appendix 3. Document all actions and their outcomes.

The families or young persons should be contacted (in the most appropriate way to meet their needs i.e. phone call, formal letter, informal note) to discuss their failure to attend and agree further action. The form of contact and agreed action should be documented. Discuss any concerns with the Team Leader and again, document any discussion and agreed action.

DNA to another service as a result of school nursing or health visiting referral Page 6 of 14

Consider the prompters in Appendix 3. Document all actions and their outcomes.

Consider reassessment / CAF pre assessment checklist if complex family issues are apparent and may be a reason for DNA. This must be done by either the Health Visitor or School Nurse depending on the age of the child. As part of this analysis, also consider seeking individual or group supervision and document any discussion and subsequent agreed action.

10.

Processing A & E slips

The relevant information should be entered on Systmone by the Health Visitor or School Nurse within 3 working days. The original hard copy notification should be shredded.

Depending upon the circumstances and professional judgement (which includes considering any previous A & E attendances), the Health Visitor or School Nurse should consider reassessment of the family. Actions should be record on Systmone It remains the responsibility of A & E staff to follow Child Protection Procedures where a child is considered at risk of significant harm.

11.

Processing hospital letters

Data Protection restrictions do not allow for hospital letters to be photocopied and shared with anyone other than the person they were originally sent to or copied into.

Details contained in hospital letters referring to children up to school leaving age are entered onto Systmone by staff in Child Health Records Department, the original is then sent to the named Health Visitor, School Nurse or team.

It should be documented within the clinical record that the information has been seen by the case manager together with any planned follow up action (if no follow up action is planned, this should also be indicated in the clinical record together with the reason why). The original should then be shredded. This should be completed within 3 working days of receipt by the case manager.

Factors which would trigger reassessment might include: o

Is this an unusual admission?

o

Is this a new condition?

o

Is this a child with a disability that is not currently known to the health visiting / school nursing service?

If the letter is to inform the practitioner that the family failed to attend for appointment, follow the procedures set out in Section 9 above.

12.

Processing domestic violence referrals from West Yorkshire Police Force

It remains the responsibility of West Yorkshire Police to follow West Yorkshire Consortium Safeguarding Children Procedures 2007 where children are identified as being at risk of significant harm and to consider the safety of both the victim and their family.

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Both Health Visitors and School Nurses need to consider whether there are younger or older children within the family who may be at risk and inform the appropriate members of the Primary Health Care Team.

Information regarding domestic violence incidents reported to Child Health Records Department by West Yorkshire Police will be faxed through to the relevant Health Visitor or School Nurse on a daily basis.

Health Visitors In cases whereby a member of the health visiting team is currently providing intervention, contact with the woman concerned must be undertaken in the most appropriate way with an offer of face to face contact in a safe environment. The Health Visitor will document both the police referral details and any subsequent actions. For families at Tier 1 where no immediate contact is due, depending upon the severity of the incident and professional judgement (which includes considering any previous incidents or causes of concern about the child or family), the Health Visitor should consider reassessment of the family and document as necessary. The Health Visitor will consider seeking individual or group supervision and document any discussion and subsequent agreed action.

School Nurses The School Nurse should contact the class dedicated teacher with safeguarding responsibilities to share domestic violence referral information. Depending on the discussion and the nature of the incident, based on professional judgement a decision should be made whether or not a child should be seen. All actions should be recorded, including the rationale behind them. If it is felt that the child is at risk of, or has suffered significant harm, parental permission to speak to a child or young person is not necessary.

13.

Processing information regarding families residing in a Kirklees Refuge

Each refuge should have a named link. Local systems must be in place between staff in the women’s refuge and the locality Supporting Families Team so that families are able to seek advice from health visiting and school nursing services, and whereby appropriate assessment of their health needs can be made.

When contact is made by health professionals with residents in refuge accommodation, a record of contact must be made in line with NHS Kirklees and NMC record keeping requirements. Information sharing and transfer of information relating to children resident in refuge accommodation should also be approached with reference to NHS Kirklees Child Protection Policy.

14.

Equality impact assessment

All public bodies have a statutory duty under the Race Relation (Amendment) Act 2000 to “set out arrangements to assess and consult on how their policies and functions impact on race equality.� This obligation has been increased to include equality and human rights with regard to disability age and gender. The Trust aims to design and implement services, policies and measures that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others.

