Case Studies

Working together to improve health for children and families

Added 18/06/2015


In December 2013, Sustain developed the Healthy Child Programme Integrated Commissioning and Delivery Toolkit for the zero to five age group. Jointly commissioned by the NHS and local authorities in the east of England, its aim was to provide a methodology to address integrated commissioning while encouraging joint working across local government and the NHS to improve child and maternal health outcomes.
Following the completion of this project, Sustain was commissioned by NHS England’s East Anglia Area Team and the Clinical Strategic Network for the East of England to carry out a six month pilot to test three elements of the toolkit, which were:

  • the antenatal pathway for up to 14 days after the birth
  • the maternal mental health pathway
  • integrated outcomes and key performance indicators (KPIs) 
Key challenges
The project brief identified five counties for inclusion in the pilots, which were:
  • antenatal pathway – Norfolk and Bedfordshire
  • maternal mental health – Suffolk
  • outcomes and KPIs – Cambridgeshire and Peterborough and Hertfordshire 

This meant it would be essential to work across geographical boundaries to effectively test each area while engaging with a wide range clinical staff, commissioners, third sector providers and service users within the five counties.
In order to achieve this and ensure the success of the project, strong working relationships between all groups and a robust engagement plan would be crucial.
Main actions
There was great enthusiasm for the pilot within both the NHS and local authorities across all five counties. Keen to capitalise on this, Sustain encouraged all groups to work constructively together to meet the challenging timelines set out in the initial brief.
We quickly established five local steering groups, under which individual site-specific workstreams were set up to focus on particular elements of the project. All aspects would be tested and developed within these workstreams before further work was carried out to pull together the findings at a county level.
Each workstream completed a range of key actions as part of the project, which included:
Antenatal pathway:
  • review and amend the best practice antenatal pathway
  • test and refine processes for the notification of pregnancy, changes in pregnancy status and birth
  • test, refine and develop effective multi-agency antenatal groups
  • test and refine processes for effective communication and coordination of care
  • test and refine processes for transferring care between midwifery and health visiting services 
Maternal mental health:
  • review the universal pathway with a focus on maternal mental health
  • review, test and agree the use of standardised assessment tools at key milestones
  • review, test and agree processes for effective multi-agency communication
  • review the availability and consistency of signposting information across provider services
  • use best practice pathways to review the uniformity of current service provision 
Outcomes and KPIs:
  • review and test the county-wide vision for the delivery of the Healthy Child Programme (HCP)
  • identify the key integrated objectives for the HCP at a county level
  • develop and agree potential integrated outcomes for the HCP
  • develop and agree additional integrated KPIs to measure local delivery of the HCP 
Outcomes and achievements

Through close and effective partnership working, Sustain was able to deliver all of the objectives set out within the original project brief on time and within budget. As a result, a refined toolkit which supports both commissioners and providers alike was created, along with a range of recommendations and key learning to support its use and implementation at a local level.
A series of workshops giving details of the toolkit and feedback on the project’s outcomes was presented within the east of England, where it was welcomed as an effective tool for assisting in the development of integrated commissioning and delivery.

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