Case Studies

Helping the NHS deliver the health visiting call to action

Added 30/03/2013


When the health visiting call to action was launched in 2011, it provided a clear mandate for strengthening and expanding services to ensure more children could get the best possible start in life. The programme set an ambitious pace, and aimed to recruit 4,200 additional health visitors within just four years to transform the service and improve outcomes for families.
This left providers from across the country facing a number of challenges, from securing the necessary investment needed to drive forward the programme to recruiting and integrating the new staff and developing enhanced services. Although undoubtedly an opportunity for health visiting provision to improve, the programme also represented a significant change for the service against a background of major upheaval in the rest of the NHS.
Sustain was called in to carry out its unique rapid appraisal to help NHS Midlands and East gain a clear picture of where each of its providers stood and the steps required to fully implement the health visiting call to action.

Key challenges
The scope of the project was incredibly wide, and involved 33 organisations from across the East and West Midlands and East of England. Because of the way the procurement was organised, Sustain was required to contract and engage with each provider/ commissioner combination individually.
In addition, Sustain quickly discovered that cultures and project management approaches differed greatly across the regions, which could potentially impact the way the rapid appraisal was delivered. This meant that careful management was required to ensure the process was consistent so that services could benchmark their progress effectively.

Main actions

Working in collaboration with NHS colleagues, we developed detailed areas of enquiry and dashboard categories specific to health visiting which were needed for the Sustain Rapid Appraisal. These would be used to assess the progress of each provider towards the full implementation required of them by 2015.
A package of materials including briefing packs, output report templates and project management processes was developed, while clinical associates were given training to assess and cross validate their assumptions.
Individual appraisals were then arranged with each service, which followed a set schedule:

  • Sustain identified key areas for enquiry and requested relevant evidence, such as workforce growth plans, performance reports and financial information.
  • Two consecutive days of meetings took place in one week to give an insight into the organisation’s culture, its relationships with key stakeholders and the support it receives. Responses given by different staff were triangulated and collated on a dashboard to give an objective overview.
  • A third day was held a week later to follow up on the responses from day one and complete a peer review using health visitors from other services.
  • A robust yet concise report providing observations, implications, recommendations and areas of possible support was delivered just eight days later. Visual and easy to digest, the report uses a series of dashboards to illustrate the findings of the appraisal, giving it immediate impact and value.

Outcomes and achievements
During the course of the Sustain Rapid Appraisal, we visited 33 services, carried out 1,229 interviews and accumulated more than 30,000 responses. The process has won praise for encouraging engagement with staff at all levels, as well as key stakeholders, and has been described by those taking part as “supportive and non-confrontational”.
The output report produced at the end of the process has also been well received, offering a factual yet objective assessment which recognises good practice and potential support required as well as areas of note and concern. The information it produced has been put to good use by the NHS’s new commissioning bodies to help them understand the actions needed to meet the challenges of the call to action.


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