The aim of this essay is to examine the significance of collaborative working to achieve positive outcomes for service users. “Collaboration is a dynamic inter-professional process which two or more professionals make a commitment to solve problems and to learn from each other in order to accomplish identified goals, purposes or outcomes” (Hamric, Spross and Hanson, 2000, p.318). Since the publication of Every Child Matters (2004), social care, health, voluntary sectors and other children’s services have been joining forces to work more collaboratively around an early intervention and preventative agenda (Department for Education and Skills, 2004).
This essay will focus on the National Childhood Measurement Programme (NCMP) and by drawing on the author’s experiences as a Nursery Nurse in the School Nursing team it will demonstrate the skills and knowledge required for successful implementation of this service and how to promote seamless working. The NCMP was established in 2005 and involves weighing and measuring all eligible children aged 4-5 years and 10-11 years. Research shows that it is difficult to visually tell if a child is overweight, which is why an objective measure if essential (Department of Health, 2012). The data gathered provides a picture about how children are growing nationally, therefore this information is used by the NHS to plan and provide better health services for children (NHS Choices, 2012). According to the NHS Information Centre (2010) one in four, 4-5 year olds, are overweight or obese; furthermore, these rates are higher among some black and minority ethnic communities and lower socio-economic groups.
Although the Primary Care Trust (PCT) oversee the delivery of the programme effective partnership working is essential, therefore this essay will explore what partnerships are required and the factors that facilitate or hinder collaborative working in this area of work. Finally, this report will provide evidence from literature and published papers to support the identified barriers and benefits of collaborative working throughout this process.
The School Nursing team comprises of a range of skill mix which consists of a Head of Service, one team leader, seven School Nurses, five of which have obtained the Specialist Community Public Health Nurse qualification (Degree or Masters Degree) and three Nursery Nurses evenly spread in three different localities around the City. The team covers fifty two Primary Schools and ten Secondary Schools, mainly in the inner City but also in the rural surrounding areas, therefore an extremely diverse region with varying socio-economic backgrounds. This City has a very large Asian population, however recently there has been an increase in Eastern European, Afro-Caribbean, Chinese and travellers all presenting a multitude of cultures, values and beliefs.
Measuring the children takes place in the school setting. Each individual school will be contacted to arrange a suitable date and time as well as organising a private area with adequate space for the ease of measuring and comfort for the children. Every school in this district has its individuality, not only do they vary in size but numerous schools have a large proportion of pupils with English as an additional language (EAL). There three special needs schools, furthermore schools with varying socio-economic backgrounds such as families experiencing poverty within the inner city and in contrast more affluent areas where the school attainment is generally higher.
Knowledge and Skills of the Health Professional in the Setting
The Knowledge and skills discussed in this section relate to the author’s role as a Nursery Nurse within the School Nursing Team and the planning, implementation and follow-up work required for the growth measurements of all eligible Reception and Yr 6 children as required by the Governments National Childhood Measurement Programme (NCMP).
The skills required for successful delivery of this program not only depend on accurate weighing and measuring children but several other elements such
as engaging with various professionals, inputting data, maximising the effective delivery of the program which is dependent on excellent communication skills, administration management, IT skills and clinical knowledge. These skills are required from the very beginning at the planning stage; high-quality organisational skills are essential when planning and booking in the measurement sessions with the schools. The Nursery Nurse requires good organisational skills as it is her responsibility to organise the logistics of these sessions; by liaising with the School Nurses a timetable is generated to complete the programme over the year, ensuring there is sufficient staff available for each school. Following this, the Nursery Nurse will contact all the Primary Schools to book in the sessions, good communication skills are necessary to request a suitable room to maintain the privacy and dignity of the children and ensure the session creates as little disruption as possible to the education of the children. Generally, the booking is made with either the School Secretary or the Head Teacher who then cascades this information to the relevant teachers and staff.
It is crucial to acquire the knowledge and understanding of the NCMP protocol regarding consent and confidentiality. Parents and children are issued with information prior to the session, subsequently the NCMP operate an opt-out basis, and therefore the parents are given the opportunity to withdraw (Department of Health, 2011). The refusal notification is sent to the Child Health Department who then records this on the specific child’s medical record; therefore communication and information sharing skills are essential for this to be implemented successfully. It is paramount to respect the parent’s choice to refuse and ensure that no pressure is placed on the family to participate (Schwab and Gelfman, 2001), by possessing the knowledge of the ethical considerations of children will assist situations where a child decides they would not like to be measured. According to Lord Scarman, children have the right to make their own decisions when they reach sufficient understanding and intelligence to be capable of making up their own mind (Children’s Legal Centre, 1985).
Annual training is mandatory which ensures competency in the accurate
measurement of children to obtain reliable results. It is the Nursery Nurses responsibility to supply the relevant equipment to the sessions ensuring that the height measure is complete, clean and in good working order, furthermore the scales are required to be calibrated as required by the trusts policy therefore good time management and organisational skills are beneficial.
