Transcript Slide 1

Delivering for
Presentation
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work of the
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outcomes
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Christine Lenehan
Director ,Council for
Disabled Children
Co-Chair , Children and
Young People’s Health
Outcomes Forum
Children and Young People’s Health
Outcomes Strategy – Commission by
SoS
• In January 2012 SoS for Health announced a
development of a Children and Young People’s
Health Outcomes Strategy
• He asked for the Strategy to deliver against 3
key outputs these are:
– 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’s Health
Outcomes Strategy – Mechanism for
Development
• To develop the Strategy SoS established an
independent Children & Young People’s Health
Outcomes Forum
• Membership of the Forum brings together a wide
range of expertise, commitment and interest in
improving healthcare for children & young people
• Members were invited as individuals rather than
as representatives of organisations
‘No decision about me without me’
Key Themes
Health Promotion &
illness Prevention
Acute illness
Long term
conditions,
Disability &
Palliative Care
Mental Health
Cross cutting Issues 1
Integration
Medicines for CYP
Safeguarding
Looked After Children
Inequality
Teenagers, young adults &
Transition
Life Course
Premature/ LBW
Early Years
School child
Teenager
Young Adult
Cross cutting Issues 2
Information and Information Technology
Education, Training & Workforce
Research
General Practice
Networks
National Context
Children lose out to demands of adults
in NHS, says report
Failure to provide more than 'mediocre
services' argues Sir Ian Kennedy
Children & Young People’s Health
Outcomes Strategy – Why the need?
• The starting point for the Forum’s work was an
acceptance of the findings in a number of reports
regarding failing of the healthcare system in
relation to children and young people.
• The most prominent of these is the Ian Kennedy
Report 2010 which outlined a range of areas and
issues with needed to be addressed
• SoS made clear that the New Health System as
set out in the Health and Social Care Bill needed
to make its contribution to improvements in
health outcomes for children and young people.
Children & Young People’s
Health Outcomes Strategy –
Why the need?
• A number of data sources show that in a number of key
areas things are going in the wrong direction when it comes
to CYP health and healthcare needs eg :
– Obesity prevalence in Yr6 (age 10 – 11) has increased
over the past 5 yrs meaning that by 2010/11 17.4% of
girls and 20.6% of boys were classed as obese within
this age group
– Rising rates of sexually transmitted infections eg
chlamydia has increased by 25% over the past 10 yrs
– Number of hospital admissions associated with diabetes,
asthma or epilepsy among 11 – 19 yr olds has increased
by 26% since 2002/03
In some areas which have improved the rate of reduction
has been such that our performance in comparison to
other EU countries has actually worsened. This is reflected in the
chart below relating to rates of death in children from all causes
Children & Young People’s Health
Outcomes Strategy – Key Principles
• A key principle that the Forum agreed and adopted at
an early stage was the need for its outputs to reflect a
life course approach
• By using this approach we are clear that there are real
improvements to be secured in the life chances of all
CYP through ensuring a healthier life through childhood,
adulthood and old age
Children & Young People’s Health
Outcomes Strategy – Key Themes &
Issues
• Taking the life course approach the Forum identified 4
themes that needed to be addressed if the Strategy was
to be comprehensive in meeting the needs for CYP.
These were:
– Health Promotion and Illness prevention [Co-Leads
Ann Hoskins/Barbara Hearn]
– Long Term Conditions, Disability and Palliative Care
[Co-Leads Gillian Baird/Colin Green]
– Mental Health [Co-Leads Margaret Murphy/Lisa
Christensen]
– Acute Illness [Co-Leads Carol Ewing/Eric Kelly]
Children & Young People’s Health
Outcomes Strategy – External
Engagement
• One of the key roles of the Forum was to facilitate as wide
an input as possible into our eventual conclusions and
recommendations.
• We used a range of mechanisms to do this including:
– Discussion of Strategy at national, regional and local
events
– DH website based engagement including on-line
feedback forms and webchats
– Meetings between the Forum with key individuals and
organisations
– Use by the theme groups within the Forum of critical
friends to inform their work
– Engagement with children and young people on what
they wanted the Strategy to address
Children & Young People’s Health
Outcomes Strategy – Engagement
• The Forum also undertook a large number of
meetings with key organisations as part of
informing their work.
• These meetings included: NHS CB, CCGs,
H&WBB, HEE, MHRA, Monitor, RCN, RCM, CMO,
DfE and DH Ministers.
Children & Young People’s Health
Outcomes Strategy – Children &
Young People’s Voice
• We were clear that if we were to meet our remit to
identify the health outcomes which matter most to
children and young people, our recommendations
must be shaped by listening to their views.
