Partners in Paediatrics Annual Conference

12.10.2012 The future for clinical networks – the

RCPCH perspective Dr Carol Ewing

RCPCH Workforce Officer

The future for clinical networks – the

RCPCH perspective • Current challenges

• RCPCH and other standards

• RCPCH and clinical network models - ‘Bringing networks to life’

• Links to Paediatric surgery

• Participation

• Next steps

The challenges ahead across the UK • NHS system - change and financial constraints - ‘children are not mini adults’

• Health and Social Care Bill and unclear education/training and workforce arrangements for England

• Poor outcomes , inconsistencies in, and fragmentation of care

• Obesity

• Safeguarding

• Transition from children’s to adult services

• Delivering care in the wrong place

• Too many in - patient units

• Middle grade shortages

OUTCOMES - All cause mortality in children aged 0-14 years in European countries

©2011 by British Medical Journal Publishing Group: Wolfe I et al. BMJ 2011;342:bmj.d1277

Children’s NHS Health Outcomes Forum Recommendations

Health Outcomes which matter most for children, young people and their families

4 new indicators :

• Time from first NHS presentation to diagnosis or start of treatment

• Integrated care - developing a new composite measure

• Effective transition for children’s to adult services

• Age – appropriate services – with particular reference to teenagers

Children and Young People’s Health Outcomes Forum report

• Putting CYPF at the heart of what happens

• Acting early and intervening at the right time-NNAP

• Integration and partnership – unique NHS number

• Safe and sustainable services

• Workforce , education and training – all GPs have validated CPD appropriate for CYPF care

• Knowledge and evidence – NHS Atlas

• Leadership, accountability and assurance

• Incentives for driving service improvements

STANDARDS

Facing the Future: A review of paediatric services

10 standards for acute care

Measurable, achievable, provider

• Who sees a child and how soon

• Consultant led handover

• Advice and availability

• Compliant rotas

• Access to child protection help

Facing The Future - Principles

1. All trainees will be WTR compliant

2. All trainees will have appropriate training/education (3 days per week)

3. Consultant delivered service with defined minimum safety standards

4. Reconfiguration - Maintaining locality services through SSPAUs

5. Increasing training places for GP Trainees

6. A sustainable consultant trainee ratio

Other Paediatric Service Standards/Policy context

• Intercollegiate standards for paediatric emergency care (2012)

• BAPM Neonatal standards( 2001/2010) • RCPCH - A charter for Paediatrician ( 2004) …A handbook

for Paediatricians • Improving services for children in hospital ( Health Care

Commission) 2007 • DH – Commissioning safe and sustainable Paediatric

services – a framework of critical interdependencies 2008 • RCPCH – Supporting reconfiguration – a framework for

standards ( 2008) • RCPCH Remote and Rural Standards 2011/2012 • MtF 1,2,3 ( 350 references) • Lack of subspecialty standards

RCPCH 2011 ‘Bringing Networks to Life’

A tool kit for paediatricians so that they can get involved in clinical networks

www.rcpch.ac.uk/networks

Local

• Regional

• National

Improving standards of kidney care, RCPCH 2011

Stepwise development of networks • Clinical association – sharing best practice

• Coordinated clinical forum – sharing audit and jointly agreed protocols

• ‘Developmental network’–operational models, links between organisations – no contract

• Managed (clinical) network – formal management structure, defined objectives, governance framework

Examples of clinical networks

• Audiology network – 2 London PCTs

Informal comprising clinical staff – doctors, health visitors and school nurses – training for all PCT staff – good communication

GM Paediatric Cerebral Palsy Network - aim to develop best practice across disciplines and 1ry, 2ry and 3ry care; using audit, outside speakers

Examples of networks

• South Wales Critical Care –driven by centralisation of services and need for education/support.

• No formal funding /management

• Good will

• Website to use as a resource for protocols and pathways

Examples of Networks

• Greater Manchester Children Young People and Families’ Network

• Making it Better www.makingitbetter.nhs.uk

• Large scale reconfiguration of children’s and maternity services – community nursing teams ;12 to 8 co-located paediatric/obstetric units( 5 SCBUs); 2 to 3 NICUs

• Implementation plan since 2007

Bolton

CMFT

Wythenshawe

Rochdale Bury

Wigan

Salford

Trafford Tameside

NMGH

Stockport

Maternity

Oldham

SCBU Children’s

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Care closer to home

Care closer to home

RMCH

Booth

Hall

Neonatal intensive care

Children’s Surgical Forum - General Paediatric surgery

• 25% of the population are children • Managed Clinical Network model is essential • Standards for Children’s Surgery – CSF 2007 report

currently being revised • Interdependency with anaesthesia and paediatrics • On – site anaesthetists for resuscitation • All staff have safeguarding training and in the management

of pain (HCC reports) • Presence of/access to on – site paediatricians and if no

overnight inpatient services- need agreed service specification with links by video/telephone/access to paediatricians out of hours

• Ensuring the provision of GPS in the District General Hospital, CSF 2010

Participation

• www.rcpch.ac.uk/participationresources

• CYPF influencing child health research, policy and advocacy to improve child health and paediatric services

• Experts leading meaningful participation of CYP

• Young patients and families advising the RCPCH

• Young patients and families influencing training and education resources

Next steps for the RCPCH

• Re - scoping the numbers and types of networks across the

UK

• Developing, auditing and implementing standards e.g. FtF

• Outcomes –CYP Health Outcomes Framework, NNAP, National

Diabetes Audit, CHR-UK

• Developing clinical and network models for sub specialties -

working with CSACs, SIGs , using pathways, quality

dashboards

• Using our own databases – e.g. workforce census and linking

to work -streams for IT developments /NHS Atlas of Variation

• For England - working with NHSCB leads, Network leads ,

Specialist Commissioning ( CRGs), CCG leads, DH and other

stakeholders

• Using RCPCH Participation leads/Youth Forum

• Strengthening links with paediatric surgery