Health Visiting caseload weighting tool

[Guest guest]

Has anyone got a health visiting caseload weighting tool that they could share

Regards

Reeta

[Guest guest]

Will try to send this over to you.

Barbara

Caseload Weighting

In the past, and even now in many cases, school nursing caseloads have been allocated historically and reviewed by using less than appropriate data which gives insight into the workload. The role of the school nurse has transformed dramatically in the last few years and allocation needs to reflect this change. There is now a clear vision (DH 1999, 2004a, 2006, DfES 2006a) that school nursing practice is underpinned by a public health approach however this could be undermined due to high caseloads and an inequity of service provision.

Successive policy documents make it clear that services should be targeted towards those in greatest need. The aim of a caseload weighting tool is to ensure appropriate allocation of caseloads within the current financial constraints.

Advantages

For children, young people and their families

· Equitable service across Suffolk

· Easier access to the health service

· Higher visibility of the school nurse

For Practitioners

· Equity of service delivery

· More manageable caseloads

· Appropriate utilisation of skills

· Fairer allocation of caseloads

· Evidence to support change

For Managers

· Equity

· Achievement of clinical governance

· Appropriate use of practitioners’ time

· Retention of staff

· Evidence to support change

· Flexible service

For PCT and partner agencies

· Modernised service

· More visible and effective service

· Delivery towards PSA. ECM. NSF, CYPP and other targets

Caseload Weighting Tool

The tool developed used a statistical technique to produce a model of equitable distribution of school nursing staff across Suffolk clusters, based on the current health funded resources (staffing including administrative staff). It is not an ideal nor a measure of actual need, but rather an assessment of relative need between clusters based on their school roll populations adjusted for three variables known to affect school nurse workload (namely proportion in each cluster eligible for free school meals; on the child protection register; and with SEN statements or action plans).

The caseload weighting tool is a modified version of a published paper used to assess relative need for Health Visitors (Steel at al 2001) with variables appropriate to school nursing including proxy measures for deprivation. Further details or questions are obtainable from the Public Health Dept, Suffolk PCT via Dr Curt on, CPHM or , Sr PH Information Analyst.

The calculations of the assessment of need for school nurses in community clusters in Suffolk PCT follow the method developed by Steel et al. The explanatory variables used in this model include:

pupils eligible for free school meals per 1000 pupils on school roll

pupils on child protection register per 1000 pupils on school roll

pupils with statements or action plans per 1000 pupils on school roll

The weighting tool comprises the following information:

ZScore_CC calculation of z-scores for school nursing need in community clusters in Suffolk PCT

SN_WTE school nurse establishment in clusters in Suffolk PCT 2006

FSMElig G graph of pupils eligible for free school meals per 1000 pupils on school roll

CPR G graph of pupils on child protection register per 1000 pupils on school roll

StatementG graph of pupils with statements or action plans per 1000 pupils on school roll

SNNeed G graph of estimated need for school nurses in community clusters in Suffolk PCT

HV area calc calculation of z-scores for health visiting need in Norwich PCT by Dr. Jane Skinner. The calculations for Suffolk PCT are based on these calculations.

Worksheet ZScore_CC contains counts and rates for the variables that are components of the z-scores and the z-score calculations themselves.

Each z-score for each variable is calculated as

(rate in cluster a - mean of rates for all clusters) / standard deviation of rates for all clusters

This formula calculates for a variable a score adjusted for the variability of the data, as measured by the standard deviation, and combinable with z-scores for other variables. A positive z-score indicates greater need in a cluster relative to the other clusters and a negative z-score indicates less need. For each cluster the z-scores for the individual variables are summed and divided by the standard deviation of the summed z-scores for all clusters to produce an overall z-score of need (zzneed: column O in worksheet).

For each cluster the overall z-score is converted to a measure of need for school nurses per 1000 pupils by the following formula:

(zzneed * standard deviation of existing school nurse establishment per 1000 pupils for all clusters) + mean of existing school nurse establishment per 1000 pupils for all clusters

The mean and standard deviation of the existing school nurse establishment per 1000 pupils for all clusters are given in worksheet SN_WTE.

Finally, from the measure of need for school nurses per 1000 pupils, the estimated number of school nurses needed in each cluster is calculated (column Q in worksheet ZScore_CC).

The full statistics and calculations of the present resources and the estimated need of school nursing hours within current resources are shown in full in Appendix 11.