Upon arrival, the school will direct the team to a suitable area to perform the growth checks and notify the relevant staff members of our arrival. The team normally consists of a School Nurse and two Nursery Nurses, however if the School Nurse has been requested to attend a Safeguarding issue then the Nursery Nurses will complete the task, so having the ability to adapt to different situations is fundamental. Being able to work as part of a team as well as work independently is a major requirement not only to this particular task but working within the School Nursing team in general.
Normally the School Nurse will discuss the process with the class teacher and then talk to the children, explaining what will happen and that the measurements will be confidential and not shared with teachers or other children, furthermore any concerns they have will be addressed. However, if the School Nurse is not in attendance the Nursery Nurse will complete this task, therefore excellent verbal and non-verbal communication skills (Philippot, Feldman and Coats, 2003), empathy and an understanding on how to reduce anxiety is imperative to ease any worries or concerns. Knowledge of the health implications from being overweight or obese would be beneficial, furthermore a general knowledge of how to achieve a healthy lifestyle by eating a balanced diet and regular exercise would be necessary to provide advice if requested.
Accurate recording of the measurements is paramount and knowledge of the correct procedure for information sharing is imperative. The trust adheres to the Data Protection Act (1998) furthermore to keep up to date with this information and gain the relevant knowledge, Information Governance training is completed annually. Normally the School Nurse will input the information onto each child’s medical record and send the records off to the Child
Health Department via secure internal mail, however according to the trusts policy it is compulsory for the information to be inputted within 24 hours after the measurements have been taken. As School Nurses have more medical responsibilities they might ask the Nursery Nurse to complete this task therefore good IT skills to input accurate and concise information is essential as well as the ability to prioritise workload according to the needs of the project are essential.
The final component of this process is responding to calls from parents after they have received the results letters from the NCMP department. Excellent communication skills and being able to calm a conversation if the parent gets upset, angry or has taken offense to the information in the letter is vital (Whitaker and Fiore, 2001). Additionally, it is important to understand the implications of different cultures and the impact they may have on diet and size of children. Knowledge of the programs of support available will enable the Nursery Nurse to advise the parents so they can seek the relevant help and support not only for their child but for the whole family. Obtaining this extensive knowledge is fundamental to ensuring that parent’s receives the correct information, help and support to contribute to understanding the necessity of healthy lifestyles for the long-term well-being of their child. Finally, it is important for the Nursery Nurse to refer any concerns or complaints to the named School Nurse who will then either contact the parent or report the situation to the specific organisation (Lynn, 2010).
There is a plethora of professional’s whom the Nursery Nurse may collaborate with throughout the NCMP process, several of which will be liaised with on a regular basis, such as the one’s named above. HHHnnjjjnjnjnslfjfljjjfieiedddeeergggggeeee333e3e3owever, further interagency working may be required to meet the needs of the children and families, these may include Dietician, Paediatrician, Social Workers, Leisure Centre Staff and MoreLife Weight Management staff.
Legislation has the impetus for collaborative working, transformation in the structure and delivery of services for children and young people initiated new alliances between statutory, public and voluntary agencies (Children Act, 2004). There are numerous Government and Local policies stating the importance of implementing interagency, partnership or collaborative working and that practitioners are required to work more closely together and form integrated teams around children and families (Department for Children, School and Families, 2007). The Governments green paper, Every Child Matters (2004) emphasised that for each child to fulfil their potential there must be a greater deal of co-operation, not only between government agencies but schools, GP’s, sports organisations and voluntary sectors. To help meet the Government strategy of multi-agency collaboration, the Common Core of Skills and Knowledge (HM Government, 2006) was introduced to work alongside the Every Child Matters agenda. This emphasised six areas of expertise that are expected to be put into practice by all practitioners who work with children and families.
Factors that facilitate or hinder collaborative working
Collaborative working is a complex and multi-faceted concept, the Latin translation “together in Labour” signifies that to meet the individual needs of children and families, successful joint working between services in a more streamlined way is required. However, although collaborative working is regarded as desirable, nevertheless, it is difficult to attain.
When the NCMP was established in 2005 the PCT set up a NCMP agency to oversee the programme with joint working with the School Nursing service, therefore clarity of the aims and objectives were to be recognised and understood by all parties for this programme to be successful (Denman, 2002). Lack of formal structure and agreed outcomes may cause confusion and can result in blaming others for inaction and lack of progress (Cameron et al, 2009), therefore clarity of roles and expectation were defined by producing a clear and comprehensive policy based upon the shared vision of all organisations (Rushmer and Pallis, 2002). The Children Act (2004) gives all statutory partners wide powers to pool their budgets in pursuit of improved outcomes
for children, furthermore sharing resources reduces cost and prevents unnecessary duplication of work (Atwal and Caldwell, 2005). However, time constraints due to other work commitments by the School Nursing team make it difficult to achieve the 85% participation rate (NMCP, 2012) particularly when children are absent and parents or children refuse. This may cause conflict due to NCMP’s ignorance of the School Nursing complex role and other significant priorities such a safeguarding (Department for Children, Schools and Families, 2010). Working in partnership with Schools is essential for the successful delivery of the programme, maintaining high participation rates by pupils and robustness of data (NCMP, 2012). A good system of communication and information sharing is required to book a convenient date and time to complete the measurements which will enable smooth running of the program with little interruption to the teachers or pupils (Integrated Care Network, 2003). However, when office staff fails to relay this information to the relevant teachers disruption to class activities, failure to provide suitable facilities and time constraints may occur which impact on the quality of service provided to the children. Factors that aid multi-agency working between schools and health services are willingness to work together, acknowledgement of professional differences, mutual respect and sharing a common purpose. Overall, the collaboration between the schools and School Nursing team is extremely good. However, occasionally conflict of interest may occur when teachers see the measurement programme as an interruption to education rather than acknowledging that children’s health status is related to their ability to learn and that children with unmet health needs have difficulties in engaging in the education process (Board et al, 2011). Therefore, creating a common purpose and employing a whole system approach (Miles and Trott, 2011) will facilitate early intervention for childhood obesity will reduce health implications such as diabetes and heart disease, improve self-esteem and enhance well-being which contributes to better educational achievement. Therefore, mutual respect for each profession is paramount for successful collaboration and better outcomes for children.
