Transcript Presentation heading

London Strategic Clinical Networks
Children’s Strategic Clinical
Network - Overview
Tracy Parr
SCN Lead Children and
Maternity
Leaders for London
January 28th 2014
Structure of Presentation
• Overview of new NHS structures
• National initiatives
• General
• Children-specific
• Strategic Clinical Networks – overview
• Children’s health in London
• Children's strategic clinical network London
2
The NHS in England structure and responsibilities
Health and Social Care act 2012 changed
• Structure
• Accountabilities
• Funding arrangements
• Working arrangements
3
Health and Social Care Bill 2010
4
Health and Social Care from April 2013
2013
5
6
Structures up to April 2013
7
NHS in England April 2013
8
New funding Arrangements
9
Regulation and Accountability - providers
10
Commissioners – performance
management and guidance
11
Patient and public involvement
12
Expectations of how
13£95billion will be spent
Children in the UK
14
Word acquisition - inequalities
15
Hart and Risley 1995
C and YP Health Outcome Forum
16
17
NHS Outcomes Framework
18
Outcomes for Children
Domain One – Preventing people from dying prematurely
Reducing deaths in babies and young children
• Infant mortality
• Neonatal mortality and stillbirths
• Five year survival from all cancers in children
Domain Two – Enhancing quality of life for people with long
term conditions
Reducing time spent in hospital with long term conditions
• Unplanned hospital admissions for asthma diabetes and epilepsy in
19
under 19s
Outcomes for Children
Domain Three – Helping people to recover from episodes of ill health or
following injury
Preventing lower respiratory tract infections (LRTI) in chidlren from
becoming serious
• Emergency admissions for children with LRTI
Domain Four – Ensuring people have a positive experience of care
Improving C and YP experience of healthcare
• C and YP experience of outpatient services
20
Outcomes for Children
Domain Five – Treating and caring for people in a safe environment and
protecting them from avoidable harm
Delivering safe care to children in acute settings
• Incidence of harm to chidlren due to “failure to monitor”
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Adult Social Care Outcomes Framework
22
Public Health Outcomes Framework
23
Public Health Outcomes Framework
24
London’s Children
• Population of London 7.8 million (ONS 2011)
• 2,049,576 children aged 0 – 19 in London
• Approx 1.7 million children in Kent Surrey
Sussex, and East of England many of whom
access tertiary services in London
• 134,186 live births in London 2012 (ONS)
25
Thematic examination of SUIs
involving children in London
Aim To identify themes and learning from Serious Untoward
Incidents (SUIs) to help inform the work of the Children’s SCN
Methodology
• SUIs involving children requested from STEIS 2008 - 2013
• Those indicating system failure identified n = 86
• Full report requested from Trusts/PCT/CCG
• 59 responses received from 29 organisations
• Common themes identified and collated
26
Thematic examination of SUIs
involving children in London
Lack of recognition of sick child
Inexperience/lack of expertise
Workload
Communication
Failure to escalate to consultant/senior review
Documentation
Transfer to tertiary centre
27
Failures of Care
• Half of all children subsequently found to have
meningococcal infection are sent home from the first
primary care consultation
• Approximately 75% of admissions of children with asthma
could have been prevented with better primary care
• Over a third of short stay admissions in infants are for
minor illnesses that could have been better managed in the
community
28
Clinical areas covered by SCNs
29
SCN core elements
Leadership
for
accelerated
change at
pace
Comprehensive
networks of
clinical expertise
Holistic
view of
health and
social care
Agreed priorities
for improvement
Meaningful and
effective patient
involvement
Widespread
engagement
What is a Strategic Clinical Network (SCN)?
• Area requiring large scale change
• Resistant to previous attempts at improvement
(or not examined holistically)
• Strategic pan-London approach
• Provide expert advice to commissioners
• Contrast with Operational Delivery Networks
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London’s Children
• Population of London 7.8 million (ONS 2011)
• 2,049,576 children aged 0 – 19 in London
• Approx 1.7 million children in Kent Surrey
Sussex, and East of England many of whom
access tertiary services in London
• 134,186 live births in London 2012 (ONS)
32
Why a Children’s SCN?
