Transcript title

Children’s Palliative Care:
National Policy Context
and the Child Health
Strategy
Liz Morgan
Professional Advisor – Children and Young People
Department of Health
January 2009
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Setting the
Context….
2
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
Cross- Govt plan
outlines how DCSF will
work with other Govt
Departments, families,
communities and frontline staff to improve the
lives of children over
the next decade
Health &
NHS
Policy
(incl.
Darzi)
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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
We need to ensure services
are sufficiently:
• We are struggling to
meet many of today’s
biggest public health
challenges and there
are worrying trends.
•Integrated
•Personalised
•Preventative
• Health promotion is
critical.
• Children with long
term conditions or
disabilities do not
get the support
needed to fulfill
their potential.
• Key issues around
access to
specialists and
ageappropriateness of
settings where
treatment is
received.
All
Ill
Vulnerable
•Targeted
• We do not
consistently
undertake risk
assessments and
target support.
• Groups suffer
disproportionately
poor health
outcomes
• Miss opportunities
10 early
to intervene
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)
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• Interdependencies of Specialist Services
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 lifelimiting or lifethreatening 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 Areas
Improved 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
Expansion of respite/short break
services
Investment in Community
Children’s Nursing services
Planning and
developing
an effective
and responsive
workforce
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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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RCOG,RCN,
CPHVA,RCGP
DH Clinical
leads
Patients
DH Policy
NMC
DSCF
BMA, Unison and Unite
RCM
HVA
Jointly agreed
approach
SHAs/PCTs
& Providers
CSIP
NHS
Professionals
HR
Services
Other stakehold
e.g. CWN,CW
Pay &
Pensions
Regulation
Education
&
Training
NHS
Employers
National
Workforce
Projects
Workforce
Review
Team
Skills for
21Health
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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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
NHS Operating Framework
• Children and maternity services are identified
as part of the national priority areas for 200810
• 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
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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 Happen
Responsibility 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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Strategic Context
Key Messages from the Primary and Community Care Strategy
• 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
sets out a vision
for primary and
community care
we have a huge
opportunity to
deliver
transformational
change
Where people shape services – giving
people more say and more choice and
more control in their own health 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
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Strategic Context
High level aims
Clinical and service improvement
1
Transforming
Community
Services
Programme
Development 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
2
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.
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Clinical services improvement
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.
Benefits
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 Families
Long term conditions
Acute care and specific treatments to be
delivered close to home
Rehabilitation
End of Life
Six high impact changes being developed
for each area through clinical engagement.
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Thank you for listening
Questions?
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