Reference

Steel N, Reading R, C (2001) An Assessment of Need for Health Visiting in General Practice Populations. Journal of Public Health Medicine June 2001: 23; 2 pg 121-128

Basis of Weighting Tool (Steel 2001)

Area

Total pop

Pop age <5

Elective admiss. age <5

Total births weight <2500g

Total death age <65

0-4 rate per 10000 popn

Admiss. rate per 10000 popn

LBW per 10000 popn

Deaths <65 per 10000 popn

z04rate

zadmrate

zlbwrate

zu65rate

zneed

zzneed

Need for HV per 10000

Need for HV

3001 SSTH

9103

423

124

40

76

92.9

27.2

8.8

16.7

-0.26

-0.09

-0.01

0.00

-0.36

-0.10

1.67

1.5

3002 SSBWE

15620

1009

277

103

157

129.2

35.5

13.2

20.1

0.93

0.70

1.59

1.17

4.40

1.19

3.15

4.9

3003 SSBWE

10872

668

210

49

85

122.9

38.6

9.0

15.6

0.73

1.01

0.07

-0.36

1.44

0.39

2.23

2.4

4001 Wensum Valley

9228

683

204

53

85

148.0

44.2

11.5

18.4

1.56

1.55

0.97

0.59

4.67

1.27

3.24

3.0

4002 North City

24547

1159

305

119

226

94.4

24.9

9.7

18.4

-0.21

-0.32

0.32

0.59

0.38

0.10

1.90

4.7

4003 Central City

23245

830

211

74

179

71.4

18.2

6.4

15.4

-0.97

-0.97

-0.88

-0.45

-3.27

-0.89

0.76

1.8

4004 South City

18944

550

139

43

101

58.1

14.7

4.5

10.7

-1.41

-1.31

-1.55

-2.08

-6.34

-1.72

-0.20

-0.4

4005 East City

16789

757

188

62

153

90.2

22.4

7.4

18.2

-0.35

-0.56

-0.52

0.53

-0.90

-0.24

1.50

2.5

14.24

20.4

Total pop

Based on registrations at a GP from an address with a Norwich city postcode, July 2003

Source: Oasis (via Selina Hockley, ESS)

Pop age <5

Based on registrations at a GP from an address with a Norwich city postcode, July 2003

Source: Oasis (via Selina Hockley, ESS)

Births

Births REGISTERED in calendar years 1997 to 2001 inclusive

Source: ONS Births File (via , ERPHO)

Deaths

Deaths REGISTERED in calendar years 1997 to 2001 inclusive

Source: ONS Deaths File (via , ERPHO)

Admissions

Admissions in financial years 1997/8 to 2001/2 inclusive, ORDINARY ADMISSIONS and DAY CASES only

Source: Hospital Episode Statistics (HES) (via , ERPHO)

Health Visiting caseload weighting tool

Has anyone got a health visiting caseload weighting tool that they could share

Regards

Reeta

[Guest guest]

Many thanks Barbara

From: Barbara -Todd <barbara.rt@...>Subject: Re: Health Visiting caseload weighting tool Date: Wednesday, January 28, 2009, 11:07 AM

Will try to send this over to you.

Barbara

Caseload Weighting

In the past, and even now in many cases, school nursing caseloads have been allocated historically and reviewed by using less than appropriate data which gives insight into the workload. The role of the school nurse has transformed dramatically in the last few years and allocation needs to reflect this change. There is now a clear vision (DH 1999, 2004a, 2006, DfES 2006a) that school nursing practice is underpinned by a public health approach however this could be undermined due to high caseloads and an inequity of service provision.

Successive policy documents make it clear that services should be targeted towards those in greatest need. The aim of a caseload weighting tool is to ensure appropriate allocation of caseloads within the current financial constraints.

Advantages

For children, young people and their families

· Equitable service across Suffolk

· Easier access to the health service

· Higher visibility of the school nurse

For Practitioners

· Equity of service delivery

· More manageable caseloads

· Appropriate utilisation of skills

· Fairer allocation of caseloads

· Evidence to support change

For Managers

· Equity

· Achievement of clinical governance

· Appropriate use of practitioners¢ time

· Retention of staff

· Evidence to support change

· Flexible service

For PCT and partner agencies

· Modernised service

· More visible and effective service

· Delivery towards PSA. ECM. NSF, CYPP and other targets

Caseload Weighting Tool

The tool developed used a statistical technique to produce a model of equitable distribution of school nursing staff across Suffolk clusters, based on the current health funded resources (staffing including administrative staff). It is not an ideal nor a measure of actual need, but rather an assessment of relative need between clusters based on their school roll populations adjusted for three variables known to affect school nurse workload (namely proportion in each cluster eligible for free school meals; on the child protection register; and with SEN statements or action plans).

The caseload weighting tool is a modified version of a published paper used to assess relative need for Health Visitors (Steel at al 2001) with variables appropriate to school nursing including proxy measures for deprivation. Further details or questions are obtainable from the Public Health Dept, Suffolk PCT via Dr Curt on, CPHM or , Sr PH Information Analyst.

