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CLINICAL POLICY

Geographical Corporate Working in St.Helens Health Visiting Service

For use in: Target Audience: Purpose: PCT-St.Helens Health Visiting Clinical Staff St. Helens The core purpose of corporate working is for two or more Health Visitors to have responsibility to one geographically defined caseload whilst retaining individual accountability for each client. Sue Large Lead Nurse Child Health Service Development Clinical Polices Guidelines Group or Equivalent Policy Sub-Committee (PSC) HStHCL239 2.0 May 2010 May 2013 N/A Pre School Services Manager Refer to attached dissemination plan

Document Author: Approved by: Ratified by: Policy Index No: Version Number: Effective From: Review Date: Statutory and legal requirements Implementation Lead Implementation Process

The Trust is committed to creating an environment that promotes equality and embraces diversity, both within our workforce and in service delivery. This document should be implemented with due regard to this commitment This document seeks to uphold the duties and principles contained within the Human Rights Act. All Staff within the PCT should be aware of its implications This policy is due for review by May 2013. After this date, this policy and associated process documents may become invalid. All users should ensure that they are consulting the current version of this document.

Key individuals involved in developing the document (Internal Staff Only) Name(s) Sue Large Julie Banat Designation Lead Nurse Child Health Service Development Service Manager Health Visiting St Helens

Distributed to the following for approvals and comments Committee(s) Members of the Policy Sub Committee (PSC) Members of the Clinical Policies Guidelines Group (CPG) Individual(s) Julie Banat Family Health Coordinators Health Visitors, Community Nursery Nurses, Community Health Nurses Carmel Hilton Ann Hodgkinson Designation Service Manager Health Visiting St Helens Health Visiting service Health Visiting service Safeguarding children service Integrated Governance

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Table of Contents Rationale Expected Benefits of Corporate Working Principles of Corporate Working Responsibility and Accountability Named Health Visitor Link Health Visitor Delegation Principles of Delegation/Allocation Active Caseload All children who are subject to a: Clinic Documentation Continuity of Care Corporate Caseload Transfer of Records Management of Information Communication within the Service Accident and Emergency Liaison Forms Hospital Liaison Letters Standard Systems Audit References Appendix 1 Appendix 2 Appendix 3 Appendix 4 Appendix 5 Appendix 6 Appendix 7 Appendix 8 Appendix 9 4 4 4 5 5 5 6 6 7 7 8 8 8 9 9 9 10 10 11 11 12 13 14 15 16 17 18 19 21 22

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RATIONALE

Nationally, Health Visiting services offer a universal service to children as part of the Healthy Child Programme 2009. Corporate working will enable more choice for clients and aims to use skill mix most effectively. The core purpose of corporate working is for two or more Health Visitors to have responsibility to one geographically defined caseload whilst retaining individual accountability for each client. The benefits to corporate working are in allowing practitioners to develop practice, lowering stress levels, improving accountability and developing community work (Houston and Clifton 2001) Corporate working will ensure that team members set and uphold the same practice and team working standards, will share the workload appropriately, will contribute to the decision making process and will take corporate responsibility for decisions that affect care provision ( Corporate working and HV and PHN teams CPHVA 2004)

EXPECTED BENEFITS OF CORPORATE WORKING

Improving service quality through sharing of knowledge and skills between practitioners therefore improving clinical effectiveness More equitable workloads Promoting team work and staff support Provides a means of dealing with operational difficulties Responding to national drivers More effective, focused planning and evaluation of services Delivery of integrated services within Children's centres.

PRINCIPLES OF CORPORATE WORKING

A shared approach is the norm within a corporate caseload with consistency of practice, to ensure that all families receive a service based upon need, supported by a sound evidence base. All team members to be recognised for the contribution they make to the team and members acknowledge their commitment to the team and develop an open and honest relationship with all team members All team members must adhere to NHS Halton and St.Helens policies and procedures and professional regulations and requirements Health visiting team skill mix staff must ensure compliance with the mandatory and essential training requirements to fulfil their role.

