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Joint health and commissioning approach to transform the health visiting service in Haringey

14th July 2016

A case study by Geraldine Butler, Healthy Child Programme Lead at Haringey Health Visiting Service, on the joint health and commissioning approach to transform the health visiting service in Haringey, from a targeted to a universal offer – a superb example of the challenges faced around the country.


In 2009, the Haringey Health Visiting Service moved from a universal to a targeted offer. The only universal contact with families was the new birth visit. The service had a small skill-mix workforce and struggled to recruit health visitors.

Following the Health Visitor Implementation Plan and Call to Action in 2011, Haringey Primary Care Trust was given additional funding to grow their workforce.

Whittington Health NHS Trust struggled to meet their trajectory target. To address this, in the summer of 2015, NHS England agreed to fund a ‘recruitment and retention premium’ for health visiting posts to address discrepancies with the London Living Allowance across the Trust. This agreement continued with the transfer of commissioning responsibility to Haringey Council in October 2015.

Whittington Health NHS Trust and Haringey Council were keen to have a universal Health Visiting Service operating in the borough. Leading up to the transfer of commissioning responsibility in October 2015, Whittington Health NHS Trust and Haringey Council agreed to a 12-month secondment opportunity for an experienced health visitor to sit with the Public Health team to implement the roll out of a universal Healthy Child Programme (HCP).  Alongside the role, a Public Health HCP Officer was recruited to provide additional capacity for this important transformation programme.

Immediately following the transfer, some of the health visiting budget was reconfigured to increase the skill-mix workforce.

This was an ambitious programme to move from a targeted service to a universal offer within 12 months, working closely with the borough’s Children’s Centres and the Council’s Children’s Services on an integrated model of service delivery.

Our achievements to date

  • Multi-partnership working groups to implement the 5 mandated points of contact
  • Protocols for each mandated contact
  • Roll out of universal one and two-year health reviews from April 2016
  • Integrated reviews in all children’s centres and some private, voluntary and independent nurseries from May 2016
  • Reconfiguration of 4 health visiting teams to 10 smaller teams, to mirror the Council’s locality teams and Children’s Centre offer, to create a virtual team around each family
  • An increase in the skill-mix workforce from 9.4 FTE to 24.6 FTE
  • Improved health visitor recruitment from 25.86 FTE to 30.46 FTE plus 15 HVs in recruitment
  • User feedback forums
  • Joint training opportunities across the integrated workforce incorporating skills practice
  • Introduction of mobile working, laptops  for  the health visiting workforce funded by Public Health
  • Monthly Healthy Child Programme newsletter to all staff and partner agencies

Future plans

  • The full roll out of a Universal Healthy Child Programme by October 2016
  • Embedding the changes across the teams
  • Harnessing training opportunities across the multiagency workforce
  • Continuing to work on an integrated model to support all families to achieve the best outcome for their children

What we have learnt

The secondment into the Council’s Public Health team allowed a bridge to be formed between the health visiting service and commissioning. It has created an opportunity for an improved, deeper understanding of the challenges faced by both and created a two-way dialogue. Taking an experienced health visitor out of practice to work with Public Health commissioners, with a focus on supporting the health visiting teams to shape the offer, has been key to the success of the programme to date.

The bespoke team of a commissioner, HCP lead and officer, with additional support to reconfigure the teams, has drawn in a wealth and variety of skills and experience which have complimented each other to great effect.

Geraldine Butler

Healthy Child Programme Lead, Haringey Health Visiting Service, Whittington Health NHS Trust