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Healthy London Partnership
Children & Young People’s Programme
PICH Programme
March 23rd 2016
Tracy Parr – Head of CYP Programme
https://www.myhealth.london.nhs.uk/healthy-london/children-and-young-people
2
Healthy London Partnership –
Children and Young People’s programme
Children’s services in London: Key facts
8.2 million people live in London
of which
2,049,576 are children aged 0-19
134,186 live births in
London in 2012
600,000 of London’s children
live in poverty
Mental Health
conditions affect
1 in 8 Children
Emotional and
behavioural
problems affect
1 in 5 Children
20% of 4-year-olds are overweight or obese
25% of 15-year-olds
First smoked
AGED 13 or younger
40% of 15-year-olds drink alcohol once a week
LESS THAN HALF of 11-15
year olds do an hour of
exercise each day
20% of 13-year-olds drink alcohol once a week
Healthy London Partnership –
Children and Young People’s programme
The most common malignancy is childhood
LEUKAEMIA at 41%, including lymphomas
Brain tumours account for
25% of all childhood
cancers
22% of the babies
who died were born at 37-40 weeks
gestation
1 in 10 of babies born in London are admitted to neonatal units — 13,596 each year
282 of those babies do not survive (2.1% of admissions)
Congenital heart disease (CHD) is the most common congenital abnormality
A recent survey of DGH service
provision shows that nearly half of hospitals operate
on less than 51 elective paediatric surgical cases per
year
4%
More than
29,000 children
in the UK have Type I diabetes. You would need
70 jumbo jets to take them all on holiday
South Asian and African Caribbean people
Are 3-5 times more likely to suffer kidney
failure requiring dialysis than white Caucasians
each year - even more quickly in children under five.
Incidence of Type 1 diabetes is increasing
by about
In London, there are more than
3000 with Type 1 diabetes
5,570 of babies born in
London admitted to neonatal units were born at 37-40 weeks
(gestational age)
679 children are on renal replacement therapy in the UK 212 of these are treated in London
3% of children have written asthma plans to prevent and manage exacerbations
3,600 paediatric surgical
procedures are performed each year
>50% of London hospitals report that they do not always have an anaesthetist with
paediatric Training on call for
paediatric emergency cases.
of all NHS expenditure on patients with IBD is for inpatient management (approximately)
1/2 11% are done at Evelina
There are
130 renal transplants undertaken on children in the UK each year
Whilst there are 13
tertiary centres across the UK, just
10 of those 13
provide renal transplantation
25% of UK transplants for children are done at GOSH
What do children, young people and families think?
5
I need rapid
access to
someone I can
talk to when I
feel depressed
We need
easier
access to
healthcare
Services are
not joined
up
I want to know
that my GP is
experienced
in caring for
children
Make sure
the school
can look
after my son
when he has
an asthma
attack
I am worried
about what will
happen next
year when I am
too old for the
children’s
clinic
7
London Health Commission
Healthy London Partnership –
The delivery arm of the London Health Commission
Goal – London to be world’s healthiest global city
8
10 programme aims from London Health Commission
Healthy London Partnership Children and Young People Programme Governance
10
HLP C&YP Transformation Board
London Transformation Group
(London’s CCGs and NHS England) London Health
Board
CYP Clinical
Leadership
Group
CYP
Commissioning
Advisory
Group
Accountable
Information sharing/
endorsement
Programme alignment
Critical Care
Clinical
Leadership
Group
Surgery Clinical
Leadership
Group
Asthma Clinical
Leadership
Group
Out of Hospital
Care Clinical
Leadership
Group
CAMHS Clinical
Leadership
Group
Primary Care Board
• CCG SRO & SEL SPG (Martin Wilkinson) • NHSE SRO (Will Huxter) • CYP Clinical Director (Russell Viner) • CCG Clinical Lead (Nicola Burbidge) • SPG rep SWL (Adam Doyle) • SPG rep BHR (Louise Mitchell) • SPG rep WELC (Satbinder Sanghera) • SPG rep NCL (Sarah Price) • SPG rep NWL (Matthew Hannant) • DPH (Dagmar Zeuner) • PHE (Marilena Korkodolis) • DCSS (Linzi Roberts-Egan) • CYP/family rep (Emma Rigby) • Programme Manager (Tracy Parr) • GP lead (Eugenia Lee) • Strategic Lead CAMHS (Steve Ryan) • NHSE asthma lead (Dave Finch)
CYP & Families Engagement throughout
U and EC Board
Mental Health Board
Prevention Board
Specialised Services Board Young
People’s
Steering Group
V0.9 Jan 2016
Primary Care
Clinical
Leadership
Group
12
Priority A
Develop Population Based Networks
• Develop guidance for model of population based CYP networks across SPGs
• Understand data requirements to describe needs analysis in population based
networks
• Develop data set and data dictionary to enable effective needs analysis CYP
• Work with SPGs to support development and implementation of population
based network
• Undertake evaluation of population based networks and disseminate learning
13
Priority B
