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Children’s Palliative Care: National Policy Context and the Child Health Strategy

Liz MorganProfessional Advisor – Children and Young PeopleDepartment of HealthJanuary 2009

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Setting the Context….

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The NHS Next Stage review: High Quality for All (DARZI)

– Working with NHS staff to ensure that clinical decision-making is at the heart of the future of the NHS and the pattern of service delivery

– Improving patient care, including high-quality, joined-up services for those suffering long-term or life-threatening conditions, and ensuring patients are treated with dignity in safe, clean environments

– Delivering more accessible and more convenient care integrated across primary and secondary providers, reflecting best value for money and offering services in the most appropriate settings for patients

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Defining Quality (NSR)

Three elements:

• Patient Safety

• Effectiveness of Care

• Patient Experience

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Principles of Change

• Co-production – working together

• Subsidiarity – decisions made as close to patients & the community as possible

• Clinical Leadership

• System alignment – same goals

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Key Policy Messages translated to Children & Families

• Listening to the child & family

• Developing services around the family

• Care closer to home/at home

• Integration of the workforce

• Partnership working – across health, education & social care

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Children’s Policy Drivers….

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The Children’s Plan: Building brighter futures

Children’s Plan sets out the vision for children & young people, and trailed development of a Child Health Strategy.

Government’s 2020 ambition for all children and young people is to:

– Secure the wellbeing and health of children and young people;

– Safeguard the young and vulnerable;– Achieve world class standards in

education; and – Close the gap in educational achievement

for children from disadvantaged families– Ensure young people are participating and

achieving their potential to 18 and beyond– Keep children an young people of the path

to success.

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Vision of Health Services shaped to promote health and care for ill health or vulnerability

in childhood

Health & NHS

Policy (incl. Darzi)

Cross- Govt plan outlines how DCSF will work with other Govt

Departments, families, communities and front-

line staff to improve the lives of children over the next decade

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The Child Health Strategy must respond to the specific challenges faced by vulnerable groups and ill children, as well as promoting healthy behaviour by

all children and young people

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Ill Vulnerable

• We are struggling to meet many of today’s biggest public health challenges and there are worrying trends.

• Health promotion is critical.

• We do not consistently undertake risk assessments and target support.

• Groups suffer disproportionately poor health outcomes

• Miss opportunities to intervene early

•Children with long term conditions or disabilities do not get the support needed to fulfill their potential.

•Key issues around access to specialists and age-appropriateness of settings where treatment is received.

We need to ensure services are sufficiently:

•Integrated

•Personalised

•Preventative

•Targeted

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Child Health Strategy

Emerging themes:

• Health promotion and prevention (eg informing families and supporting healthy lifestyles)

• Early intervention

• Personalised and integrated services (accessible and designed around the needs of users)

• Effective, targeted access to specialist services

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Child Health Strategy

Key Challenges to address:

• Unwanted variability in outcomes and

effectiveness of services

• Poor co-ordination of services – a barrier to personalisation and a shift to prevention

• Nature of public health challenges

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Other Links and Dependencies

• Darzi Next Steps Review

• Maternity and neonatal services networks

• Bercow review into services for children with speech, language and communication needs.

• Healthy schools programme

• Facing the future (Health Visitors)

• Neonatal Taskforce

• Child Health Promotion Programme (Healthy Child Programme)

• Family Nurse Partnership

• Care Closer to Home (Our Health, Our Care, Our Say)

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Links and dependencies contd…

• HR issues around the wide range of employers/organisations providing NHS services

• Public Health

• Long Term Conditions

• Palliative Care (including End of Life Care) ‘Better Care: Better Lives’

• “Aiming High” programme for Young People and Disabled Children

• Modernising Careers (nursing, medical etc)

• Working Time Directive (including more consultant Paediatricians)

• Interdependencies of Specialist Services

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Children’s Palliative Care

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The Government’s Response:

“Better Care,

Better Lives”

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The Vision…

“Every child and young person with a life-limiting or life-threatening condition will have equitable access to high-quality, family centred, sustainable care and support, with services provided in a setting of choice, according to the child and family’s wishes.”

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Priority AreasImproved data

Equality of access to universal services

Responsible and accountable leadership

Choice in preferred place of care

Better end-of-life care

Stronger commissioning & value for money

Successful transition – children’s to adult services

Planning and developing an effective and responsive workforce

Expansion of respite/short break services

Investment in Community Children’s Nursing services

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Current Children’s Workforce Issues

• Darzi Next Stage review including maternity, the new born and children’s services as well as the review of workforce planning - ‘High Quality for All’

• Primary Care Strategy• Inequalities Agenda• DSCF long term Workforce strategy to support 10

year Children’s Plan • PCT & LA Joint Needs Assessments – joint

commissioning and workforce planning• SHA role• National Neonatal Taskforce (including workforce

sub-group)• Maternity – current and future services, access to

help and advice within 12 weeks of pregnancy• Adolescent health

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What do we mean by the Children’s Workforce?

