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Integrated Models of Care. Presentation to the West Midlands NHS/ PiP Event: 9.7.09. by Jonathan Smith. Introducing Myself. Current post (since Feb. 2005): Chief Executive of the Child Health Development Programme (CHDP), based in Cheshire and Merseyside Formerly: PCT Chief Executive

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Integrated models of care l.jpg

Integrated Models of Care

Presentation to the West Midlands NHS/

PiP Event: 9.7.09.

by

Jonathan Smith


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Introducing Myself

Current post (since Feb. 2005):

  • Chief Executive of the Child Health Development Programme (CHDP), based in Cheshire and Merseyside

    Formerly:

  • PCT Chief Executive

  • Strategic Director (local government)

  • Director of Social Services

    Also:

  • Chair of the Steering Group of the National Collaborative for Children’s Integrated Healthcare


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National Collaborative for Children’s Integrated Healthcare

  • Formed in the autumn of 2007

  • Aim: to provide a focus for those health communities engaged in innovative changes to children’s services, especially involving greater integration between primary and secondary care

  • In 08/09, funded by Skills for Health and the DH; in 09/10, by the DH only

  • Completed a first phase of its work in October 2008, with reports to Sheila and other DH senior colleagues


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National Collaborative for Children’s Integrated Healthcare

Outputs:

  • Two national workshops

  • Report on the paediatric medical workforce by Symmetrics SD

  • Three Reports on the engagement of young patients and their families

  • Benefits Realisation Statement

  • A number of ‘linked’ health communities

  • A Steering Group, with many of the key stakeholders ‘round the table’

  • A web-site


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National Collaborative for Children’s Integrated Healthcare

09/10 “Desired Outcome”:

A transformation in the seamlessness and accessibility of child health and other related services,

through the promotion of a stronger integration:

  • (within health) of primary and secondary care

    and,

  • (across the whole of the children’s services agenda), of services for targeted and specialist needs, closer to home.


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National Collaborative for Children’s Integrated Healthcare

Focus for 09/10:

  • Adopting shared quality outcomes for children’s services

  • Learning together about how to use them for evaluation purposes

  • Applying this learning to service re-design

  • Producing better health and services for children and young people


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National Collaborative for Children’s Integrated Healthcare

Progress Report:

08/09: 8 out of 10

09/10: 3 out of 10, but

still very enthusiastic!

  • We would welcome re-establishing our links with the West Midlands


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Why the status quo is not an option Healthcare

There is a crisis in many parts of the integrated children’s workforce, e.g.:

~ neonatal nurses

~ midwives

~ health visitors

~ school nurses

~ paediatric medical workforce

~ social workers

~ head teachers

~ safeguarding lead roles

~ some therapists (especially SALTs)


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Why the status quo is not an option Healthcare

There is concern over the quality of services for children and young people, e.g.:

~ universal public health indicators

~ inequality gaps not narrowing

~ ‘HCC’ review: hospital care for children

~ Doncaster and Haringey

~ what families of children with complex needs say

~ level of paediatric expertise in walk-in centres

~ CEMACH report on why children die


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Why the status quo is not an option Healthcare

Confidence and competence in primary care is seeping away:

~ 25% of patient contacts, but not 25% of training focus

~ breaking down of the long-term, single family practitioner: ? impact of “Maternity Matters”

~ few incentives, e.g. QOF

~ impact of children’s centres development

~ patchy to poor relationship with local government


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Why the status quo is not an option Healthcare

Information systems do not support integrated working:

~ in some areas, we cannot share birth information between PCTs and children’s centres

~ ContactPoint is coming, but is delayed

~ no realistic prospect of shared IT systems between Health and Local Government

~ difficult to spot the progress from Climbie to Baby Peter

~ few Children’s Trusts with active, joint information sub-groups


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So, where can we find some answers? Healthcare

The truth is that:

  • here we are, half-way through 2009, and there is no community where genuine, ‘whole system’ transformation is being attempted

  • there are no examples of ‘ownership’ by Children’s Trusts

  • there are precious few ‘external’ incentives for integration

  • none of the final list of the national “Integrated Care Pilots” focuses on children’s services

  • we are a loose collaborative of pioneers!

