NHS England – Safe Transition for Young People to Adulthood

National Context

Children lose out to demands of adults in NHS, says report Failure to provide more than 'mediocre services' argues Sir

Ian Kennedy - 2010

The Forum was launched on 26 January 2012 and reported to the Government with independent advice in July 2012 on: •The health outcomes that matter most for children and young people•How well these are supported by the NHS and Public Health Outcomes Framework•How the different parts of the health system will contribute and work together in the delivery of these outcomes

Children & Young People Health Outcome Forum: Role

Key Themes

Promoting HealthAcute illnessLong term conditionsDisabilityMental HealthPalliative Care

Cross cutting Issues 1Integrating servicesGeneral PracticeSafeguardingLooked after childrenInequalityTransition to adult servicesChoice

Cross cutting Issues 2Information and dataTechnologyEducation & Workforce developmentClinical leadershipAligning NHSE and PHE care outcomesLevers of funding – PbR / CQUINs Networks – local / hub; specialised; national

‘No decision about me without me’

Life Course

Premature/ LBWEarly YearsSchool childTeenagerYoung Adult

Children & Young People’s Health Outcome Forum:

The NHS Outcomes Framework will be organised around 5 national outcome goals/domains that cover

all treatment activity for which the NHS is responsible.

Networks will support local clinicians to deliver the Framework in local systems

Preventing people from dying prematurely

Enhancing quality of life for people with long-term conditions

Helping people to recover from episodes of ill health or following injury

Ensuring people have a positive experience of care

Treating and caring for people in a safe environment and protecting them from avoidable harm

Effectiveness

Domain 1

Domain 2

Domain 3

Domain 4

Domain 5

Patient experience

Safety

NHS Outcomes FrameworkNCD Children, YP and Transition - Objectives

Preventing people from dying prematurely

Reducing avoidable deaths – perinatal/neonatal, infant, focus

on injury, childhood cancers

Reducing time spent in hospital Unplanned hospitalisation asthma, diabetes , epilepsy

Enhancing quality of life for people with long-term conditions

Emergency admissions for

conditions not usually requiring hospitalisation, improving recovery

from injuries & trauma,

Helping people to recover from episodes of ill health or following

injury

Improving Children, YP and Families experience of

healthcare (GP, OOH’s, A&E, acute IP care, end of life care)

Ensuring people have a positive experience of care

Treating and caring for people in a safe environment and

protecting them from avoidable harm

Harm due to ‘failure to monitor’, delivering safe care to children

in acute settingsMedication errors, infections

NCD Additional Objectives

• Generic Framework for consistent approach to Transition to adult services, & measurable outcome indicators to inform commissioning

• Mental Health on a par with physical health, measurable progress towards parity of esteem, roll out of CYP IAPT programme.

• Acutely sick child – supporting urgent care through Primary/Secondary Care Interface and OOH services, with appropriate workforce needs assessment

• LTC’s, Disability and Palliative Care in children – support and develop integrated care pathways, and enhanced community nurse support

• PbR – Lead commissioning support of tariff for directly and CCG commissioned services for CYP and Fetal Medicine

• Work with DH and DfE from NHS England to support response to Pledge, working also through Children’s Health and Wellbeing Partnership and EIF

• Identifying and addressing inequalities in vulnerable children: looked after, adopted, travellers, those in criminal justice system

The New System

NHS

NHS EnglandMonitor

(economic regulator)

Clinical Commissioning Group

Department of Health

CQC (quality)

Primary Care Specialised Providers

Public Health

England

(Local health improvement

in LAs)

Local authorities (via health & wellbeing boards)

HealthWatch

Local HealthWatch

Paediatric Medicine

Paediatric Neurosciences

Metabolic disorders

Paediatric Surgery

Paediatric Cancer Services

Paediatric Cardiac Services

Complex Gynaecology

Specialised Maternity

Paediatric Intensive Care

Medical Genetics

Fetal Medicine

Internal Medicine

Neonatal Critical CareTrauma

Blood and Cancer

Mental Health

Women and Children

Multi-system disorder

Women’s and Children’s Programme of Care

•Specialised Service status achieved for Paediatric Palliative Care

•35 Service Specifications and 5 Policies delivered across 12 Clinical Reference Groups – all clinicians committed and enthusiastic to ensure safe commissioning of whole pathway, from primary and secondary to tertiary care