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RESPONSIBILITY AND ACCOUNTABILITY

Professional accountability is fundamentally concerned with weighing up the interest of patients and clients in complex situations, using professional knowledge, judgement and skills to make a decision and enabling the professional to account for the decision made. Specific reference to accountability in the context of team work is provided by the NMC in the Code (2008) that states: "When working as a member of a team, you remain accountable for your professional conduct, any care you provide, and any omission on your part". (4.5) Individual accountability is maintained within the team, with the named Health Visitor holding accountability for the team management overall.

NAMED HEALTH VISITOR

The named Health Visitor in a corporate team is responsible for managing the corporate caseload and where co-workers are involved, peer review of cases, is recommended as good practice. As an unallocated case comes into the team, it is a health visitor's responsibility to be the named Health Visitor for that case during assessment and to take to allocation. If another Health Visitor takes the case from allocation, accountability transfers to the new named Health Visitor Child protection cases and co-working must have a named Health Visitor who is accountable for that case even though a safeguarding specialist nurse may have advised on practice. Health visitors must adhere to the standard operating procedures: Safeguarding Children Record Keeping Standards Safeguarding Children Transfer of Clinical Records Standards

LINK HEALTH VISITOR

Each GP practice should have an identified named health visitor who will maintain contact with the surgery as agreed and collect messages and information from that surgery The link health visitor will liaise with the surgery ensuring the GP is informed of Early Years Health Service Developments and those families receiving targeted care packages including child protection The link health visitor will receive information regarding families with pre school children who are newly registered with the GP practice

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The communication form (appendix 1) identifying the named HV for each new born baby on the caseload should be faxed to the GP practice concerned, by the end of the the week in which the birth is allocated

DELEGATION

When delegating work to others, registered practitioners have a legal responsibility to have determined the knowledge and skill level required to perform the delegated task. The registered practitioner is accountable for delegating the task and the support worker is accountable for accepting the delegated task, as well as being responsible for his/her actions in carrying it out. (NMC 2008. RCN 2006) Delegation to qualified or unregistered staff entails the professional delegating, being responsible to ensure: The delegation criteria is met (appendix 2) That appropriate levels of supervision and support are in place That it is in accordance with professional standards and the employing organisation's policies, procedures and guidelines. (NMC Code 2008) The health visitor always retains accountability and responsibility. The health visitor will assess the need to delegate to other team members and the most efficient use of the skill mix team is considered with a rational for the delegation documented The decision whether or not to delegate an aspect of care and to transfer and/or to rescind delegation is the sole responsibility of the health visitor and is based on their professional judgment. The PCT holds vicarious liability for staff if safe and appropriate delegation with a sound rationale using these guidelines can be demonstrated

PRINCIPLES OF DELEGATION/ALLOCATION

An allocation meeting should be held weekly and prioritised by all members of the team. The Family Health Coordinator should lead the meeting and take responsibility for allocating work and completion and recording in the allocations book. Attendance should be recorded in the allocations book When there is no Family Health Coordinator available, the health visitor, using a rota system to chair the meeting, will delegate the work Allocation of families is for the week following the allocation meeting and depends on the individual practitioners competence and capacity. All team members have a responsibility to share the week's workload with their colleagues, taking into account the active workload.

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Monthly corporate team meetings to be scheduled for all members of the team to attend whenever possible and to incorporate part time members of staff. The focus of the meeting is on team building, review of active families, planning workload and writing and reviewing team objectives and action planning. All families waiting to be allocated must be assessed by a health visitor and allocated using the delegation criteria (appendix 2) to a registered nurse, nursery nurse or another agency, without the need to be seen by the health visitor. A letter or telephone contact may also be considered as an alternative contact. When an antenatal contact has been allocated to a named health visitor, he/she will remain the named health visitor. Families who transfer into the borough are a high priority for assessment and contact should be made within 5 working days. Families who move area within the same borough should be individually assessed by the health visitor for the type of contact and those who do not require a home visit, should receive a letter of introduction and contact to the health visiting team. A new or change in allocation must be discussed at the allocation meeting.

