Just a few weeks into 2011-12, I find myself reflecting on the council’s most difficult decision last year, as I steel myself for the future
Was it any of the following? Setting a 2% decrease in council tax; restructuring senior managers months before the CSR announcement; voting to step outside county boundaries by joining the Greater Birmingham and Solihull LEP; or advising local politicians to press ahead with a lucrative asset disposal of a shared (crematorium) service, which will not win votes.
It was none of them. The toughest call has to be keeping faith with a Total Place project in a ward which features in the most 5% deprived across the country.
East Staffordshire BC’s Anglesey ward in Burton upon Trent has disproportionate levels of deprivation and a number of social inequalities that the council and its partners are looking to address. The ward has a high proportion of children and residents who class themselves in poor health or with life limiting illnesses. So much so, East Staffordshire hit the headlines in 2009 as statistics showed the area had the sixth highest infant mortality rate in England.
Consequently, in January 2010, the council adopted a Total Place Strategy for the Anglesey. The main objective of the strategy was to raise people’s aspiration, at the same time nudging residents into influencing decision making in relation to wealth, health and wellbeing.
The strategy looked at how partners and residents could work together to reduce inequalities, in particular education and employment, environment and health, crime and safety to tackle anti social behaviour, infant mortality and teenage pregnancy.
The most significant project by far was the introduction of a ground-breaking support scheme for new mothers to reduce infant mortality rates. The widely acclaimed Nurse Family Partnership introduced from the US is now being delivered with expectant mothers in Anglesey ward. The Family Nurse Partnership (FNP) - as it is known in the UK - provides intensive support for first-time mothers during pregnancy and for the first two years of the child’s life, helping mothers with such aspects as healthy eating, relationships with the father and wider family, and financial planning.
Each nurse typically supports 10 mothers.
FNP is delivered by East Staffordshire and Derby City PCT in a partnership crossing regional, county and district borders. Having selected FNP as the preferred scheme, we found it was available only at Derby so we got permission from the Department of Health and South Staffordshire PCT to purchase a health care service from over the regional boundary. We are working with a community interest company, as well as investing £120,000 of our own money over the next three years, to fund the scheme because of cash restrictions amongst other partners.
We justified this under the council’s community leadership role and the ‘power of well being’ from the LGA 2000.
Health minister Anne Milton highlighted our project in a speech in November 2010 saying she was “delighted the Family Nurse Partnership will be extended (into East Staffordshire) to provide the highly targeted, highly specialised support that the most vulnerable families need”.
Initially, the project experienced difficulties as rigid organisational structures and geographical boundaries prevented delivery of the FNP scheme. However, ‘Family Nurses’ are now active in the ward visiting expectant mothers. Recent figures show rates have reduced from 8.7 to 6.2 deaths per 1,000 live births.
Andy O’Brien, chief executive, East Staffordshire BC
FNP supervisors have to practice clinically and keep a caseload of families. At the same time, they are responsible for clinical and safeguarding supervision of the nurses in their team, for managing and quality assuring the work, supporting team learning as well as engaging colleagues and ensuring the systems are in place for delivery of the programme locally. A tall order no doubt, but one that FNP supervisors are showing can be done – with training, support and a good service model to focus on. This system still needs local clinical leaders but with a different role from before. We need people who are experts in their field, in our case prevention and early childhood development, who understand evidence based practice and replication, with a good understanding of how to use data and outcome measures and who can mirror the ethos of FNP in their relationships and behaviours. It seems to me that key in this is staying close to communities, clients and practice. Perhaps credible and applied clinical leadership comes from being only one or, at a maximum, two handshakes away from clients/patients as well as one or two handshakes away from decision making. Otherwise, how can we ever make sure that ‘no decision about me, without me’ happens?