Shared learning database

Solihull Metropolitan Borough Council
Published date:
November 2014

In Solihull, a short training session has been delivered to a range of health professional teams. The training includes local policies and procedures in relation to Vitamin D as well as local distribution points for Healthy Start supplements and a recommended alternative children's product for non-eligible families.

Training provided at Solihull demonstrates recommendation 8 of the NICE guidance for tackling Vitamin D deficiency in practice. The recommendation states: "Raise awareness among health, social care and other professionals of the importance of vitamin D".

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

The aim of the training package was increase uptake of Healthy Start vitamins in Solihull. In the course of planning to increase the regular use of vitamin supplements in pregnant women, breastfeeding others and children under the age of 4, a training need was identified to develop skills and a knowledge base to support and promote the provision of Healthy Start vitamins. The main objectives of the training were to ensure that specific health professionals understood the system for stocking and distributing Healthy Start vitamins and were able to deliver factually correct messages confidently when passing vitamins directly onto families. A further objective was the positive promotion of the concept of supplementation with families and a good understanding of the effects of vitamin D deficiency particularly. The training also sought to promote understanding of stock control of the vitamins, safe storage and the process for disposal of expired products, as well as how the distribution of vitamins to both eligible families (the children's drops) and all families (the women's tablets) would be audited and their role to support this.

Reasons for implementing your project

Solihull has a population of 206,000 and an average of 2,300 live births every year. The Healthy Start scheme has been running for a number of years but the uptake of the free vitamins amongst the eligible population was low (between 1-7% of the eligible population were accessing the vitamins). The majority of children living in poverty in Solihull borough live in four wards in the north, where smoking rates are double that of the south and breastfeeding rates, in some parts, a third compared with more affluent wards. Life expectancy in the northern wards is almost 10 years less than that in the south. The uptake of Healthy Start vouchers for food and milk in Solihull was marginally higher than the West Midlands average, but the uptake of both the children's drops and the women's tablets was below the average for the region. This highlighted an opportunity to increase uptake of vitamins as we have experienced good initiation onto the food voucher scheme. The health professionals who recruit eligible families onto the scheme were identified as key to engaging pregnant women, breastfeeding mothers and parents and carers of young children on the issue of vitamins and why they are important. In response to this, a position statement was developed and a new system was designed to ensure robust systems which aimed to increase the availability of the vitamins in line with a positive perception and a normalisation of their use in these target populations.

How did you implement the project

Initially, a short training session was developed to be delivered in conjunction with an intervention for Community Midwives to give out vitamins directly at booking to all pregnant women in Solihull universally, regardless of income. The training was then tailored to develop skills and knowledge for colleagues in all participating clinics, Children's Centres and the Healthy Lifestyle Shop in a deprived area of Solihull borough. This aimed to ensure that the messages that accompanied the vitamins supply were factually correct and positively promoted the use of vitamin supplements. The Family Nurse partnership team (who work directly with first-time mothers under 19) were also trained to ensure that their clients could receive the vitamins directly from the Family Nurses and the Infant Feeding team in Solihull have also begun direct supply at their sessions and clinics. The training package was then developed for Health Visitor Team Leaders and Health Visitors and Nursery Nurses now distribute children's vitamin drops to all eligible families at the 8-12 month development check. Non-eligible families are recommended an alternative product (Abidec Multi-vitamin drops), as recommended by Solihull Clinical Commissioning Group).

The new system aimed to maximise efficiency, provide robust re-stocking arrangements, reduce waste and provide a clear audit trail. The commissioning of the vitamin deliveries to NHS Property Services has delivered efficiencies and a dependable service for vitamin re-stocking.

The training programme took health professionals through the rationale for the Healthy Start scheme and for vitamin supplementation with particular reference to vitamin D deficiency. The process for distribution was outlined alongside the rationale for the universal supplementation of pregnant women and breastfeeding mothers. The differing processes for the distribution of women's and children's vitamins were covered as were the audit processes, and guidance on the safe storage, stock rotation practices and the procedure for the disposal of expired product. The relevant audit processes were covered, dependant on the audience for the training. The training had minimal costs, most notably staff time to deliver the training and small printing costs for supporting guidance material.

Key findings

In Solihull, the uptake of Healthy Start vitamins has been monitored since the scheme began. The training of health professionals in the newly designed scheme took place in quarters 3 and 4 of 2012-3 and quarters 1 and 2 of 2013-4. Training has been repeated where necessary, which has been the case, largely with Children's Centres, where high staff turnover in some centres has necessitated a further training session.

Increased awareness of the scheme amongst health professionals and the positive promotion of vitamins supplementation resulting from the training has contributed to the increased uptake of vitamins in Solihull, along with the effect of the direct universal supply by Community Midwives to pregnant women. Similarly, with children's drops, the direct supply to eligible families at 8-12 month development check has also increased uptake which has been supported by the training programme.

Please see the supporting material which includes graphs for:
- Uptake of women's vitamins for low-income, eligible families only
- Uptake of Healthy start children's drops by eligible families

Key learning points

The enablers for the training were the engagement of management in both Community Midwifery and Health Visiting to the direct supply and the need for training to facilitate this. The identification of Healthy Start Champions in both Community Midwifery and Health Visiting Services was key for driving the professionals to access the training and guidance documents, and the Champions themselves delivered training to teams of professionals. They also acted as a key contact point for the Public Health department into the workforce for Healthy Start updates and further guidance which has developed into a wider Public Health champion role. Similarly, training of the Clinic Clerks would not have been as successful without the full engagement of the Clinics Manager.

Effective advocacy with senior managers around the importance of vitamin supplementation has been vital to enable their buy-in and access to their workforce. Community pharmacists have been harder to engage, and training them face-to-face has not been possible due to an inability to fund locum cover whilst pharmacists attend training. In hindsight, it may have been more effective to pursue the face-to-face training of pharmacists further and attempt to engage local groups of pharmacists to do this. Participating pharmacies have received the guidance pack and ongoing telephone and e-mail support to enable the scheme to operate in an effective manner as possible. Understanding amongst pharmacy staff has been lower and the pharmacies have been less engaged in the process which may well be a result of the failure to deliver face-to-face training to this group. There had been an attempt to engage to Local Pharmaceutical Committee (LPC) to facilitate engagement in the scheme and training but there was a resultant request for funding by the LPC to operate the scheme in pharmacies which has proved a significant barrier in vitamin distribution from pharmacies in Solihull.

Contact details

Denise Milnes
Health Improvement Specialist - Children and Families
Solihull Metropolitan Borough Council

Is the example industry-sponsored in any way?