• We have heard this ‘voice’ in different ways,
including
• A commission from the DH to the National Children’s
Bureau to capture the findings from consultations
with children and young people on their views on
their health and experience of health services
Children & Young People’s
Health Outcomes Strategy –
Children & Young People’s Voice
• A number of events across the country where
children and young people have come together to
discuss and set out what contribution they
wanted from the healthcare system to support
them in living positive and fruitful lives and;
• Discussions with children and young people about
our draft recommendations to ensure that we
have captured their key priorities
Children & Young People’s Health
Outcomes Strategy –
Key messages from Children & Young
People
• From the engagement already undertaken with CYP a
number of key issues that they want the Strategy to
address have emerged. These are too many to fully set out
but here are some examples:
– Better access to child friendly information
– Care by professionals who have had training in working
with CYP
– Care to be in environments which are appropriate to
their age and needs
– Appropriate and efficient system for transfer from child
to adult services
– CYP want to have a say and be listened to in decisions
about their health and take a lead where able
Children & Young People’s Health
Outcomes Strategy – DH website
based feedback
• There were over 1,000 individual sets of feedback received,
which included around 600 feedback forms, comments
made on the DH website, papers and reports submitted.
•
Wide range of individuals and organisations submitted
views and suggestions including:
o Parents groups submitting comments that have taken
account of the views of their members
o national stakeholders such as RCM, RCN,, Asthma UK,
Action for Children took the opportunity to submit their
views.
o System based organisations such as NICE and the Care
Quality Commission
Feedback – Key Issues which emerged
There was a wide range of areas covered in the
feedback.
•The majority of responses were focussed around
children with long-term conditions and disabilities
• Some responses focussed on very specific illnesses,
issues and conditions such as allergies, diabetes,
asthma and a range of rare conditions.
• However, a large number of responses were more
holistic in terms of the issues they raised and the
actions needed to address them.
Children & Young People’s Health Outcomes
Strategy – Outcomes & Indicators
• When considering what the Forum might recommend in
relation to outcomes & indicators we acknowledged and
took account that we were not starting from a blank
sheet
• There are already a large number of child specific
indicators which are included in the NHS and PH
Outcomes Frameworks
• We also recognised that there is also the Commissioning
Outcomes Framework being finalised and this will
similarly need to reflect the outputs from this Forum
Child Specific Outcomes & Indicators in
the NHS Outcomes Framework
• Examples of these:
• Domain One – Improvement Area
• Reducing deaths in babies and young children
• Infant mortality
• Neonatal mortality and stillbirths
• Domain Two – Improvement Area
• Reducing time spent in hospital by people with
long-term conditions
• Unplanned hospitalisation for asthma, diabetes
and epilepsy in under 19s
• Domain Three – Improvement Area
• Preventing lower respiratory tract infections
(LRTI) in children from becoming serious
• Emergency admissions for children with LRTI
Outcomes continued
• Domain Four – Improvement Area
• Improving women and their families’ experience of
maternity services
• Women’s experience of maternity services
• Improving the patient experience of CYP in
healthcare settings
• Improving CYP’s experience of healthcare
• Domain Five – Improvement Area
• Improving the safety of maternity services
• Admission of full-term babies to neonatal care
• Delivering safe care to children in acute settings
• Incidence of harm to children due to ‘failure to
monitor’
Child Specific Outcomes &
Indicators in the PH Outcomes Framework
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•
Examples of these
Domain One – Improving the wider determinants of health
Children in poverty
School readiness (placeholder)
Pupil absence
First time entrants to the youth justice system
16-18 year olds not in education, employment or training
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Domain Two - Health improvement
Low birth weight of term babies
Breastfeeding
Smoking status at time of delivery
Under 18 conceptions
Child development at 2 – 2.5 years (Placeholder)
Excess weight in 4-5 and 10-11 year olds
Hospital admissions caused by unintentional and deliberate injuries in under 18s
Emotional well-being of looked after children (Placeholder)
Smoking prevalence – 15 year olds (Placeholder)
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•
•
•
•
Domain Three – Health protection
Chlamydia diagnoses (15-24 year olds)
Domain Four - Healthcare public health and preventing premature mortality
Infant mortality
Tooth decay in children aged 5
Public health outcomes contd
• Domain Four – Improvement Area
• Improving women and their families’ experience of
maternity services
• Women’s experience of maternity services
• Improving the patient experience of CYP in
healthcare settings
• Improving CYP’s experience of healthcare
• Domain Five – Improvement Area
• Improving the safety of maternity services
• Admission of full-term babies to neonatal care