The calculations of the assessment of need for school nurses in community clusters in Suffolk PCT follow the method developed by Steel et al. The explanatory variables used in this model include:

pupils eligible for free school meals per 1000 pupils on school roll

pupils on child protection register per 1000 pupils on school roll

pupils with statements or action plans per 1000 pupils on school roll

The weighting tool comprises the following information:

ZScore_CC calculation of z-scores for school nursing need in community clusters in Suffolk PCT

SN_WTE school nurse establishment in clusters in Suffolk PCT 2006

FSMElig G graph of pupils eligible for free school meals per 1000 pupils on school roll

CPR G graph of pupils on child protection register per 1000 pupils on school roll

StatementG graph of pupils with statements or action plans per 1000 pupils on school roll

SNNeed G graph of estimated need for school nurses in community clusters in Suffolk PCT

HV area calc calculation of z-scores for health visiting need in Norwich PCT by Dr. Jane Skinner. The calculations for Suffolk PCT are based on these calculations.

Worksheet ZScore_CC contains counts and rates for the variables that are components of the z-scores and the z-score calculations themselves.

Each z-score for each variable is calculated as

(rate in cluster a - mean of rates for all clusters) / standard deviation of rates for all clusters

This formula calculates for a variable a score adjusted for the variability of the data, as measured by the standard deviation, and combinable with z-scores for other variables. A positive z-score indicates greater need in a cluster relative to the other clusters and a negative z-score indicates less need. For each cluster the z-scores for the individual variables are summed and divided by the standard deviation of the summed z-scores for all clusters to produce an overall z-score of need (zzneed: column O in worksheet).

For each cluster the overall z-score is converted to a measure of need for school nurses per 1000 pupils by the following formula:

(zzneed * standard deviation of existing school nurse establishment per 1000 pupils for all clusters) + mean of existing school nurse establishment per 1000 pupils for all clusters

The mean and standard deviation of the existing school nurse establishment per 1000 pupils for all clusters are given in worksheet SN_WTE.

Finally, from the measure of need for school nurses per 1000 pupils, the estimated number of school nurses needed in each cluster is calculated (column Q in worksheet ZScore_CC).

The full statistics and calculations of the present resources and the estimated need of school nursing hours within current resources are shown in full in Appendix 11.

Reference

Steel N, Reading R, C (2001) An Assessment of Need for Health Visiting in General Practice Populations. Journal of Public Health Medicine June 2001: 23; 2 pg 121-128

Basis of Weighting Tool (Steel 2001)

Area

Total pop

Pop age <5

Elective admiss. age <5

Total births weight <2500g

Total death age <65

0-4 rate per 10000 popn

Admiss. rate per 10000 popn

LBW per 10000 popn

Deaths <65 per 10000 popn

z04rate

zadmrate

zlbwrate

zu65rate

zneed

zzneed

Need for HV per 10000

Need for HV

3001 SSTH

9103

423

124

40

76

92.9

27.2

8.8

16.7

-0.26

-0.09

-0.01

0.00

-0.36

-0.10

1.67

1.5

3002 SSBWE

15620

1009

277

103

157

129.2

35.5

13.2

20.1

0.93

0.70

1.59

1.17

4.40

1.19

3.15

4.9

3003 SSBWE

10872

668

210

49

85

122.9

38.6

9.0

15.6

0.73

1.01

0.07

-0.36

1.44

0.39

2.23

2.4

4001 Wensum Valley

9228

683

204

53

85

148.0

44.2

11.5

18.4

1.56

1.55

0.97

0.59

4.67

1.27

3.24

3.0

4002 North City

24547

1159

305

119

226

94.4

24.9

9.7

18.4

-0.21

-0.32

0.32

0.59

0.38

0.10

1.90

4.7

4003 Central City

23245

830

211

74

179

71.4

18.2

6.4

15.4

-0.97

-0.97

-0.88

-0.45

-3.27

-0.89

0.76

1.8

4004 South City

18944

550

139

43

101

58.1

14.7

4.5

10.7

-1.41

-1.31

-1.55

-2.08

-6.34

-1.72

-0.20

-0.4

4005 East City

16789

757

188

62

153

90.2

22.4

7.4

18.2

-0.35

-0.56

-0.52

0.53

-0.90

-0.24

1.50

2.5

14.24

20.4

Total pop

Based on registrations at a GP from an address with a Norwich city postcode, July 2003

Source: Oasis (via Selina Hockley, ESS)

Pop age <5

Based on registrations at a GP from an address with a Norwich city postcode, July 2003

Source: Oasis (via Selina Hockley, ESS)

Births

Births REGISTERED in calendar years 1997 to 2001 inclusive

Source: ONS Births File (via , ERPHO)

Deaths

Deaths REGISTERED in calendar years 1997 to 2001 inclusive

Source: ONS Deaths File (via , ERPHO)

Admissions

Admissions in financial years 1997/8 to 2001/2 inclusive, ORDINARY ADMISSIONS and DAY CASES only

Source: Hospital Episode Statistics (HES) (via , ERPHO)

Health Visiting caseload weighting tool

Has anyone got a health visiting caseload weighting tool that they could share

Regards

Reeta