ACTIVE CASELOAD

Records will be filed in a lockable filing cabinet, identifying the named health visitor. They will be filed in alphabetical order by the initial of the surname of the youngest child. Tracer cards must be filed if there are older siblings with different surnames One section within this filing cabinet is to be used to file the records of:children who are classed as `child in need' -children assessed at level 3 on the continuum of needs framework - `looked after children' - children on a child protection plan -

All children who are subject to a: Child in Need plan should have their records placed in a blue coloured folder. Safeguarding plan should be placed in a red coloured folder Looked After Children proceedings should be placed in a yellow coloured folder All records should clearly identify children subject to a Child in Need Plan, Safeguarding plan or who are looked after by the Local Authority, in accordance with the Standard Operating Procedure Safeguarding Children Record Keeping Standards. The following cases are designated as active and to be retained by a named health visitor. These active cases will be identified in sections in the filing cabinet: 1st section contains children in procedures 2nd section contains families with children up to the age of twelve months 3rd section contains vulnerable families with open care episodes

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Following the twelve month contact, the family record to be transferred to the corporate caseload unless there is continuing needs as deemed by the named health visitor Families who have a completed episode of care are to be assessed by the health visitor before being transferred to the corporate inactive caseload.

CLINIC DOCUMENTATION

A diary is to be maintained in clinics to identify the dates when families have been asked to return to clinic when there are stated concerns from any team member. This will provide a check system to ensure attendance and any child who does not re-attend is reported to the named health visit for follow up. The diary is stored at the front of the clinic records box or cabinet. This diary will offer effective communication between practitioners and entries will be in accordance with standard guidance (appendix 3) A contact sheet is completed for every child who attends the infant welfare clinic (appendix 4)

CONTINUITY OF CARE

All health visitors have a case management responsibility and have an identifiable active caseload within the corporate caseload as a named health visitor. The named health visitor will ensure there is continuity of care for a child It is the responsibility of the named health visitor to decide when the child's records are filed as part of the corporate inactive caseload. When a child's records have been identified as inactive and there are new episodes of care required, the previously named health visitor for that child will continue to provide any continuing care.

CORPORATE CASELOAD

The corporate caseload will consist of all families who do not meet the criteria for the active caseload. The records will be housed in a separate lockable filing cabinet and include families of children aged 12 months to pre school age Records will be filed in alphabetical order according to the surname of the youngest child. Tracer cards must be filed if there are older siblings with different surnames Allocations from the corporate caseload to the active caseload will be inline with the active caseload criteria. A child who does not attend for a 2 year assessment and has not had a previous 12 month assessment, must be referred to the named health visitor who will assess the need to contact the family and arrange to see the child

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TRANSFER OF RECORDS

A single birth book is used for the whole caseload, divided into yearly births An allocated team member will be responsible for maintaining the birth book, recording transfers in and out and notifying changes to the information services department Transfer of records to the school nursing service is the responsibility of the clerical support officer. The health visitors will share the workload in checking these records and liaise with the school nurse on continuing care needs or child in need issues. Tracer cards to be used when records are requested by different professionals or transferred out of base.

MANAGEMENT OF INFORMATION

A `clear desk' practice should be in operation. No records or patient identifiable information to be left on desktops overnight or when there are no staff in the office Tracer cards must be held in every Child/Family Health Record. The cards must always be completed by the person who removes a record from the filing cabinet and be placed where the record was removed. The tracer card is to include details of the date of removal and the name of the individual requesting the record. When records are replaced, the date of return is recorded on the tracer card. Individual staff are responsible for completion of the tracer card when passing records to other personnel so that the whereabouts of the records are always correctly recorded All Family Health records to be filed in lockable filing cabinets. Staff must ensure that filing cabinets are locked at the end of the working day or when the office is empty.

