Derby City and DerbyshireFamily Nurse Partnership

David StephensonTaking over delivery of services for young parent and their children

29th June 2012

Who we are Ripplez?

• An ex-NHS service that has operated since 2007

• Social Enterprise since Jan 2011 – staff transferred out of the NHS 31 March 2011.

• Owned and run by staff for the benefit of young families in Derby and the surrounding areas

• Deliver Family Nursing Partnership in Derby, Derbyshire and Burton

What Ripplez do?

• Preventive, intensive, structured home visiting programme.

• Offered to first time mothers 19 and under • Recruited in early pregnancy no later than

28weeks gestation and remain with the family nurse until child is 2.

• Licensed programme with fidelity measures to ensure replication of original research.

Objectives of the FNP Programme

• Improve pregnancy outcomes;

• Improve child health and development and future school readiness and achievement;

• Improve parents’ economic self-sufficiency.

Why we left?• Creating a focussed organisation with less management

layers and bureaucracy • Empowering staff through direct control of the organisation;• Enabling access to more funding streams not currently

available to PCTs to increase sustainability and reduce overheads;

• Developing more services for existing service users such as volunteer programmes, housing support and greater access to employment or training;

• Expanding services to other geographical areas;• Creating community ownership that has formal links with

service users and key partners;• Ensuring surpluses are reinvested into the communities we

work to further develop and improve services.

History – Before leaving NHS

• Service setup as a national pilot in 2007;• Right to Request process in late 2009;• FNP became part of DoH Operating Framework –

early 2010; • Approved by the PCT Board in April 2010 and started

working as a Shadow Organisation;• Won contract to provide Family Nursing in Burton• 5 Yr Contract & Transfer Agreement Agreed March

2011 (11 staff transferred);• Commenced trading 1 April 2011

Actions required to leaving NHS

• Business Plan, due diligence and approvals;• Agreeing contracts;• Staff consultation and training;• Setting up Company;• Appointing board and organisational

structure;• Setting up bank account, tax status and

accounting system;• Setting up policies & procedures.

History – After leaving NHS

• June 2011 - won contract to deliver FNP to Derbyshire;

• August 2011 – signed contract with Impetus Trust;• Set up Footsteps – Young Families Group in Derby• Won Big Venture Challenge 1 of 25 out 800

organisation;• Strategic review – Nov 11 to May 12;• Extention to Derby Contract – Jan 12• First year end completed March 2012 (25 staff). • Extention to Derbyshire Contract – Jun 12

Our Plan to Scale Up• Settling down in a new organisational form.• Achieve a three/six months cash buffer.• Maintain and develop our workforce.• Be aware of competition.• Secure additional funding to develop the business.• Develop specifications for new services.• Improve tendering and contractual skills (capability

and capacity).• Ensure young parent involvement in the running and

development of the business.

• This was uncharted territory for the whole team!

Lessons learnt (1)

• Understanding the level of commitment, time and effort required to run a company;

• Creating an identity & ethos;• Communication – keep staff involved;• Staff are your greatest asset – knowledge &

ideas;• Recruiting is expensive in resources so it is

important to get it right;• Managing relatonships – commissioners,

clients, funders and partnership organisations;

Lessons learnt (2)

• Get on top of your finances;• Going for realistic funding opportunities;• Managing multiple locations;• Maintaining staff training;• Managing the Board of Directors;• There is still bureaucracy to manage;• Get your self noticed in a good way; • You can not wait for thing to happen for you.

Summary

• The experience has energised staff;• Have increased our Family Nursing capacity

from 130 to 390 clients;• Ripplez has grown from 11 to 27 staff,

maintaining financial stability.• Staff are now more focussed on service and

financial issues;• Staff are empowered and feel more

comfortable with service development and growth;

Family Nursing

More About the Programme

Theoretical Basis

• Human ecology theory (client’s social and material context)

• Attachment theory (client as a ‘safe base’ from which her child can grow and learn).

• Self efficacy theory (ability to change behaviour by learning to draw on strengths and successes – building skills and confidence).

What do Parents Receive?

• Voluntary programme.

• Frequency of visits in pregnancy weekly first 4weeks then fortnightly.

• Infancy weekly first 6 weeks then fortnightly to 21 months.

• Monthly preparing for ending of programme.

• Each visit has structure and planned content.

The ‘6 domains’

• Personal Health

• Environmental Health

• Life Course Development

• Maternal (and Paternal)

role

• Family and Friends

• Health and Human

Services

Guidelines for Nurses

• Pregnancy

• Infancy

• Toddlerhood

• Supported by PIPE, Ages

and Stages and DANCE

Approach

• Therapeutic alliance

• Focus on bonding,

attachment and emotional

availability of caregivers

• Utilises client’s primary

motivation

• Strength based, positive

and hopeful

• Using motivational

interviewing skills

• Respectful agenda

• Setting goals

Communication Styles Used to Engage

• Self Efficacy – “Well done, what a great achievement cutting down to 15 cigarettes per day”

• Guiding/MI – “Sounds like you already had a knowledge of risks of smoking in pregnancy”

• “What motivated you to cut down?”

• “It sounds like your baby’s health is very important to you”

Case Studies - Burton

‘Making a Positive Difference to the Lives of Young Families’ RippleZ Mission Statement

Case Study 1

Before FNP• Involved with Social Care• 20 a day smoking habit and

cannabis• Unemployed and homeless• Poor diet• Low self esteem• Unplanned pregnancy• No parental support

With FNP• Social Care no longer involved• Smoking reduced and not using

cannabis• Living in rented accommodation• Eating more healthy meals• Aspires to entire education in

future years• Using contraceptives• Improved relationships with

family

2121/04/23

Case Study 2

Before FNP• Involved with a “bad

crowd”, social involved• Abusive ex-partner• Poor diet and smoker• Father spent time in prison• Low self esteem• Unplanned pregnancy• No parental support

With FNP• Social Care no longer

involved• Partner in prison• Quit smoking and eating

healthy meals• Taking A-levels• No GP visits• Using contraceptives• Supported by the family

2221/04/23

Financial outcomes and benefits

Individual• Stopping a 20 a day habit

saves £1971.00• Breast feeding saves

mothers £435 each year• Mothers qualified to A-level

standard can earn £3.07 per hour more than unqualified

Public sector• Obesity costs NHS £950 per

person per year• Costs saved of placing child

into care £2500 per week• Social care saving £400 per

week • Domestic Violence £240 per

incident• Council hostel £484 per

week

23

Health & Social outcomes and benefits

Individual• Stronger family

relationships• More interaction with the

fathers for mother and baby• Healthier lifestyles• Preventing of infections

acquired by babies• Increased self esteem• Stable accommodation

Public sector• Reduced crime• Reduced levels of obesity

and smoking related illness• Reduced demand on hostel

accommodation

24

Public sector savings (Years 1 & 2)

25

Ripplez!

Ripplez CICDerby City Family Nurse

Partnership

Revive Healthy Living CentreRoe Farm Lane

DerbyDE21 6ET

T: 01332 888091E: info@ripplez.co.uk

www.ripplez.co.uk

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