Multi-speciality provider

Partnerships:

Commissioning safe,

comprehensive &

sustainable CCN Services

Trudy Ward SCN Clinical Lead

Trudy.Ward@nhs.net

UK Children, Young

People & their families

deserve better

• Priority need to tackle child health inequalities in the UK

• Care delivered closer to home/out of hospital where clinically

appropriate and safe

• The CCN role for LTC/palliative/complex needs- well established;

clinically effective and value for money

• Whole system approach required to shift care out of hospitals &

provide in the community

• CYP urgent care/sepsis/deteriorating child & SEND reforms

• Designing services around the individual CYP and not the system

• Integration, collaboration & multispecialty providers

Key messages from policy &

1959-2015

• Equitable, safe, comprehensive &

sustainable children’s community nursing

is critical to realising a whole system

approach to

• reducing avoidable hospital attendances

• delivering care closer to home

• improving patient experience and clinical

effectiveness 24 hours/day, 7 days a week

• Current nursing services in the community are not integrated for CYP with long term conditions, continuing healthcare needs or end of life care- fragmented and fragile service provision with limited accessibility for families

• No formal partnership working or joint plans from the different provider organisations

• Historical gaps in service access for all CYP across SEC- disparity and inequity in service provision.

• The current community workforce is below the recommended staff WTE per population ratio

• Nursing services across community and acute settings are working in silos with a lack of strategic vision and leadership.

• No completed commissioning review of all of these nursing services and no updated and agreed service specifications within contracts. Unreliable funding streams and significant lack of data some challenges.

• The development of community children’s nursing (CCN) teams across Kent, Surrey and Sussex remains fragmented and inequitable.

• Although some CCN services are successfully delivering quality services, very few of the existing CCN services are able to offer a 24/7 service that is especially critical for end of life care.

• Workforce challenges for future registered children’s nurse demand has not been tackled.

• KSS have not embraced the post-qualified workforce challenges for postgraduate children’s nurses. There has been a lack of investment in education to allow for delivery of both primary and community-based care advances roles.

• Non-qualified workforce challenges: There needs to be a skill mix approach with teams working together to provide nursing care across all sectors.

• Shifting towards more out-of-hospital care provides opportunities to extend current services and develop different and exciting ways in which children and young people receive or access care

The South East CCN Audit- familiar?

CCGs should move quickly to

commission equitable services and

ensure that each acute general

children’s service is supported by a

community children’s nursing

service which operates 24 hours a

day, 7 seven days a week for advice

and support for unscheduled and

end of life care, with visits as

required depending on the needs of

the children using the service

• 4% increase (HEE 2015/6) nurse training places

• Workforce planning is not aligned to strategic plans

• An ageing workforce

• Disparity and lack of consistency in preparation for training for contemporary roles across England

• Reduced number of HEIs offering CCN/APNP training

• Lack of clearly defined career pathways and progression

• Children’s training overseas not recognised in UK

• Challenges also with AHP’s and LD nursing

Workforce: children’s nursing

Children’s Nursing Workforce Supply HEE

Secondary and community

providers should work with

Health Education England (Kent,

Surrey and Sussex ) to support

the development of a SEC acuity

tool to determine nurse

workforce requirement.

The Kent Surrey

& Sussex Vision

• A comprehensive children’s community nursing service forms an integrated part of a co-located wider network of multiagency child and family services.

• An integrated service can provide for the existing and future needs of children, ensuring consistent, high quality transition between services such as hospital and home or between health, social care, education or children’s and adult services (Parker et al 2012 in RCN 2014).

The service vision

Community and secondary care

providers should support CCGs

to explore further the concept of

‘Teams within Teams’ across

localities to facilitate a

sustainable model that is

productive and equipped for

multiagency integration.

• A safe service with consistency of care across environments and professionals; there is clarity of level of autonomy, accountability and responsibility within the teams and professionals with robust community accorded clinical governance

• A comprehensive service with integrated and coordinated locality care that caters for all four groups of CYP; the service is responsive and flexible to local population needs and accessible seven days a week, with 24 -hour provision and an on-call service

• A sustainable service with robust workforce planning and development and the innovative use of critical mass of workforce within a locality; the right people with the right skills will be available in the right place at the right time

Attributes of a good CCN service RCN 2014

Components of a comprehensive needs led

CCN service – Kent Surrey & Sussex

Access scope

4 CYP Groups (0-24yrs)

7 Days 8-8 visits

24hr End of Life Care

Integrated delivery

that is locality & community positioned

Sustainable service models and skilled

workforce

Collaborative relationships

Agreed care pathways

Supported by

technology innovations

& performance data review

Clinical nursing leadership

Robust clinical governance; supervision & education frameworks

• There needs to be 24 hours a day, 365 days a year access to end of life nursing care for children and young people at home if that is the families choice (DH/NHS England).