COMMUNICATION WITHIN THE SERVICE

All staff are expected to maintain an electronic diary which is accessible by the team leader Meetings between Early Years Personnel and PCT staff are essential in the development and maintenance of robust communication channels. Staff are expected to attend the weekly corporate meetings, monthly sharing good practice meetings, and monthly child protection supervision unless on leave, on sick leave, on agreed training or covering child protection meeting. When unable to attend, apologies need to be forwarded to the relevant person

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Family Health Coordinators will meet monthly to agree key messages to staff and to ensure consistency of approach across the service. Messages for staff who are not in the office or not available, need to be written in message books to include the name of the staff member receiving the message, time and date the message was taken. This needs to be signed and dated by the recipient of the message once seen/actioned. When a message relates to a child, parent or family member of a pre school child, the message is filed in the appropriate child's notes or family records. A list of babies/children who do not attend sessions following arranged appointments, to be forwarded electronically at the end of each month to the service lead (appendix 5) The service lead will be notified monthly of the current waiting times for developmental assessments

ACCIDENT AND EMERGENCY LIAISON FORMS

The A&E forms are received by the clerical staff and stamped with the date of receipt. The relevant notes are identified and made available with the form attached The allocated health visitor is responsible for assessing the A&E forms each day. If the child is currently weighted as belonging to the universal caseload, the health visitor will write, underneath the signature on the form, stating that no action is required. The notes are given to the clerical support who will enter the details on the chronology of significant events form and finally, file the notes. When further action is required, the health visitor enters the information on the chronology significant events form and retains the notes (using a tracer card), to action as appropriate at the next corporate meeting.

HOSPITAL LIAISON LETTERS

The hospital letters are received by the clerical staff and stamped with the date of receipt. The relevant notes are identified and made available with the form attached The named health visitor to read and sign the letter and action as appropriate to need. Where there is no named health visitor, the allocated health visitor for liaison forms will read the letter and assess the need for action following the procedure for A&E forms as above.

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STANDARD SYSTEMS

Health visiting teams working as a corporate caseload will practice using a standardised process and equipment. (Refer to Appendix 6).

AUDIT

The content of this clinical policy will be audited by the Health Visiting Team annually.

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REFERENCES

Reference Relevance (whole document or section, please state) Evaluation Study Whole document Evidence Grade Professional document

Houston And Clifton (2001) An evaluation of the transition of health visiting service delivery from individual caseload holding to corporate working CPHVA (2004) Corporate Working And HV And PHN Teams NMC (2008) The Code Royal College of Nursing (2006) Supervision, accountability and delegation of activities to support workers Halton and St.Helens NHS (2007) Policy on Clinical Record Keeping Halton and St.Helens NHS (2010) Non- Clinical Standard Operating Procedure (SOP) Safeguarding Children Record Keeping Standards Halton and St.Helens NHS (2010) Non- Clinical Standard Operating Procedure (SOP) Safeguarding Children Transfer Of Clinical Records Standards

Professional guidance Whole Document Section Delegated duties Whole document

Professional document Professional Document Professional document Clinical policy SOP

Whole document Whole document

Whole document

SOP

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APPENDIX 1

Click here to download the letter Communication form GP

Clinic address Contact number

Our ref: Date:

Dear Dr.

Re: Child's name Date of birth Address Mother's name

I wish to inform you that the Health Visitor caring for this mother and baby is

Name of Health Visitor: Base: Contact number:

This parent/carer has advised that for the 6 week assessment, the baby will be taken to Clinic general practice (please circle)

Yours sincerely

Health Visiting Team

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APPENDIX 2

Delegation criteria The health visitor will retain responsibility and accountability for the delegation. The health visitor will carry responsibility to intervene if s/he feels that the delegation becomes inappropriate or unsafe. S/he has the right to refuse to delegate if they believe that it would be unsafe to do so or is unable to provide or ensure adequate supervision No one should feel pressurised into either delegating, or accepting a delegated task The delegation of care must always take place in the best interests of the client The decision to delegate must always be based on an assessment of the individual client's needs. The health visitor may only delegate an aspect of care to a person whom they deem competent to perform the task and they should assure themselves that the person to whom they have delegated, fully understands the nature of the delegated task and what is required of them. The person to whom the task is delegated must have the appropriate role, level of experience and competence to carry it out. They should have demonstrated they are competent to undertake the role and have been trained & assessed as competent to undertake the activity. The person to whom aspects of care is being delegated, understands their limitations and when not to proceed should the circumstances within which the task has been delegated changes. The level of supervision and feedback provided is appropriate to the task being delegated. Delegated tasks must be monitored at agreed intervals, using agreed documentation and lines of communication Delegated duties are in accordance with professional standards and the employing organisation's policies, procedures and guidelines. Clears lines of delegation should be included in patients' care plans with a rationale for the delegation

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APPENDIX 3

Communication book guidance for clinic attendees A diary is to be maintained in clinics to identify the dates when families have been asked to return to clinic when there are stated concerns from any team member. This will provide a check system to ensure attendance and any child who does not attend is reported to the named health visit for follow up. The diary is stored at the front of the clinic records box or cabinet.