•Children’s Services described in 43 of the former SSNDS

•Need identified for a Generic Paediatric Service Specification, to be appended to all Service Specifications where Children described. This could also have potential as guidance for CCG commissioning of Children’s Services, work in progress

•Develop work programme for 2013-14, Transition a priority

•Work alongside SCN’s

NHS OUTCOMES FRAMEWORK

CLINICAL REFRENCE GROUPS

CLINICAL COMMISSIONING GROUPS

PRIMARY CARE

STRATEGIC

CLINICAL

NETWORKS

PATHFINDER

GROUPS

NHS | Presentation for SCN Development Day| [21st May 2013]

Geography

• 12 senate geographical areas

• One core support team per senate

• Number and size of each network is locally determined, to take account of patient flows and clinical relationships

North East, north Cumbria, and the Hambleton & Richmondshire districts of North Yorks

Greater Manchester,

Lancashire and south Cumbria

Cheshire & Mersey

West Midlands

East Midlands

South West

Thames Valley

East of England

Wessex

Yorkshire & The Humber

South East

Coast

London

Proposals for CYP SCN Work Programme

•D1 – 40% premature babies hypothermic, temp< 36.5

•D2 – LTC’s – Depression - poorly defined and diagnosed

Diabetes - poor HbA1c levels

Asthma - only 7% of patients have management plan

Disability – on 50% hav

•D3 - Paediatric Surgical Networks, particularly GPS

Transition to Adulthood Policy

•D4 – Palliative Care, end of life plans, choice of place of death

•D5 – DNA Policy, present, adhered to? Safeguarding implications

Medication errors

Paediatric safety thermometer – the deteriorating child

NHS Outcomes Framework

Senates [12] Strategic Clinical Networks

Local Professional Networks

Operational Delivery Networks

Other Local

Networks

“The conscious and guiding intelligence”

“Engines for change and improvement across complex care systems”

“Gathering frontline knowledge and expertise”

“Mapping patient pathways to ensure access to specialist support”

“15 AHSNs: Masters of science and evidence based practice”

Multi-professional

i.e. Cancer; CVD; Maternity and Children’s; Mental Health / Dementia / Neurological Conditions

i.e. Pharmacy; Eye health; Dental

e.g. Adult Critical Care; Neonatal Intensive Care; Trauma; Burns; Paediatric NM; Paediatric IC

e.g. Academic Health Science Networks, Research Networks

NHSCB Network Support Teams (AT-based)

Annual national priorities from the NHSCB Medical and Nursing DirectoratesAll supported by Improvement Body and Leadership Academy

Different Types of Network

Young People’s Transition to Adulthood

• Opportunity - Uniform commissioning – Direct and CCG National process with national engagement More equity, resulting in secure systems for delivery High level input from the NHS

•Challenge - Service re-design moving towards integration Precise definitions of levels of skills and workforce needed Whole pathway approach with appropriate and timely Transition to Adult Services Absolute clarity in Service Specifications, define outcome indicators

•Conundrum - To link all the parts of Transition service pathways from Primary to Secondary & Tertiary care, working with CCGs to commission a care continuum with SCN support.

•Solution - SCN Work Programmes and Pathfinder Working Groups – eg developing guidelines for the CCG commissioned elements of the complex transition paediatric pathways - neurodisability/rehab pathway, paed diabetes, LTV,

•Working Relationships – Close working vital with: CRG’s and other POC’s, Children and Young People Health Outcomes Forum Royal Colleges including RCPCH and RCP, RCN, RCGP, DH and DfE, PHE, HEE, NICE, CQC, Monitor, Charitable Sector.

Objectives for Today

•To share learning from existing good practice – successes, challenges and barriers to implementing clinically and patient designed Transition models

•To define the critical elements of an effective Transition model

•Using the above, develop a generic Service Specification as a commissioning template, onto which all specialised and complex services can be bolted

•Start to consider measurable outcome indicators against which successful Transition plans can be commissioned and monitored