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Using the
to improve services for children,
young people and their families
BACCH/BACAPH
September 2014
FAMILY FRIENDLY FRAMEWORK
Structure
• Introduction• Where are we?• Systems - theory• Family Friendly Framework• Application - commissioning• Application - provision• Application – regulation• Benefits
Why is the FFF needed?
• System reform - free market
• Austerity – public service cuts
• Unnecessary variations
• Waste
• Resource allocation
Biological systems
• Genetic coding in DNA• Basic proteins plus encoded fractal formulae• Iterative designs• Control systems based on feedback loops
• Interaction with environment• Innovation• Communication• ‘Survival of the fittest’
Learning“Simple rules”
Innovation plus learning = survivalCommunication
Service
Lifestyles
Determinants
InputInput Output
Evidence
Competence
Settings
Timing
Initial
Review
Transition
Life course
Prevention
Recognition
Assessment
Interventions
Purpose
Values
Leadership
Learning
Basics
Systems
Pathways
Networks
FFF 4x4 overview
Recent Reports• UK
– Berwick Report A Promise to Learn
• England – Kennedy Report, Atlas of Variations– Children + Young People’s Health Outcome Forum
• Scotland – GIRFEC (getting it right for every child) – Early Years Collaborative
• Wales – Rights of Children and Young people Measure 2011,– ‘Flying Start’, ‘Families First’
• Northern Ireland
– ‘Transforming Your Care’
Key themes
• Whole system approaches - culture
• Clear outcomes
• “Integrated care” = “pathway-based”
• Relentless focus on prevention
• Patient participation in the system
• Measurement – information - feedback
• Learning through innovation/improvement
Don Berwick
“You are stewards of a globally important treasure: the NHS.
In its form and mission, guided by the unwavering charter of universal care,
accessible to all, and free at the point of service, the NHS is a unique example for
all to learn from and emulate”.
For PCTs in England, the emergency admission rate for children with asthma ranged from 38.7 to 732.6 per 100,000 population aged 0–17 years (19-fold variation).
When the five PCTs with the highest rates and the five PCTs with the lowest rates are excluded, the variation is 5-fold.
Action to reduce emergency admissions requires a whole pathway approach, including public health, and primary and secondary care. Parental education and school medication management are vital to good care.
Variations
Trans
formation
Environment
positive
InputInput Output
Customer
Worldview
Actors
Owner
CATWOE
Soft systems methodology
Environment
negative
Peter Checkland
Service
Environment
positive
InputInput Output
Clients
Worldview
Actors
Owner
Services for CYP + Families
Patients
Commissioners
Providers
Politicians
Environment
negative
Service
Lifestyles
Determinants
InputInput Output
Children
Families
Communities
Health
Education
Social care
Providers
Regulators
Commissioners
Government
Private sector
Voluntary sectors
Users
Policymakers
Teams
Managers
Stakeholders-Partnerships
Complex adaptive systems
• They are complex in that they are dynamic networks of interactions, not aggregations of the individual static components.
• They are adaptive, in that the individual and collective behaviour mutate and self-organise depending on the internal environment or adapt to the changing external environment.
• Complex adaptive systems are systems that have a large numbers of components that interact and adapt or learn"
JH Holland
Service
Lifestyles
Determinants
InputInput Output
Evidence
Competence
Settings
Timing
Initial
Review
Transition
Life course
Prevention
Recognition
Assessment
Interventions
Purpose
Values
Leadership
Learning
Basics
Systems
Pathways
Networks
4x4 Approach
Prevention Recognition Assessment Interventions
NeedsOutcome
Lifestyles
Determinants
Complicated pathway
Service
Lifestyles
Determinants
InputInput Output
QuantitativeQualitativeEconometric
ProfessionalCulturalImprovement
PlaceSpaceSupport
AccessExperienceOutcome
Evidence
Timing
Competence
Setting
Basics
Serous otitis media
Needs Outcomes
HealthEquitySustainable
Protection
Promotion
Concern
Screening
Family
Child
Social
Psychiatric
ChildFamilyCommunity
Condition
Community Educational
Medical
Behavioural
Surgical
HealthEquitySustainable
27
Needs Outcomes
Initialpathway
Transitionpathway
Reviewpathway
Lifestyles
Determinants
Long term condition
Life course pathways
B 1 5 1510 Adult
QAL Ygap
Quality of life
Ag e
QoL gap
Years gapSocial capital
Empl oyment
LifestylesPeer group
Marketi ng
EducationParenting
Safety
Nutrition
Genetics
Neil Halfon Transforming Early Childhood Community Systems
Services
DeterminantsLifestyles
Pathogenesis Salutogenesis
Specific programmes
PromotionProtection
AssetsHazards
Needs
Infant
Child
Young person
Life course pathway
Hazards Assets
Lifestyles Determinants
Infant
Child
Young person
Promotion Protection
Lifestyle hazards
