A realist evaluation of the enhanced health visiting service in NHS Ayrshire and Arran

1 Introduction

Background

1.1 The early years of life is an important time for children and families. It has been argued that the provision of universal access to healthcare in early years has the greatest potential to promote health and wellbeing and reduce health inequalities in later life (Marmot et al., 2008; Roberts, 2012). In the UK, one such provision is the universal child health programme, often but not solely provided by the Public Health Nursing Services. Recently, the Public Health Nursing Services - Future Focus (CEL 13: (2013) recommended a refocusing of the Public Health Nursing (PHN) roles, responsibilities and titles. Briefly, it specified that the existing Public Health Nursing role as defined in Nursing for Health 2001, should be refocused and the titles of health visitor and school nursing reintroduced. Further, it suggested that the role of the health visitor should focus on pre-birth to 5 years. This refocusing of the PHN role is intended to support the delivery of targeted interventions, delivered by a specialist workforce, who will be better equipped to address the specific needs of children and families.

1.2 The Scottish Government is currently supporting NHS boards to implement the recommendations of CEL 13. In line with this, and in recognition that families were receiving variable service experiences, the Nurse Director at NHS Ayrshire and Arran commissioned a nursing review to provide intelligence to support the development of the Community Nursing Service that allows the workforce to develop and puts children and families at the centre. The goal was to improve care delivery by improving access to services closer to home. As a result, significant organisational changes were introduced to the health visiting service in NHS Ayrshire and Arran from mid-2013. The key changes include an introduction of a universal assessment timeline that increases assessment contacts with children and families. Core families (families who do not usually require additional monitoring and support) now receive eleven visits from their health visitors, beginning from when children are 11-14 days old until the preschool handover assessment contact. Moreover, throughout the period, additional programmes of care can be offered to children and families if required. Moreover, health visitors are no longer required to immunise children or be involved in drop-in clinics. How these changes impact on health visiting practice and whether or not they make a difference in terms of outcomes for children and families need to be examined in order to inform the impending roll-out of the enhanced health visiting service across Scotland.

Aim and objectives

Aim:

1.3 To understand how the enhanced health visiting service in NHS Ayrshire and Arran works since its introduction in 2013, with a view to informing the implementation and evaluation of a structured, increased home visiting service in Scotland.

Objectives are to:

1. Describe the model of enhanced health visiting implemented; expected outcomes and how the service would achieve these (using a logic model)

2. Assess whether the service was delivered as expected and whether outcomes were achieved

3. Explore parent and nurse experiences of the service

4. Identify barriers/enablers to implementing the service

5. Assess the implications for wider adoption of an increased health visitor service

6. Identify the implications for future national evaluative activity of the roll-out of the health visiting model

Structure of the report

1.4 The first chapter outlines the background, aim and objectives of the evaluation. Chapter two provides an overview of the realist design adopted by this evaluation and also describes the methods used to generate data. In line with the stages of realist evaluation, the findings are presented in three chapters. Chapter three outlines the logic model of the enhanced visiting service (Phase 1). Health visitors and parents' findings are reported separately in chapter four and five (Phase 2). Chapter six provides further explanation and refinement of the findings (Phase 3). Chapter seven summaries the key conclusions of the evaluation and provides recommendations both for NHS Ayrshire and Arran and in the context of implications for national implementation and evaluation of the enhanced health visiting service.