Reduce variation in care Standards and models of care
• Acute care (completed)
• Asthma (completed)
• Surgical networks (completed)
• HDU (level 1 critical care)
• Out of hospital care - directory of models and financial modelling
• Develop model of primary care to meet needs CYP
Implementation
• CAMHs – support for implementation of CAMHS transformation plans
• Baseline assessment of trusts against standards based on peer review
• Asthma – implementation plan at pan-London, SPG and CCG level
• Community pharmacy engagement plan
• Surgical networks – support pilot in SW London linked into 111 DoS
• HDU –funding and co-commissioning models
• Develop workforce strategy for implementation of CYP programme
Acute Care Standards
14
• Collation of all acute standards from Royal
Colleges, DH, RCN, LQS into one document
• Currently being revised with new surgical
standards
• Peer review process to be undertaken 2016 –
2017 to share best practice and describe
baseline
Asthma mortality and children with wheeze
Ingrid Wolfe, Lancet, Mar 2013
15
0
5
10
15
20
25
30
0
0.05
0.1
0.15
0.2
0.25
0.3
Sweden Portugal Finland Italy Austria Germany Spain UnitedKingdom
Pe
rce
nta
ge w
he
eze
10
ye
ar S
DR
pe
r 1
00
00
0 (
0-1
4 y
ear
s)
Mortality
6-7 age group
13-14 agegroup
Asthma Mortality in London under 19 years
16
• 4 deaths per million population aged < 19 years
• Estimated 8 asthma deaths aged <19 per year in London
• 24 Maternal deaths London 2014 – 2015
• 2 direct
• 21 indirect
London Asthma Standards
18
• 14 ambitions across specific areas
• System-wide
• Patient and family support
• Schools
• Acute and high risk care
• Integration and co-ordination
• Discharge planning
• Transition
• Effective and consistent prescribing
• Workforce education and training
• All settings
• Primary care
• Secondary and tertiary care
• Community pharmacies
• Schools
• Self care
Asthma Community Pharmacy Audit
Interim results
19
9,462 responses
1,858 Community pharmacies
across the whole of London
were invited to a take part
1,101 Pharmacies
responded
48% Do have an
asthma action
plan or wheeze
plan
70% Had a inhaler
technique
assessment in
the last 12
months
64% Have a spacer
device
96% Do not smoke
23% Live with
someone who
smokes
64% Did not have a
flu jab last year
25% Had to make an
emergency request
for an inhaler in the
last 12 months
60% of the total
number of
pharmacies
32 boroughs
(all) took
part
Campaign
extended to 10 weeks
till 2 October
9.4 Average age
of participant
9 Average
entry per
pharmacy
1 in 4 Entries were
using a smart
device
Participation per
borough
Results
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
Bark
ing a
nd D
age
nham
Hackney
Lew
isham
New
ham
Islin
gto
n
Lam
beth
City o
f Londo
n
To
wer
Ha
mle
ts
Bro
mle
y
Gre
enw
ich
Redb
ridge
Cam
den
Mert
on
Wa
lth
am
Fo
rest
Cro
ydon
Bexle
y
South
wark
Kin
gsto
n u
pon T
ham
es
Sutton
Wa
ndsw
ort
h
Haverin
g
Ric
hm
ond
upo
n T
ham
es
Barn
et
Hill
ingd
on
Enfield
Kensin
gto
n a
nd
Che
lsea
We
stm
inste
r
Ham
mers
mith a
nd F
ulh
am
Harin
gey
Ealin
g
Harr
ow
Bre
nt
Houn
slo
w
CYP Asthma Implementation Toolkit
20
Self Care Primary
Care Schools
Secondary
Care
Community
Pharmacies
School Asthma
Policy
Persons responsible
for annual
review_____________
Review date
CYP Mental Health and Well Being
21
• Supporting CCGs in developing local CAMHS transformation plans
• Producing pathway for crisis care in conjunction with U and E care
• Delivering workshops on specific areas of concern – eating disorders/learning difficulties
• Working with DCO team to support assurance process
• Working with voluntary sector to support collaboration with CCGs
• Team expertise expanding – Steve Ryan, CAMHS commissioners, clinical advisor
• Future work • Continue to support CCGs
• Develop KPIs and informatics solutions
• Linking in and supporting IAPT
• Looked after children
• Linking with schools pilots
Other priority deliverables
22
• Level 1 critical care standards (DGH HDU)
• Surgical networks pilot
• Population of MiDoS (111 directory of services) for CYP services
• Directory of out of hospital models of care for CYP and economic modelling
• Primary care model of care for CYP
23
Priority C
Integration of care
▪ Develop integrated models of care for CYP based on other workstream outputs)
▪ Undertake scoping of models in relation to CYP care
– Multispecialty community providers
– Primary and acute care systems
Link in with Vanguard bids and work within HEE
24
Priority D
Improve commissioning
• Develop CYP commissioning programme structure(completed)
• Procure educational provider (Feb – Mar 2016)
• Recruit first cohort (commence May 2016)
• Support development of new commissioning models for CYP services (2016-17)
• Support CCGs to develop commissioning strategies to implement:
• Level 1 critical care (HDU in DGH)
• CAMHS
25
Priority E
Innovative Access
• Development of young-person friendly app using validated content from NHS
Choices
• Development of materials to illustrate when medical advice should be sought
• Establishment of pan-London steering group
Recommended