Substance misuse
Lack of exercise
Smoking
Poor diet
Determinant hazards
Poverty
Poor housing
High crime areas
Inaccessible services
Lifestyle assets
Stable family
Good diet
Creative play
Friendships
Determinant assets
Stable communities
Sustainable economy
Affordable homes
Small inequalities
Lifestyles Determinants Services
Child
Preschool Parental smokingSmoking in media
Asthma services
School Health education in schools
Young person Health educationSmoking enquiry
in clinical consultations
Access to cigarettes near
schools
Smoke stop services
Family
Parents Tackling smoking in pregnancy
Nicotine replacement
Siblings Access to cigarettes
Extendedfamily
Smoking cessation
advertising
Tobacco taxation Nicotine replacement
Community
Home Smoke-free homes
Quality of housing
SUDIinformation
Neighborhood Smoke-free cars No advertising Smoke free shops
+ leisure
Society Smoke-free public places
Legislation increasing age of
accessControl of illegal
imports
Health services
Smoking cessation
interventions
Valuesparticipationpromotionprotectionprovision
Purposehealthequitysafesustainable
Learningmeasuresfeedbackinnovationimprovement
Leadershipintegrityaccountabilitytransparencyinclusivity
Lifestyles Determinants
Values Purpose
LearningLeadershi
p
ProtectionPromotion
11
2
3
4
5
6
Hazards Assets
System Culture
Serous otitis media
Needs Outcomes
HealthEquitySustainable
Protection
Promotion
Concern
Screening
Family
Child
Social
Psychiatric
ChildFamilyCommunity
Condition
Community Educational
Medical
Behavioural
Surgical
HealthEquitySustainable
Planning otitis media services
Recognition InterventionsAssessmentCommissioner Prevention Outcomes
Rates of smoking in pregnancy.HCP uptake
Healthy ChildProgramme
Smoking cessationPH
Language devEducational achievement
Teachers for the deafHearing loops
LA
AccessTimeliness
Hearing aidsSaLTParent support
Paediatricaudiology assessment
CCG
Br feeding rates @6/52
Recognition of hearing impairment in primary care
Breast feeding promotion in primary care
NHS England
Providers Prevention Recognition Assessment Interventions
Child
Specialist services
General services
Local Authority
Public Health
Third sector
Private
Providers Prevention Recognition Assessment Interventions
Family
Specialist services
General services
Local Authority
Public Health
Third sector
Private
Generic framework for providers
Transition pathway
Review pathway
Initial pathway
NeedsChild
FamilyCommunity
OutcomesEffectiveness
EfficiencyEquity
Initial Review Transition
Needs Outcomes
Child
Family
Community
Inspectors for Safeguarding
• Chief Inspector of Social Services • Director for Health Improvement,• Care Quality Commission • Her Majesty's Chief Inspector of Constabulary • Her Majesty's Chief Inspector of the Crown Prosecution
Service• Her Majesty's Chief Inspector of the Magistrates' Courts
Service• Her Majesty's Chief Inspector of Schools• Her Majesty's Chief Inspector of Prisons • Her Majesty's Chief Inspector of Probation
46
A myriad of measures!!!
needs outcomes
Child
Community
Family
Determinants
Harm Exposure
Effectiveness
EquityEfficiency
AccessibilityAffordability
Acceptability
Outputs
Components
ProcessStructure
Environment
Service measures simplified
needs outputs outcomes impacts
benefit valueeffectexpectations
Lifestyles +
Determinants
Life course and service pathway measures
Service outcomesmeasures
Life course outcomesmeasures
Healthimpact
measures
Health measures
Service impact
measures
Health service
measures
Public health
service measures
Needs
Benefits - Families
• Improved experience and outcomes with • more timely care, closer to home.
• Better coordination and continuity of services.
• Greater participation at every level.
Benefits - Professionals
• Enables evidence into practice, through the use of agreed guidelines, algorithms and protocols across the network.
• Investment in inter-professional training and better support by improved learning through improvement.
• Increased skill mix within multidisciplinary teams, coupled with staff rotations within the network.
• Greater involvement in decision-making and the allocation of resources across the network.
Benefits - Managers
• Reduced costs achieved through greater integration – less duplication.
• A shift from a short-term focus on efficiency, to a longer-term (whole-life) focus on effectiveness and equity (the added value agenda).
• A framework for learning through continuous service improvement.
• Greater participation of clinicians and families in decision-making, delivery and improvement.
Benefits - Planners
• Brings multiple planners and commissioners together with shared thinking/values/models and a culture of collaboration rather than competition.
• Less fragmentation, duplication or omission and therefore better value for money across the network.
• Clearer lines of responsibility and accountability.• A framework for leadership and partnership
working.