• Delivering safe care to children in acute settings
• Incidence of harm to children due to ‘failure to
monitor’
Child Specific Outcomes & Indicators
in the PH Outcomes Framework
•
•
•
•
•
•
•
Examples of these
Domain One – Improving the wider determinants of health
Children in poverty
School readiness (placeholder)
Pupil absence
First time entrants to the youth justice system
16-18 year olds not in education, employment or training
•
•
•
•
•
•
•
•
•
•
Domain Two - Health improvement
Low birth weight of term babies
Breastfeeding
Smoking status at time of delivery
Under 18 conceptions
Child development at 2 – 2.5 years (Placeholder)
Excess weight in 4-5 and 10-11 year olds
Hospital admissions caused by unintentional and deliberate injuries in under 18s
Emotional well-being of looked after children (Placeholder)
Smoking prevalence – 15 year olds (Placeholder)
•
•
•
•
•
Domain Three – Health protection
Chlamydia diagnoses (15-24 year olds)
Domain Four - Healthcare public health and preventing premature mortality
Infant mortality
Tooth decay in children aged 5
Child Specific Outcomes & Indicators
in the PH Outcomes Framework
•
•
•
•
•
•
•
Examples of these
Domain One – Improving the wider determinants of health
Children in poverty
School readiness (placeholder)
Pupil absence
First time entrants to the youth justice system
16-18 year olds not in education, employment or training
•
•
•
•
•
•
•
•
•
•
Domain Two - Health improvement
Low birth weight of term babies
Breastfeeding
Smoking status at time of delivery
Under 18 conceptions
Child development at 2 – 2.5 years (Placeholder)
Excess weight in 4-5 and 10-11 year olds
Hospital admissions caused by unintentional and deliberate injuries in under 18s
Emotional well-being of looked after children (Placeholder)
Smoking prevalence – 15 year olds (Placeholder)
•
•
•
•
•
Domain Three – Health protection
Chlamydia diagnoses (15-24 year olds)
Domain Four - Healthcare public health and preventing premature mortality
Infant mortality
Tooth decay in children aged 5
Children & Young People’s Health
Outcomes Strategy – Outcomes &
Indicators
In finalising our recommendations in relation to
outcomes and indicators we adopted an
approach based on 3 categories.
• These are:
– Strengthening of existing indicators
– Adaptation of current indicators to make them more
relevant to children
– New outcomes and indicators
Children & Young People’s Health
Outcomes Strategy – Methods for
Assessing Proposed outcomes and
indicators
• When the Forum has been considering its
recommendations around outcomes and indicators it
has focussed on two key areas. These are
– Alignment of proposed outcomes and indicators with
the domains in the NHS and PH Outcomes
Frameworks
– Alignment with a patient centred pathway
Children & Young People’s Health
Outcomes Strategy – Outcomes and
Indicators Patient Centred Pathway
• A number of questions have been developed by the
Forum against each of the Domains in the Outcomes
Frameworks as part of the patient centred approach eg
in Domain 1 relating to preventing people from dying
prematurely the patient question being used is ‘Am I
getting the best treatment with the best outcomes?’
• In Domain 6 relating to treating people in a safe
environment the patient question is ‘Is my treatment
safe?’
Children & Young People’s Health
Outcomes Strategy – Outcomes and
Indicators
• It is fair to say that the 4 themed groups initially
established within the Forum came to very different
views regarding the comprehensiveness of the current
indicators within the NHS and PH Outcomes Framework.
• For example in the case of PH the view of the Forum is
likely to be that the current indicators within the PH
Outcomes Framework are already substantial in
coverage for CYP and the recommendations focus on
strengthening existing indicators rather than
recommending new outcomes
Children & Young People’s
Health Outcomes Strategy –
Outcomes and Indicators
• However, in the case of children with
disabilities, long term conditions and palliative
care as well as the groups looking at acute
illness and mental health the initial
conclusions are that the existing indicators do
not adequately meet the needs of CYP.
• This is reflected in the approach we took in
our final report
Children & Young People’s Health
Outcomes Strategy – Outcomes and
Indicators Emerging Themes
• There were some strong and common themes which
emerged
• For the NHS Outcomes Framework these include
– Time from presentation at NHS setting to definitive
diagnosis
– Time from presentation at NHS setting to establishment
of care plan
– Extension of indicators focussed on a limited age group
within CYP eg infant to the whole CYP population
– Medication errors that reach the patient
– Emergency re-admissions of children within 48 hrs of
discharge
Children & Young People’s Health
Outcomes Strategy – Outcomes
and Indicators Emerging Themes
• For the PH Operating Framework most of these
are related to extensions of current indicators to
strengthen them for CYP. Areas included are:
– Extension of suicide measure to look at rate in
CYP
– Extension to measurement of weight to cover
adolescent age group
– Educational attainment and progress to be
used as measures of effectiveness of
healthcare for children with LTCs and
disabilities
Children & Young People’s Health
Outcomes Strategy – System
• For these outcomes and indicators to actually get
traction it needs to be clear what the role of the
health system as a whole and the individual
elements within it are in terms of their
achievement.