Each clinic session has an identified communication diary to record the details of the baby/child who has been asked to return for review. The name and date of birth of the child is entered on the date the child is due to return to clinic. The person requesting the review, enters the reason for review alongside the child's name The practitioner who undertakes the clinic session, identifies the children who have been asked to return and the results of attendance or not, entered against the child's name The practitioner, who undertakes the clinic session, is responsible for reporting attendance and outcomes to the appropriate health visitor.

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APPENDIX 4

Clinic contact record A documented record is maintained for every child who attends clinic to aid in communication and continuing care. A contact sheet is completed for every child who attends clinic and has contact with the practitioners in the health visiting team The reason for the attendance is recorded Documentation to include: Content of the discussion Type of feeding/diet Condition of the baby/child Growth measurements Identification of the Carer in attendance Significant concerns stated by the Carer Concerns of the practitioner

An action plan is identified

Weight and centile charts completed at attendance at infant welfare clinics

The Practitioner, who undertakes the clinic session, is responsible for reporting any concerns regarding a child or family to the appropriate health visitor and documenting this action.

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APPENDIX 5

Template for non attendance

Click here to download the form To be returned electronically to the Health Visiting Service Lead at the end of each month

NOTIFICATION OF NON ATTENDANCE HEALTH VISITING SERVICES

Month ending : Name of Health Centre:

Name NHS No Date Of Birth Date and name of clinic session Episodes of non attendance this month

Total episodes of non attendance

Action

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APPENDIX 6

Standard Systems and Equipment

Resource Allocation book Contents Process Rationale To identify a child's status and professional responsible for care To promote team working To enable the team to allocate workload efficiently To identify where staff are working alone To ensure equity in delivery of services

Team diary

Filing cabinets

Duty box file

Stored in the allocation drawer of the Confidential filing system information of child and family Child details entered: status in caseload Name Date of birth Name of allocated professional Description of allocation i.e.birth Date of allocation and named professional Working practices Each team member to insert dates and and whereabouts venue information for each working day. of team members To include: for reference -Allocated duties - Attendance at clinic/groups sessions with venue and time - annual leave - flexi time - sick leave -study days All records stored in the filing system. No Lockable filing records to be kept in desk drawers or left cabinets on desk tops overnight Child and Records filed alphabetically according families within to the family surname or the youngest the corporate child's surname if differs caseload Double barrelled surnames filed by Drawer first letter of the surname containing the allocation book Older children filed with the youngest sibling and tracer cards used to identify the location of the notes Unallocated children, new birth visits or removal in records temporarily stored in the allocation drawer Correspondence This box file to be stored in the allocation and liaison forms drawer of the filing cabinet. The health visitor will manage correspondence as per policy

To ensure a consistent approach in retrieving or identifying family records To maintain secure documentation and data protection

To assess care according to need To provide integrated care

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APPENDIX 7

Record Keeping Protocol in a Corporate Caseload

The additional guidelines in this protocol will ensure that practitioners practice in a robust and secure environment that offers continuing and safe care to the children and families on the caseload. All practitioners must also adhere to the Trust Health Records Policy 2010 and the NMC guidelines on Record Keeping as stated in the Code 2008.

Records initiated A child's record should commence following an antenatal contact or information received in the antenatal period where the information is relevant to the child's future health and well-being. If there is no antenatal information, the child's record commences at the birth visit.

