Priorities for Children & Young People’s
Health & Wellbeing in Cumbria
Dr Neela Shabde
Clinical Director – Children
Cumbria CCG
Cumbria Youth Alliance Planning conference
14th May 2014
Presentation will cover :
Vision for Children & Young People
The Pledge
Commissioning arrangements in the new NHS
Strategic Priorities for Children & Young People
Partnership working
Summary
Tital
Vision
Children and families of Cumbria should expect support
to be healthy by having :• Fair access to a range of support and services to
ensure a healthy future, provide early intervention &
when required have ready access to safe, sustainable
high quality health services that are designed around
their needs to achieve best possible outcomes.
• Integrated services delivered as close to home as
possible, provided by a team of healthcare
professionals working together in partnership with
children, their families and other agencies.
Strategy V16
3
The Pledge
In response to the report of The Children and Young People’s health
Outcomes forum this pledge has been made and will be used to underpin all
that we do across the health organisations in Cumbria.
• Children, young people and their families will be at the heart of
decision-making, with the health outcomes that matter most to them
taking priority.
• Services, from pregnancy through to adolescence and beyond, will be
high quality, evidence based and safe, delivered at the right time, in
the right place, by a properly planned, educated and trained
workforce.
• Good mental and physical health and early interventions, including for
children and young people with long term conditions, will be of equal
importance to caring for those who become acutely unwell.
• Services will be integrated and care will be coordinated around the
individual, with an optimal experience of transition to adult services for
those young people who require ongoing health and care in adult life.
• There will be clear leadership, accountability and assurance and
organisations will work in partnership for the benefit of children and
young people.
(Better health Outcomes for Children
and Young People, The pledge)
Final version
4
Commissioning arrangements in
the New NHS
Department of Health
NHS England
Public Health
England
NHS North
Area Team
Cumbria Clinical
Commissioning Group
Cumbria County Council
Children’s Services
Adult & Local Services
Director of Public Health
Health Services Commissioning
Structure
PHE
CCG
Community
Paediatrics
Therapies
Community Nursing
AT
CCC
Health Visiting
Imms &
Vacs
Family Nurse
partnership
Screening
HCP 0-5
School
Nursing
HCP 5-19
CAMHS
CPFT
Commissioning community health services
Cumbria Clinical Commissioning Group
Allerdale
Copeland
Carlisle
Eden
Furness
S Lakes
Clinical Commissioning
Group
North of England Commissioning Support Unit
National & International context
Our work in Cumbria is set against the national context.
In England;
• all-cause mortality rate for children aged 0 – 14 years has
moved from average to amongst the worst in Europe
• 26% of children’s deaths showed ‘identifiable failure in the
child’s direct care’
• more than 8 out of 10 adults who have ever smoked regularly
started before 19
• more than 30% of 2 to 15 year olds are overweight or obese
• half of life time mental illness starts by the age of 14
• nearly half of LAC have a mental health disorder & two thirds
have at least one physical health complaint
• about 75% of hospital admissions of children with asthma could
have been prevented in primary care
Strategy V16
12
Why do things need to change
• Prevention, early intervention & high quality
consistent services in childhood are crucial
to child’s experience & set pattern for
adulthood.
• The way we live is constantly changing,
resulting in a range of complex effects on
health & wellbeing of children & their families
-results in increasing pressures on healthcare
e.g. increasing obesity & impact of social
media on emotional wellbeing. .
Strategy V16
13
Drivers for change
Health Needs
Tital
• Outlier -young people and alcohol, mental health, emergency
admissions for asthma and admissions for bronchiolitis for children
under 2
• Higher rates of mortality in areas of significant economic & social
deprivation
Quality & safety of services
• CQC / Ofsted inspection 2011/2012
Engagement
• the three providers – this will enable both commissioning and
provision of services to develop with the patient voice at the heart.
• Health economy to develop a pathway approach to patient
feedback across
Strategy V16
14
Drivers for change
Rurality & Accessibility
•
•
•
•
More than half the population living outside a town or city.
Easy access to services based in local communities .