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In order to meet these requirements, a single equality impact assessment is used to assess all its policies/guidelines and practices. These guidelines were found to be compliant with this philosophy.

15.

Training needs analysis

It is not considered necessary to develop any specific training to accompany this policy, however Health Visitors and School Nurses currently working in Kirklees and those that are in the future should be made aware of the need to adhere to them.

This can be done via team meetings, professional forums or through departmental induction and be recorded via meeting minutes or the induction checklist.

16.

Monitoring compliance with this policy

Compliance with this policy will be monitored through clinical audit in the following way: o o o 17.

Bi annual audit will be carried out It will be the responsibility of team leaders to ensure that this audit is carried out, results disseminated and action plans developed Technical support and advice can be supplied by the Clinical Governance team if necessary References

Hall D.M.B. & Elliman D. (2003) Health for All Children. 4th ed. Oxford University Press Appendices 1.

List of stakeholders consulted in the development of this policy

2.

Confirmation of receipt of clinical records proforma

3.

Prompters to consider when attempting engagement with families or individuals with whom there are difficulties in accessing

4.

Equality impact tool

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Stakeholder Consultation

Appendix 1

Involvement and participation of others in the process of developing this policy as shown below:

Stakeholders name Key participant and designation Provider Services - Joan Booth Locality Managers

Feedback requested 19 May 2008

19 May 2008

Provider Services Team Leaders

– Gemma Brown

6 May 2008

7 May 2008

Provider Services School Nurses

– Ann Heley

6 May 2008

6 May 2008

Provider Services School Nurses

– Trish Thornton

6 May 2008

9 May 2008

Provider Services Health Visitors

– Margaret Battye

6 May 2008

9 May 2008

Safeguarding Team

Jean Selbie

6 May 2008

7 May 2007

Safeguarding Lead

Karen Hemsworth

6 May 2008

6 May 2008

Children’s Commissioning Team

Karen Poole

6 May 2008

19 May 2008

6 May 2008

13 May 2008

Yes

Yes

Provider Services – Angela Horner Children’s Service Development Policy Development Group

Feedback accepted

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Appendix 2

PRIVATE & CONFIDENTIAL

Acknowledgement of Receipt of Records I acknowledge receipt of the: HV Records

[

]

School Health Records

[

]

Confidential File

[

]

For the following family or young person: Surname/s

First Name

DOB

Signature: ……………………………………… Print Name:…………………………………....

Designation:

…………………………………………………

Base: ………………………………………………………

Date: ……………………..

Please post or using the Safe Haven system fax to the sender of the records

Sender name

Address

Fax number

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Appendix 3

Prompters to consider when attempting engagement with families or individuals with whom there difficulties in accessing

1. Is the address correct (confer with GP, housing where appropriate or other involved agency)?

2. Has the family or individual had any contact with any other member of the primary health care team or hospital, nursery or school?

3. Are there any difficulties regarding literacy, language or communication?

4. Have opportunistic visits been considered?

5. Are any other family members known to services that the practitioner might consider contacting?

6. Is the service accessible to the family or individual e.g. at a time and place that is convenient and acceptable?

7. Have cultural issues been considered?

8. Does the individual have hearing or mobility problems?

9. Is the person frightened of answering the door?

10. Consider making an enquiry to the Social Services Contact Point or the Initial Assessment Teams

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Equality Impact Assessment Tool

Appendix 4

To be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval.

Insert Name of Policy / Procedure Yes/No 1.

Does the policy/guidance affect one group less or more favourably than another on the basis of: • Race • Ethnic origins travellers)

2.

3.

4.

5.

6.

7.

(including

gypsies

and

Comments

No No

• Nationality

No

• Gender

No

• Culture

No

• Religion or belief

No

• Sexual orientation including lesbian, gay and bisexual people

No

• Age

No

• Disability - learning disabilities, physical disability, sensory impairment and mental health problems

No

Is there any evidence that some groups are affected differently?

If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable?

Is the impact of the policy/guidance likely to be negative?

If so can the impact be avoided?

What alternatives are there to achieving the policy/guidance without the impact?

Can we reduce the impact by taking different action?

No N/A

No N/A N/A N/A

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