The new NHS and the Children’s Strategic Clinical Network Tracy Parr SCN Lead Children and Maternity Leaders for London January 28 th 2014 London Strategic.

The new NHS and the Children’s Strategic Clinical Network

Tracy Parr

SCN Lead Children and Maternity

Leaders for London

January 28th 2014

London Strategic Clinical Networks

2

Structure of Presentation

• Overview of new NHS structures• National initiatives

• General• Children-specific

• Strategic Clinical Networks – overview• Children’s health in London• Children's strategic clinical network London

3

The NHS in England structure and responsibilities

Health and Social Care act 2012 changed• Structure• Accountabilities• Funding arrangements• Working arrangements

Health and Social Care Bill 2010

4

Health and Social Care from April 2013

2013

5

6

7

Structures up to April 20013

8

NHS in England Apirl 2013

9

New funding Arrangements

10

Regulation and Accountability - providers

11

Commissioners – performance management and guidance

12

Patient and public involvement

13

Expectations of how £95billion will be spent

Children in the UK

14

Word acquisition - inequalities

15 Hart and Risley 1995

C and YP Health Outcome Forum

16

17

NHS Outcomes Framework

18

Outcomes for Children

Domain One – Preventing people from dying prematurely

Reducing deaths in babies and young children

• Infant mortality

• Neonatal mortality and stillbirths

• Five year survival from all cancers in children

Domain Two – Enhancing quality of life for people with long

term conditions

Reducing time spent in hospital with long term conditions

• Unplanned hospital admissions for asthma diabetes and epilepsy in

under 19s19

Outcomes for Children

Domain Three – Helping people to recover from episodes of ill health or

following injury

Preventing lower respiratory tract infections (LRTI) in chidlren from becoming serious

• Emergency admissions for children with LRTI

Domain Four – Ensuring people have a positive experience of care

Improving C and YP experience of healthcare

• C and YP experience of outpatient services

20

Outcomes for Children

Domain Five – Treating and caring for people in a safe environment and

protecting them from avoidable harm

Delivering safe care to chidlrne in acute settings

• Incidence of harm to chidlren due to “failure to monitor”

21

Adult Social Care Outcomes Framework

22

Public Health Outcomes Framework

23

Public Health Outcomes Framework

24

25

London’s Children

• Population of London 7.8 million (ONS 2011)

• 2,049,576 children aged 0 – 19 in London

• Approx 1.7 million children in Kent Surrey

Sussex, and East of England many of whom

access tertiary services in London

• 134,186 live births in London 2012 (ONS)

26

Why a Children’s SCN?

UK has a higher all-cause childhood

mortality rate compared with Sweden,

France, Italy, Germany and Netherlands

London has higher than expected mortality for 1 – 19 year olds

27Data courtesy of London Health Programmes

Hospital mortality for children in London is rising compared to other areas of UK

28

There are low rates of consultant review of paediatric emergency admissions within 12 hours

29

78% of London trusts undertake elective surgery on less than two children per week

30

Most surgery on children is being undertaken by adult surgeons

31

32

What is a Strategic Clinical Network (SCN)?

• Area requiring large scale change

• Resistant to previous attempts at improvement

(or not examined holistically)

• Strategic pan-London approach

• Provide expert advice to commissioners

• Contrast with Operational Delivery Networks

Over 50% of hospitals do not have a paediatric anaesthetist available

33

Attendance at A & E by children is very high in London

34

ACCIDENT & EMERGENCY attendances, ages 0-17, London 2010-11

Source: PHE ChiMat using HES Data

0 100 200 300 400 500 600

BarnetHavering

HarrowCity of London

Richmond upon ThamesRedbridge

Barking and DagenhamBexley

Waltham ForestBromley

Kingston upon ThamesCamden

HillingdonLONDON

SuttonLambeth

Kensington and ChelseaCroydon

Hammersmith and FulhamIslington

EalingNewham

SouthwarkTower Hamlets

MertonBrent

HounslowEnfield

LewishamGreenwich

Westminster, City ofHackneyHaringey

WandsworthEngland

Accident & Emergency attendances, rate per 100,000 population aged 0-17

Accident & Emergency attendances, rate per 100,000 population aged 0-17, England LAs, 2010-11