The Child Health Department works closely with the NCMP, School Nursing team, schools, parents and other professional bodies. Their main responsibility
during the NCMP process is distribution of information to parents to explain the purpose of the programme and give parents the opportunity to withdraw. This information is recorded onto each child’s medical record and then highlighted on the lists issued to the School Nurses prior to the sessions. If the withdrawal of consent is not forwarded to the School Nurse in time for the session, then errors may occur, leading to legal and ethical issues, therefore to facilitate collaborative working improved communication and improved information sharing is vital for co-ordinating safe provision of care (Samuel, 2011). It is also the responsibility of Child Health to input the data onto each of the children’s medical record, however due to the NCMP agency possessing a different IT systems this task is duplicated therefore integrated services are hindered (Atwal and Caldwell, 2005).
Within the School Nursing team roles and responsibilities are established, the School Nurse takes the lead role in the programme, however the Nursery Nurse will ensure that all the necessary equipment and paper work is present, both will perform the accurate weighing and measuring and recording of the data. According to Rushmer and Pallis (2002) positive joint working relies upon the merging of skills, knowledge and expertise from different professional hierarchies and reliance on team members can contribute to positive attitudes to other professionals. Dilemmas arise when there is a shortage of staff due to staff turnover, lack of trained staff to perform the task or competing priorities which may result in poor staff morale and impact on the accuracy of the task (Maguire and Trustcott, 2006). Furthermore, challenges may occur when there are status issues and blurring of professional boundaries, according to Wall (1998) when staff operates outside their area of expertise there will be loss of efficiency. The author recognises her role in the NCMP process; therefore any queries will be referred to the named School Nurse to respond to.
Health and Clinical Excellence, NICE (2006) and Cochrane Collaboration (Summerbell et al, 2005) state there is an urgent need for evidence of effective strategies for reducing childhood obesity, therefore annual weighing and measuring data collected can be shared at National and Local levels to analyse the efficacy of the regional weight management programmes
to receive continued funding to sustain the initiative to provide better health services for children (NHS Choices, 2012).
Parents will be provided with feedback of their child’s weight status from the NCMP, effective information sharing raise awareness of potential associated health risks and provides parents with the opportunity to seek advice and support if they choose to (NCMP, 2012). However, complications arise when policies and guidelines differ; the School Nursing team employ a different guideline to the NCMP resulting in complex telephone conversations regarding the letter sent by the NCMP stating their child is overweight. Subsequently, for competent collaboration to exist, clarity of referral criteria’s is needed to be standardised across boundaries (NICE, 2013).
The Laming Report (2009) stated a need for significant shifts in working relationships between schools, health services and parents and engaging with parents to enabling them to feel valued and encourage decision making will engage parent participation which is essential for positive outcomes to be achieved (Every Child Matters, 2004). Parents are important influences on children’s eating and physical activity behaviour (Golan, 2006) therefore collaboration with parents is vital (Whitaker et al, 1997). School based interventions such as MoreLife are effective when the whole family participate, furthermore NICE Clinical guideline 43 (2006) states that school based interventions engage families regardless of socio-economic status, cultural background and ethnicity, this is evident with the number of participants for this weight management programme in this diverse region. In contrast, barriers may occur with the lack of partnership working, power struggles, lack of commitment and lack of equal representation, these will decrease opportunities for working together, therefore creating a shared responsibility to reduce obesity will increase the health outcomes for children.
Multi disciplinary team work will identify children at risk from obesity and promote quicker and easy access to services (ECM, 2004). Additionally, the Common Assessment Framework (CAF) can be shared between practitioners to refer children to appropriate services, promote information sharing and
reduce duplication of and streamline assessments (CAF, 2012). However, collaboration with other professionals can be hampered when there are variations in working conditions, such as the School Nursing team and Schools working on term time only contracts. Furthermore many GP’s and Paediatricians have a professional hierarchy and delegate work to other agencies which in turn may have an effect on job satisfaction. Conversely, working with other professionals can be rewarding, stimulating, improve working relationships and increase knowledge and understanding of specialist practitioners.