At times when very specialist help will warrant further travel to
specialist centres.
Opportunities that tele- health can bring.
Deprivation
very different levels of income affecting health outcomes of people
living in different communities.
• improve the health outcomes of the poorest so that they get closer to
those of the best off.
Strategy V16
15
Drivers for change
• Financial challenge & affordability- health economy
limited amount of money
• Commissioning environment- new arrangements hence
multiple commissioners
• Need for strategic whole system change- South of
county : Better care together
• Current model of provision: acute care model , unit
size / national standards
• Tertiary services- fewer more specialised centres
commissioned
Drivers for change
• Community services- under developed ,lack of
defined community model, multiple sites, new
investment , new social & education care plans
• Mental health services- whole systems
approach including Tier 1 & 2
• Access to tier 4 beds problematic
• Public Health agenda: prevention & early
intervention- now led by Cumbria county
council
• Integrated approach – Health Builders
What are strategic priorities?
Priorities for CYP
:-
Embedding the voice of the child and family in all we do
Appropriate services for teenagers across all sectors
Age appropriate settings across all sectors
Improve effective transition
Effective Information Communication Technology support
Standardise quality across settings and days of week
• Developing a fully integrated children’s team - integrating across
all sectors, departments, disciplines – NO BARRIER approach
• Share information to keep children safe
•
•
•
•
•
Strategy V16
19
CYP Priorities (2)
•
•
•
•
•
•
•
•
Develop sexual assault services
Whole systems model for emotional wellbeing and mental health
Reduce hospital admissions
Implement Health Builders pathways » ADHD,
» Autism
» Diabetes
» Diarrhoea
Enhance Childrens Community Nursing Services
Continue to monitor outcomes for children looked after
Strengthen safeguarding culture and processes
Improve quality of care for CYP admitted to paediatric wards
with mental health issues
What are high level objectives to
deliver change?
To develop whole system patient feedback across services for children and young people.
To support children and young people to be healthy and safe by working with partners to
strengthen prevention and early help.
To standardise quality and provide better health outcomes providing more focussed and
integrated services, including children with long term conditions and complex needs.
To develop and implement services to reduce unnecessary hospital attendance and
admission.
Develop Comprehensive Emotional Wellbeing and Mental health services.
Produce a workforce development plan that addresses the needs of the whole workforce.
Develop ways to effectively monitor and support continuous improvement.
Strategy V16
21
The healthy child – Public Health
The provision of the Healthy Child Programme, including
immunisation and screening
Leadership for the delivery of both the Breastfeeding and
Healthy Weight Strategy -within the Healthy Child Programme.
Risk taking behaviour in children and young people remains
everyone’s business but specific targeted services aimed at
adolescents in the community.
The Local Authority commissions 28 Children’s Centres from 3
organisations. The core offer -Child and Family Health &Wellbeing
component that includes Ante Natal and Postnatal Support, Oral
Health Improvement & Surveillance, Healthy Child Programme and
other specialist support
Strategy Delivery model v5
22
Children seen in Primary Care
All workforce ( GPs , Urgent Care, Out of hours)
dealing with CYP – paediatric training
• The NHS England Improving General Practice; A call
to action phase 1 report (March 2014) identifies a
number of actions particularly relevant to the
provision of care to children and young people;
Different ways of accessing services
Person centred care for people with long term
health conditions
Pooling of clinical expertise, offering a greater
range of generalist and
more specialist services
Local systems of extended primary care
•
Strategy Delivery model v5
23
Children seen in Community
Enhanced provision of children’s community nursing:
• acute and short term conditions
• long term conditions
• disabilities and complex, including neonates
• life-limiting and life-threatening illness, including those requiring
palliative and end-of-life care
Integrated Children’s Health Team:
• Training & education
• Outreach of consultant paediatricians into community settings,.
• Pathways involving Health Visitors, School Nurses, and the Children’s
Community
• Integrated therapy support across hospital and community
• Provision of care in settings that are age appropriate
Strategy Delivery model v5
• Integrated care across providers
24
Children with complex needs
Children with complex needs will have their care planned in partnership with colleagues in
the local authority. This will ensure that their educational, health and care needs are met
in a co-ordinated way.