96.6 - 243.9

244.0 - 301.9

302.0 - 336.9

337.0 - 413.9

414.0 - 880.6

National quintilesrate per 100,000

0

100

200

300

400

500

600

700

800

900

London - lowest

London average

England average

London - highest

26 London boroughs have A and E attendance higher than the national average for children

Data courtesy of ChiMat

Some boroughs have high rates of admission to hospital for asthma

35

ASTHMA Emergency hospital admissions, ages 0-18, London 2011/12

Source: DMIT using HES Data

0 50 100 150 200 250 300 350 400 450

WestminsterWandsworth

Richmond and TwickenhamHavering

EnfieldBarnet

KingstonGreenwich

Kensington and ChelseaHillingdon

Tower HamletsHounslow

BromleySutton and Merton

HaringeyBexley

CamdenHammersmith and Fulham

LONDONNewham

BrentCity and Hackney

SouthwarkHarrow

RedbridgeEaling

LewishamBarking and Dagenham

LambethIslingtonCroydon

Waltham ForestEngland

Emergency hospital admission rate per 100,000 population aged 0-18

Emergency hospital admission rate per 100,000 population aged 0-18, England PCTs, 2011/12

74.8 - 142.0

142.1 - 162.0

162.1 - 210.0

210.1 - 262.0

262.1 - 495.7

National quintilesrate per 100,000

0

50

100

150

200

250

300

350

400

450

500

London - lowest

London average

England average

London - highest

Thematic examination of SUIs involving children in London

36

Aim To identify themes and learning from Serious Untoward Incidents (SUIs) to help inform the work of the Children’s SCN

Methodology

• SUIs involving children requested from STEIS 2008 - 2013

• Those indicating system failure identified n = 86

• Full report requested from Trusts/PCT/CCG

• 59 responses received from 29 organisations

• Common themes identified and collated

Thematic examination of SUIs involving children in London

37

Lack of recognition of sick child

Inexperience/lack of expertise

Worlklaod

Communication

Failure to escalate to consultant/senior review

Documentation

Transfer to tertiary centre

Failures of Care

38

• Half of all children subsequently found to have meningococcal infection are sent home from the first primary care consultation

• Approximately 75% of admissions of children with asthma could have been prevented with better primary care

• Over a third of short stay admissions in infants are for minor illnesses that could have been better managed in the community

39

Clinical areas covered by SCNs

SCN core elementsComprehensive

networks of clinical

expertise

Leadership for

accelerated change at

pace

Agreed priorities for improvement

Holistic view of health

and social care

Widespread engagement

Meaningful and effective

patient involvement

41

What is a Strategic Clinical Network (SCN)?

• Area requiring large scale change

• Resistant to previous attempts at improvement

(or not examined holistically)

• Strategic pan-London approach

• Provide expert advice to commissioners

• Contrast with Operational Delivery Networks

42

London’s Children

• Population of London 7.8 million (ONS 2011)

• 2,049,576 children aged 0 – 19 in London

• Approx 1.7 million children in Kent Surrey

Sussex, and East of England many of whom

access tertiary services in London

• 134,186 live births in London 2012 (ONS)

43

Why a Children’s SCN?

UK has a higher all-cause childhood

mortality rate compared with Sweden,

France, Italy, Germany and Netherlands

London has higher than expected mortality for 1 – 19 year olds

44Data courtesy of London Health Programmes

Hospital mortality for children in London is rising compared to other areas of UK

45

There are low rates of consultant review of paediatric emergency admissions within 12 hours

46

78% of London trusts undertake elective surgery on less than two children per week

47

Most surgery on children is being undertaken by adult surgeons

48

Nearly half of children are not reviewed by a consultant surgeon within 12 hrs of admission

49

Over 50% of hospitals do not have a paediatric anaesthetist available

50

Attendance at A & E by children is very high in London

51

ACCIDENT & EMERGENCY attendances, ages 0-17, London 2010-11

Source: PHE ChiMat using HES Data

0 100 200 300 400 500 600

BarnetHavering

HarrowCity of London

Richmond upon ThamesRedbridge

Barking and DagenhamBexley

Waltham ForestBromley

Kingston upon ThamesCamden

HillingdonLONDON

SuttonLambeth

Kensington and ChelseaCroydon

Hammersmith and FulhamIslington

EalingNewham

SouthwarkTower Hamlets

MertonBrent

HounslowEnfield

LewishamGreenwich

Westminster, City ofHackneyHaringey

WandsworthEngland

Accident & Emergency attendances, rate per 100,000 population aged 0-17

Accident & Emergency attendances, rate per 100,000 population aged 0-17, England LAs, 2010-11

96.6 - 243.9

244.0 - 301.9

302.0 - 336.9

337.0 - 413.9

414.0 - 880.6

National quintilesrate per 100,000

0

100

200

300

400

500

600

700

800

900

London - lowest

London average

England average

London - highest

26 London boroughs have A and E attendance higher than the national average for children

Data courtesy of ChiMat

Some boroughs have high rates of admission to hospital for asthma

52

ASTHMA Emergency hospital admissions, ages 0-18, London 2011/12

Source: DMIT using HES Data

0 50 100 150 200 250 300 350 400 450

WestminsterWandsworth

Richmond and TwickenhamHavering

EnfieldBarnet

KingstonGreenwich

Kensington and ChelseaHillingdon

Tower HamletsHounslow

BromleySutton and Merton

HaringeyBexley

CamdenHammersmith and Fulham

LONDONNewham

BrentCity and Hackney

SouthwarkHarrow

RedbridgeEaling

LewishamBarking and Dagenham

LambethIslingtonCroydon

Waltham ForestEngland

Emergency hospital admission rate per 100,000 population aged 0-18

Emergency hospital admission rate per 100,000 population aged 0-18, England PCTs, 2011/12