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Jointly agreed approachSHAs/PCTs

& Providers

HRServices

Pay &Pensions

Regulation Education&

Training

NHSEmployers

NationalWorkforceProjects

Workforce Review Team

Skills forHealth

RCM

DSCF

RCOG,RCN,CPHVA,RCGP

HVA

BMA, Unison and Unite

NMC

DH Policy

Other stakeholders e.g. CWN,CWDC

NHSProfessionals

CSIP

DH Clinical leads

Patients

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Workforce Priorities

• Health visiting

• School nursing

• Neonatal nursing

• Community Children’s Nursing

• Paediatric medicine

• Speech and Language Therapists

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Making it Happen:Levers and Initiatives to drive change……..

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Child Health and Wellbeing is a priority for the Government as reflected in a Number of Public Service Agreements:

The Children, Families and Maternity Branch has a structured Programme of work in Support:

PUBLIC SERVICE AGREEMENTS:

PSA 12: Improve the Health and Wellbeing of Children and Young People;

PSA 13: Improving Children and Young People’s Safety

PSA 14: Increase in the Number of Young People on the Path to Success;

PSA 18: Promote better Health and Wellbeing for All;

PSA 19: Better Care for All

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NHS Operating Framework

• Children and maternity services are identified as part of the national priority areas for 2008- 10

• Supporting this 5 of the 12 PSA indicators focus on child health, & 4 are reflected in the Vital Signs indicators for PCTs

• 3 of these PSA indicators – breast-feeding at 6-8 weeks, obesity among primary aged children, and CAMHS – are national priorities for local delivery i.e. all PCTs required to include in local plans

• There is also a PSA priority on services for disabled people & therefore includes CYP – PCTs working with communities and local partners prioritise for themselves

Child Health and Wellbeing is a priority for the Government – this is reflected in the NHS Operating Framework and related Vital Signs and NIS indicators

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2009/10 Operating Framework

• ‘five key Areas where PCTs are expected (working with local partners) to pay particular attention:– Improving cleanliness and reducing HCAI’s– Improving access through the 18 week referral

pledge & access to GP services– Keeping adults & children well, improving

health and reducing health inequalities– Improving patient experience, staff satisfaction

and engagement – Preparing to respond in a state of emergency,

such as an outbreak of pandemic flu’

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Making it HappenResponsibility for Local delivery……

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Commissioning is the Key

• World Class Commissioning

• Transforming Community Services

• Outcomes and quality focussed

• Data & evidence

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Clarity of components

• What needs to be done, based on best evidence.

• Who needs to do it, based on competencies.

• Where it needs to be delivered, based on safety and convenience.

• With what additional resources e.g. equipment, investigation access, decision support.

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And finally…..

Transforming Community Services

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Key Messages from the Primary and Community Care Strategy

Strategic Context

• Community services are critical to the delivery of improved services for patients and communities

• There is much good practice but too much variation in quality and outcomes

• Investment in staff and infrastructure is required to develop and deliver excellent ‘out of hospital’ care

• Clinical staff are central to driving change to improve quality, access and health outcomes

• something like Staff need the business tools to support them commission and provide high quality community services.

• DH is committed to driving the national improvement programme

• DH is committed to working with and supporting clinicians working in the community to maximise the potential for –Best heath services and health outcomes–Rewarding clinical careers and opportunity in the community

–Incentivising high quality and innovation

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Our Vision : Primary and Community Care Strategy

Where people shape services – giving people more say and more choice and more control in their own health care

sets out a vision for primary and community care

Which promotes healthy lives and tackles health inequalities – working with key partners

Where services are continuously improving quality through effective clinical leadership ,new freedoms and improved infrastructure

Where public and clinical professionals are leading local change and developing best practice and joined up local services

we have a huge opportunity to deliver transformational change

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Transforming Community Services Programme

High level aims

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Clinical and service improvementDevelopment of clinical and leadership skills and resources to deliver high quality evidence based care and services that promote health and well

being with action on inequalities.

Business improvement Strengthening business process. Reforming the provision and commissioning of community services. Enabling performance and outcomes to be demonstrated and benchmarked, driving-up quality

and reducing variation in performance.

Strategic Context

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Objectives and scope

To determine action that is required at national level to enable local leadership and delivery of best practice, evidence based care and excellent patient experience in six key areas.

To enable change in community services through focus on six key areas by providing leadership, tool kits and approaches to quality and incentives at national level.

Six key areas:Health improvement and health inequalities

Children and FamiliesLong term conditionsAcute care and specific treatments to be delivered close to homeRehabilitationEnd of Life

Six high impact changes being developed for each area through clinical engagement.

Benefits

Clinical services improvement

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Thank you for listening

Questions?