• This is why we have spent significant time as a
Forum seeking to understand how best we can
position our recommendations.
• The following slide seeks to reflect the system
components that we have taken account of in our
work
PARLIAMENT
Secretary of State and Department of Health
Healthcare, public health, adult social care policy
Mandate, Outcomes Framework,
Framework Agreement
Outcomes Framework
NHS
Commissioning
Board
PHE
Local Authorities
Public Health
Adult Social Care
Advice.
challenge
Local
accountability
Health and
Wellbeing Board
Local
accountability
Eg Equality
and Diversity
council
Clinical
Commissioning
Groups
Framework Agreement
Contracts
NHS Care
Framework Agreement
Regulation
Care Quality
Commission
Providers
Monitor
Regulation
Regulation
NHS Trusts, FTs and other
providers (VCS, private
sector)
Children & Young People’s Health
Outcomes Strategy – The System
• We applied 3 lenses in looking at the system,
these were:
– The prospective of the child and their family on their
journey through the system
– Those cross cutting themes which the Forum looked
at in relation to outcomes due to their particular
importance for a wide range of impacts for CYP
– The organisations and institutions in the system and
the related mechanisms, tools and incentives
following the Health & Social Care Act 2012
Children & Young People’s Health Outcomes
Strategy – The System, Early
Recommendations from the Forum
• Due to decisions being made in advance of the
completion of the Forum’s work we wrote to the
SoS in April with 3 early recommendations these
related to:
– Increased training for GPs in relation to working with
CYP
– The need for all organisations within the new health
system to adopt a life course approach in terms of its
operating model
– The establishment of a strategic clinical network at a
national level for CYP
Children & Young People’s Health
Outcomes Strategy –Themes for
Recommendations
• These are:
–
–
–
–
–
–
–
–
Leadership, accountability and assurance
Patient voice
Commissioning at all levels
Partnership and integration
Safe and Sustainable services
Workforce Education and Training
Knowledge and Evidence
Incentives and funding flows
Children & Young People’s Health
Outcomes Strategy – Example
recommendations
• Recommendations include
– To promote effective integration of services across
health, education and social care the establishment
of the NHS Number as being the unique identifier
across all the system
– All health system organisations need to be able to
demonstrate how the voice of CYP has influenced
their decisions and priorities
– All data should be collected and published in a way
that allows you to be better able to assess progress
at frequent points in a child’s development eg data
should be collected and published based on key
transition points such as leaving primary school
Children & Young People’s Health
Outcomes Strategy – Example
recommendations cont’d
• Recommendations on improving safety in relation to
children’s medicines both to improving prescribing
accuracy and safety in delivery
• The NHS Mandate truly reflects necessary objectives
which will deliver health improvements from everyone
from cradle to grave
• Child Health Records currently captured through the
Red Book should be transferred to an electronic system
accessible to both professionals and patients to enable
real time working
SEND Next Steps
• DfE published in May an update of progress on its
Green Paper relating to Children with Special
Educational Needs and Disabilities which it issued
last year.
• Within the update it set out how education,
health and care services should work together to
meet the needs of this group effectively.
• As part of this it asked us to advise on some
specific issues relating to the role that health has
to play in this agenda.
SEND Issues – CYP Outcomes Forum
• Recommendations from Outcomes Forum and early
findings from the Green Paper pathfinders will be
considered and used to inform the Children and Families
Bill on joint commissioning.
• Reflect on the NHS Future Forum’s recommendations on
Integrated Care and link to own recommendations and
outcomes for disabled children and those with SEN.
• To consider the routes of redress available within the
NHS to children, young people and their families as part
of the Outcomes Forum’s recommendations.
• NHS Future Forum working group asked to look at
securing improvements for this group of children as part
of its work considering how the constitution can be
strengthened.
•
Where are we now ?
• Report presented to the SOS at the end of July
• Some workstreams already planned/ being
discussed – neuro disability data , paediatric
rehabilitation, planning wider intelligence
networks , next stages in improving GP
training
• Formal response from Government delayed
due to reshuffle but internal planning
continues
Where are we now 2
• Formal government response expected
November
• New SOS and Children’s Minister now engaged
• It is likely the majority of recommendations
will be accepted and these will form the basis
of a Children and Young People’s Health
Outcomes strategy with a clear
implementation plan