UK has a higher all-cause childhood
mortality rate compared with Sweden,
France, Italy, Germany and Netherlands
33
London has higher than expected
mortality for 1 – 19 year olds
34
Data courtesy of London Health Programmes
Hospital mortality for children in London is
rising compared to other areas of UK
35
There are low rates of consultant review
of paediatric emergency admissions
within 12 hours
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78% of London trusts undertake elective
surgery on less than two children per week
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Most surgery on children is being
undertaken by adult surgeons
38
Nearly half of children are not reviewed by a
consultant surgeon within 12 hrs of
admission
39
Over 50% of hospitals do not have a
paediatric anaesthetist available
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Attendance at A & E by children is
very high in London
Accident & Emergency attendances, rate per 100,000 population aged 0-17, England LAs, 2010-11
900
800
al quintiles
r 100,000
700
96.6 - 243.9
244.0 - 301.9
600
London - highest
302.0 - 336.9
337.0 - 413.9
500
London average
414.0 - 880.6
400
England average
300
London - lowest
200
100
0
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Data courtesy of ChiMat
26 London
boroughs have
A and E
attendance
higher than
the national
average for
children
Some boroughs have high rates of
admission to hospital for asthma
ASTHMA Emergency hospital admissions, ages 0-18, London 2011/12
England
Emergency hospital admission ra
Waltham Forest
Croydon
Islington
Lambeth
Barking and Dagenham
Lewisham
Ealing
Redbridge
Harrow
Southwark
City and Hackney
Brent
Newham
LONDON
Hammersmith and Fulham
Camden
Bexley
Haringey
Sutton and Merton
Bromley
Hounslow
Tower Hamlets
Hillingdon
Kensington and Chelsea
Greenwich
Kingston
Barnet
Enfield
Havering
Richmond and Twickenham
Wandsworth
Westminster
500
450
400
London - highest
National quintiles
rate per 100,000
74.8 - 142.0
162.1 - 210.0
250
210.1 - 262.0
262.1 - 495.7
200
London average
England average
150
100
50
0
50
100
150
200
250
300
350
400
Emergency hospital admission rate per 100,000 population aged 0-18
Source: DMIT using HES Data
300
142.1 - 162.0
0
42
350
450
London - lowest
Thematic examination of SUIs
involving children in London
Aim To identify themes and learning from Serious Untoward
Incidents (SUIs) to help inform the work of the Children’s SCN
Methodology
• SUIs involving children requested from STEIS 2008 - 2013
• Those indicating system failure identified n = 86
• Full report requested from Trusts/PCT/CCG
• 59 responses received from 29 organisations
• Common themes identified and collated
43
Solutions to the care of children
“Children’s services should be seen as a whole system,
designed within a framework of pathways and networks
which enable the right things to be done, at the right time
and place, using teams that work together within a
managed network.”
RCPCH 2013
44
Issues across healthcare systems
“It is clear that in relation to service failure, problems
often occur at the borders between one organisation or
team and another”
Learning from Investigations
Healthcare Commission
February 2008
45
SCN Oversight
Group
Governance
Clinical Senate
London Strategic
Clinical Networks
December 2013
Children’s Strategic Clinical Network
Assurance
Children’s Commissioning Group
Strategic Clinical Leadership Group
Patients and public
Chair: TBC
SCN Lead: Andy Martin
Critical Care Pathway
Group
Oncology Pathway
Group
Chair: Duncan MaCrae
SCN Lead: Andy Martin
Chair: Julia Chisholm/Darren
Hargrave
SCN Lead: Caroline Moren
Patient and Public
Involvement (PPI)
Mental Health
Asthma Pathway Group
Chair: John Moreira
SCN Lead: Sara Nelson
Health in the Justice
System
SCN Lead: Andy Martin
ENABLERS
SCN Lead: Andy Martin
Data and Information
SCN Lead: Andy Martin
Chair: Peter Hindmarsh/Martha FordAdams
SCN Lead: Sara Nelson
Nephrology Pathway
Group
Chair: Simon Eccles
SCN Lead: Suzanne Sweeney
Chair: Lesley Rees
SCN Lead: Sara Nelson
Gastrointestinal Pathway
Group
Neonates Pathway
Group
Chair: Ian Sanderson
SCN Lead: Suzanne Sweeney
Chair: Sandy Calvert
SCN Lead: Suzanne Sweeney
Commissioning
Immunisation, Healthy
Child and Safeguarding
SCN Lead: Sara Nelson
SCN Lead: Sara Nelson
Programme
Management
Surgery Pathway Group
SCN Lead: Suzanne Sweeney
Information Technology
Education & Workforce
Communications
SCN Lead: Sara Nelson
SCN Lead: Sara Nelson
SCN Lead: Suzanne Sweeney
SCN Lead: Andy Martin
Children’s Network
STANDARDS
Children’s Network
Primary care
Community care
Secondary care
Tertiary care
Children’s Network
Children’s Network
Collaborating with:
► Academic Health Science Networks
► Clinical Commissioning Groups (CCGs)
► Health and Wellbeing Board
► Local Education and Training Boards
►Public Health England
► Regulatory bodies
► Royal Colleges
► Voluntary sector
PATHWAYS
Chair: Owen Miller
SCN Lead: Andy Martin
Diabetes Pathway Group
ENABLERS
Neuroscience Pathway
Group
STANDARDS
PATHWAYS
Cardiology Pathway
Group
Initial work programme - Networks
•
•
•
•
•
•
•
Subgroup of SCLG developing network model
Chaired by Professor Russell Viner, UCL/ICH
Networks of care across all children's providers
Currently considering 3 based on AHSNs, LETBs, LATs,
Population based view of children’s health
Linkage with public health
Governance pathway through commissioners linked
into commissioners
• Funding identified to establish networks
47
Initial work programme - Standards
• Subgroup of SCLG chaired by Tina Sajjanhar, Paediatric
ED Consultant, Lewisham Hospital
• Identify standards of care within the networks collating
existing standards:
• Service specifications for specialised services
• All existing standards for children in-hospital care (eg
RCPCH, London Health Programmes, RCA, RCS)
• General practice outcome standards
48
Initial work programme - pathways
• A number of pathway groups
• Some illustrative of issues in primary secondary and
tertiary care settings
• High volume
49
Contact details
[email protected]
020 7932 9069
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