74.8 - 142.0

142.1 - 162.0

162.1 - 210.0

210.1 - 262.0

262.1 - 495.7

National quintilesrate per 100,000

0

50

100

150

200

250

300

350

400

450

500

London - lowest

London average

England average

London - highest

Thematic examination of SUIs involving children in London

53

Aim To identify themes and learning from Serious Untoward Incidents (SUIs) to help inform the work of the Children’s SCN

Methodology

• SUIs involving children requested from STEIS 2008 - 2013

• Those indicating system failure identified n = 86

• Full report requested from Trusts/PCT/CCG

• 59 responses received from 29 organisations

• Common themes identified and collated

Solutions to the care of children

54

“Children’s services should be seen as a whole system,

designed within a framework of pathways and networks

which enable the right things to be done, at the right time

and place, using teams that work together within a

managed network.”

RCPCH 2013

Issues across healthcare systems

55

“It is clear that in relation to service failure, problems

often occur at the borders between one organisation or

team and another”

Learning from Investigations

Healthcare Commission

February 2008

PA

TH

WA

YS

London Strategic Clinical NetworksDecember 2013

Children’s Strategic Clinical NetworkChildren’s Commissioning Group

Strategic Clinical Leadership Group

Patients and public

SCN Oversight Group

GovernanceClinical Senate

Assurance

Children’s Network Children’s Network

Children’s Network Children’s NetworkSTA

ND

AR

DSS

TAN

DA

RD

S

Primary care

Tertiary care

Secondary care

Cardiology Pathway GroupChair: Owen MillerSCN Lead: Andy Martin

Neuroscience Pathway GroupChair: TBCSCN Lead: Andy Martin

Diabetes Pathway GroupChair: Peter Hindmarsh/Martha Ford-AdamsSCN Lead: Sara Nelson

Nephrology Pathway GroupChair: Lesley ReesSCN Lead: Sara Nelson

Surgery Pathway GroupChair: Simon EcclesSCN Lead: Suzanne Sweeney

Critical Care Pathway GroupChair: Duncan MaCraeSCN Lead: Andy Martin

Oncology Pathway GroupChair: Julia Chisholm/Darren HargraveSCN Lead: Caroline Moren

Asthma Pathway GroupChair: John MoreiraSCN Lead: Sara Nelson

Gastrointestinal Pathway GroupChair: Ian SandersonSCN Lead: Suzanne Sweeney

Neonates Pathway GroupChair: Sandy CalvertSCN Lead: Suzanne Sweeney

Patient and Public Involvement (PPI)SCN Lead: Andy Martin

Mental HealthSCN Lead: Andy Martin

Health in the Justice SystemSCN Lead: Sara Nelson

CommissioningSCN Lead: Sara Nelson

Immunisation, Healthy Child and SafeguardingSCN Lead: Suzanne Sweeney

Data and InformationSCN Lead: Andy Martin

Programme ManagementSCN Lead: Andy Martin

Information TechnologySCN Lead: Sara Nelson

Education & Workforce SCN Lead: Sara Nelson

CommunicationsSCN Lead: Suzanne Sweeney

Community care

Collaborating with:

► Academic Health Science Networks► Clinical Commissioning Groups (CCGs)

► Health and Wellbeing Board► Local Education and Training Boards

►Public Health England► Regulatory bodies

► Royal Colleges► Voluntary sector

PA

TH

WA

YS

ENABLERS EN

ABLE

RS

Initial work programme - Networks

57

• Subgroup of SCLG developing network model

• Chaired by Professor Russell Viner, UCL/ICH

• Networks of care across all children's providers

• Currently considering 3 based on AHSNs, LETBs, LATs,

• Population based view of children’s health

• Linkage with public health

• Governance pathway through commissioners linked into commissioners

• Funding identified to establish networks

Initial work programme - Standards

58

• Subgroup of SCLG chaired by Tina Sajjanhar, Paediatric ED Consultant, Lewisham Hospital

• Identify standards of care within the networks collating existing standards:

• Service specifications for specialised services

• All existing standards for children in-hospital care (eg RCPCH, London Health Programmes, RCA, RCS)

• General practice outcome standards

Initial work programme - pathways

59

• A number of pathway groups

• Some illustrative of issues in primary secondary and tertiary care settings

• High volume

Contact details

60

[email protected]

020 7932 9069