• There needs to be 24 hours a day, 365 days a year access to children’s community nursing advice and support for unscheduled care, with as a minimum visits from 8am to 8pm, 7 days a week (RCPCH/RCN/RCGP).

• There needs to be 24 hours a day, 365 days a year access to children’s community nursing advice and support for children with long term conditions, complex needs and disability, with, as a minimum, visits from 8am to 8pm, 7 days a week (NHS at Home DH).

24/7

• Joined up, high quality**, community positioned models of care, which effectively reduce the need for hospital attendances and admissions ** robust community accorded clinical governance

• Scope, advancement & innovations in nursing to deliver core, specialist and advanced practice across a range of settings

• Nursing that is primary and community positioned in addition to nursing in hospital- for all 4 groups of CYP

• New approach needs to maintain the excellence in the children’s community nursing specialism that has existed for those children with long term conditions, complex needs, disability and life limiting conditions together with integrating new advanced children’s nurse practitioner roles to diagnose and treat children with acute short term conditions

• Maximising the critical available RNC resource & evidential skill mix

The nursing vision: think child not base

All 4 groups of CYP

Education Social Care

Palliative EOLC

Safeguarding

Administrator

Nurse Counsellor

Safeguarding

Short breaks

Advanced Community

Nurse

Specialist Health Visitor

Special School

Nursing

Rapid Response

Care

CORE COMMUNITY

NURSING

Epilepsy Specialist

Nurse

Diabetes Specialist

Nurse

Cystic Fibrosis

Specialist Nurse

Specialist Health Visitor

Children’s Community

Matron

Head of Children’s

Community Nursing

Practice Educators

Paediatric Nurse

Practitioner CYP ADVANCED

Nurse Practitioner

CYP ADVANCED

Nurse Practitioner

Paediatric Nurse

Practitioner

Administrator

CORE COMMUNITY

NURSING

Advanced Community

Nurse

Nurse Counsellor

Palliative EOL Care

Short breaks

Rapid Response

Care

Special School

Nursing

Acute tertiary/

local

Healthy Child Programme

Child Development

Team

Hospices Primary Care

• Agreed clinical pathways across providers

and settings will avoid duplication in roles

and expose gaps

• Specialised service specs need to be

aligned with local CCG service specs

• ……AHP’s eg community respiratory

physiotherapists

Nursing roles: who is responisble for

what?

• CYP urgent care pathways

• RCPCH/RCN/RCGP Standards 2015

• Primary care, acute hospital & community collaborations

• New work stream within majority of CCN services

• Data on demand/need a challenge

• Requires whole system approach & sign up

CYP: Acute short term conditions

• Tertiary, local acute, primary care,

community health services alongside

education

• Business continuity regarding nursing –

align specialised commissioning with local

commissioning

• Agreed collaborative care pathways

CYP: Long term Conditions

Specialist CCN roles that incorporate:

• Keyworking/case management/lead professional; transition co-ordination

• Emotional support throughout childhood

• Liaison, information and signposting

• Specific nursing care & management

• Education and training parents/family & wider children’s workforce

• Multiagency & multi-provider partnerships

• Special school nursing & SHV’s

CYP: Complex needs & disability

• Good will & skilled workforce not sustainable with addition of acute short terms conditions work and expansion of 7 days- 24/7 for other groups of CYP

• Children are not always given the choice to die at home as there are not enough trained community children’s nurses to provide 24/7 children’s palliative care in the community RCN June 2015

• NHS provider/Charity provider formal partnerships – joint KPI’s & governance

CYP: Life Limiting, Life threatening

conditions & End of Life Care

Care Pathways for LTC should clarify roles and

outcomes using Clinical Nurse Specialists and

CCN Specialist Practitioners to ensure business

continuity across primary, secondary and

community providers.

CCGs and providers should work with Together

for Short Lives.

Providers should build on current strategies to

build on good practice in advance care planning

for CYP.

CCGs and providers have to accelerate

discussions on the implications of the recent

NHS England report Developing a New Approach

to Palliative Care Funding.