Health professionals will provide training, advice and guidance to family and staff to
enable them to become both competent and confident in meeting an appropriate level of
the child’s health needs.
On-going and Complex Care: Services for people ‘at risk ‘of/with on-going care needs
whose needs are complex and require care and support on an on-going basis.
Principles:
• Care should be delivered outside of hospital settings - safe, cost effective and
provides improved patient experience
• Specialist care at local or tertiary level
• Services should be provided locally where possible
• Services should only be provided in hospitals where necessary
• Telephone or email advice and guidance for GPs
• Other opportunities to increase interaction between primary care and paediatric
Strategy Delivery model v5
25
Children - acutely unwell
• Children will access the same unscheduled care
services as adults, including GPs, GP Out-of-Hours
Services, Urgent Care Centres, Minor Injury Services
and A&E.
• Paediatric consultant-led Short Stay Paediatric
Assessment [SSPAs]
• Community services will be supported by the
increased presence of Consultant Paediatricians
working in community settings.
• Development of an integrated children’s nursing
service
• Integrated pathways for common conditions
Strategy Delivery model v5
26
Children who need Emotional
wellbeing and mental health services
Emotional wellbeing and mental health of children and young people is everyones
responsibility.
Services will be provided locally – CYP will have a choice
• The services offered will be described clearly so that everyone involved can
understand them
• Families will be included except when it is in the interest of the child not to do
so
• Expertise and good practice will be shared with all colleagues
• Care will be co-ordinated with Partners
• Care will be evidence based, have clear objectives and measurable outcomes
• The voice of the child will always be heard
• Transitions between services will be planned with support in place throughout
• Risks will be understood and shared by partners
• The additional needs of specific groups will be recognised and met.
• Children on acute wards/ link to tier 4 services
Strategy Delivery model v5
27
What would the model of delivery look
like?
Integrated Children’s care in Cumbria
Strategy Delivery model v5
30
Strategy Delivery model v5
31
Strategy Delivery model v5
32
The Child’s Journey
Characteristics;
• No barriers; a culture of ‘entitlement’ will underpin access to services.
• Hearing the child’s voice;
• Services will be provided in age appropriate settings. You’re Welcome standards
will be applied throughout.
• Communication with children, young people and their families
• Services primarily aimed at meeting the physical needs will also include their
emotional wellbeing
• Services primarily aimed at meeting the emotional needs of the child will also
include their physical wellbeing
• All services will take full account of the long term benefits of prevention and
early intervention
• Transition; children receiving health services will experience a number of key
transitions, for example between childhood and adulthood and between targeted
and specialist services.
Strategy V16
33
The Child’s Journey
Amongst a number of other priorities DH response identified need
for :
four new outcome indicators for inclusion within the NHS
Outcomes Framework:
• time from first NHS presentation to diagnosis or start of
treatment;
• integrated care – developing a new composite measure;
• effective transition from services for children and young
people to those for adults; and
• age-appropriate services – with particular reference to
teenagers.
Strategy V16
34
The Child’s Journey
Issues identified by the Children and Young People’s Health
Outcomes Forum :
• understand that peer pressure and advertising can work against
healthy choices;
• need better information and advice about healthy lifestyles;
• believe that too many public health campaigns are aimed at
adults;
• connect being healthy with ‘things to do’ in their area and access
to public transport and sports facilities;
• want involvement in design, development and evaluation of child
friendly campaigns & services;
• recognise and value role of school in encouraging healthy
behaviour; &
• recognise a place for social media.
Strategy V16
35
Summary
• Current NHS commissioning is clinically led
•
complex with multiple commissioners
• Money is limited & need for stronger
partnerships with health and social care
• Innovative & integrated models of care to
improve outcomes
• Public health approach – prevention and early
intervention
Thank you for your
attention
Any Questions
Neela.shabde@cumbriaccg.nhs.uk
?