Filing Records are filed at the front of the cabinet containing the active caseload and sectioned as `antenatal' When the baby is born, this information is included in the child's records, if it is relevant to the child's future health, well-being and safety. If the baby dies in-utero or if the baby is still born, the record is stored at the back of the nonactive caseload cabinet and sectioned as `inoperative'. These records are to be retained for 8 years after death of the foetus (annex D1: Health Records Retention Schedule Part 2, 2nd Edition 2009) If the illness or death could have potential relevance to adult conditions or have genetic implications for the family of the deceased, the advice of clinicians should be sought as to whether to retain the records for a longer period.

Antenatal documentation Antenatal documentation is recorded on a white record card, together with an attached referral sheet and is to contain the following basic information: Maternal surname Current address of the mother Maternal date of birth Expected date of delivery Information relating directly to the child or has an impact on the welfare of the child, is recorded on the white card. A reference to indirect information contained on a family green card may be made. Information concerning other family members that are of no direct relevance to the child's welfare is recorded separately on green card. This information may be reference on the white card but is stored independent of the child's records.

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Content of Record

Information and activity relating to the child and/or family is to be recorded. This includes: Information from the use of the assessment frameworkDevelopment of the child Family and environmental issues Parenting capacity Information relating to a direct contact Information relating to an indirect contact Liaison correspondence (see Corporate Caseload Policy) Messages from other colleagues/services/agencies Referral to or from internal/external agencies: Rationale for referral Designation of referee/to whom referred Time and date of referral Expected outcome of referral

Action Plans

Following each direct contact or when a change in care needs is identified, records should include a final evidence of analysis that identifies: Immediate actions Rationale for decision making Future care provision Expected outcomes. Records are stored in line with the colour code system of the Corporate Caseload Policy and recorded entries should this status.

Audit

Records and record keeping will be audited annually as per policy on Corporate Caseload working.

References

PCT policy DH 2010 Corporate Caseload Policy 2006 Records management: NHS code of practice

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APPENDIX 8

Equality Impact Assessment Tool

To be completed with the policy document when submitted to the appropriate committee for consideration, approval and ratification. Yes/No 1. Does the policy/guidance affect one group less or more favourably than another on the basis of: 2. 3. Race Ethnic origins (including gypsies and travellers) Nationality Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Age Disability - learning disabilities, physical disability, sensory impairment and mental health problems No No No No No No No Yes No No Yes See above Specific to infants 0-5 years Comments

Is there any evidence that some groups are affected differently? If you have identified potential discrimination, are there any exceptions valid, legal and/or justifiable? Is the impact of the policy/guidance likely to be negative? If so can the impact be avoided? What alternative are there to achieving the policy/guidance without the impact? Can we reduce the impact by taking different action?

4. 5. 6. 7.

No NA NA NA

If you have identified a potential discriminatory impact of this policy document, please refer it to [insert name of appropriate person], together with any suggestions as to the action required to avoid/reduce this impact. For advice in respect of answering the above questions, please contact [insert name of appropriate person and contact details].

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APPENDIX 9

Dissemination and Training Plan

To be completed with the policy document when submitted to the appropriate committee for consideration, approval and ratification. The status column must be given a Red, Amber or Green rating with evidence to demonstrate an action has been completed. DISSEMINATION PLAN

Title of document: Corporate working in health visiting service Dissemination Lead: (Print name and contact details) Sue Large Date finalised: February 2010

Previous document already being used?

appropriate)

/No (Please delete as

If yes, in what format and where? Proposed action to retrieve out-of-date copies of the document: To be disseminated to: Disseminated by whom? Julie Banat Timescale (Date) By March 2010 Status

RAG

Red

Paper or Electronic Electronic

Comments

Health Visitors and Nursery Nurses within the Health Visiting service.

Document not yet ratified.

TRAINING PLAN

Event (Please provide details of available training venues/dates to educate staff about this policy document) Timescale Owner Status

RAG

June 2010 Team leader A

To be arranged by service Team members to be trained individually by the team leader

Training Plan Lead (Please provide details of staff who will be responsible for overseeing this training) Family Health Coordinators Julie Banat Additional information (Please provide details of any processes in place to support implementation) Caseloads already organised

A

Denotes: Action not yet taken or deadline for action not met. Action plan to address this must be provided. Denotes: Action partially implemented. Denotes: Action complete.

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