  • our destinies, and that of our patients, are in our own hands


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What I have come across: Healthcare

  • “Acute re-configuration”

  • Engagement with users/patients = consultation

  • Little trust given to the public to evaluate risks

  • Traditional roles

  • Undeveloped engagement of Directors of Children’s Services

  • Weak input from public health

  • No coherence about: ‘how we judge success?’

  • Therefore, no means to demonstrate ‘continual quality improvement’

  • Which leads to: poor accountability


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Transformational Processes Healthcare

Full participation for users, patients and the public: placing them at the centre

  • Are you embedding participation?

  • Do you know enough about what your users and patients think are the solutions they would (a) wish for, and (b) accept?

  • Have you got agreed quality outcome measures?

  • Have you carried out a baseline audit, and planned how regular evaluation is going to take place?


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Transformational Processes Healthcare

‘Whole system’ thinking and planning,

in particular: ‘vertical’ collaboration and ‘horizontal’ integration

  • Is this mainly acute Health services finding their own answers to what they perceives as their own problems?

  • How are you using the emerging Children’s Trusts to engage the ‘whole system’?

  • What evidence is there, from elsewhere, of the benefits of a more holistic approach?


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Transformational Processes Healthcare

Engaging public health ‘up front’

  • Is the ‘prevention’ part of this agenda being given a high-enough profile?

  • Can you close the gap between the traditionally-separate domains of: public health; and secondary care treatment services?

  • What assumptions will your strategy be making about the impact of preventative interventions: ambitious, cautious, or zero?


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Transformational Processes Healthcare

Partnership/networking to solve problems

  • Are you all convinced that networks are the most effective way to reach sustainable solutions to difficult problems?

  • Are those to whom you are accountable convinced of this?

  • Do you have the skills to get the best out of a networking approach?

  • Might it mean: moving at the pace of the most sceptical?


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Transformational Processes Healthcare

Freeing people up to become creative

~ e.g. the use of modelling tools

  • Seems like you’ve made a great start: can you keep this going when the ‘chips are down’?

  • Are you maximising the contribution of your creative thinkers?

  • What ‘critical friend’ input do you need from elsewhere?

  • Will the respective Boards and Scrutiny Committees ‘hold their nerve’?


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Transformational Processes Healthcare

There’s no replacement for “co-location”

  • This is really challenging, so, are you committed to seeing it through?

  • Are you developing an estate strategy, right from the start – or will it be an after-thought?

  • Is the workforce being prepared for working in very different ways?

  • Are the IT strategists engaged in what you are trying to achieve?


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So, where can we find some answers? Healthcare

  • Manchester: “Making it Better”

    NCCIH Links:

  • West London: investment in children’s community nursing, and research

  • North Oxfordshire: establishing a local “centre of excellence”

  • ‘North East’ West Sussex: whole health system change management e.g. including mental health

  • Wirral: testing out new ways to change the patient flows of the “wheezy child”


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So, where can we find some answers? Healthcare

NHS Institute for Innovation and Improvement:

  • “Children and young people emergency and urgent care pathway” June 2008

  • Children’s unplanned care rapid improvement pilots

  • Tyne and Wear: respiratory pathway – whole system solution – capturing data underway

  • East and North Hertfordshire: ambulatory centres supported by acute ‘hub’

    Outcomes-based Commissioning:

  • Kent: commissioning CAMHS on the basis of SDQ scores

    .


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So, where can we find some answers? Healthcare

Cheshire and Merseyside

  • Listening to families

  • The impact of the role of the Advanced Paediatric Nurse Practitioner

  • Smithdown Road Children’s Walk-in Centre

  • Children’s Surgery and Anaesthesia in Secondary Care

  • Liverpool “Team Around the Child”


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For Children with Healthcare“Targeted and Specialist” Needs:the NCCIH Model

A Children’s Services Centre:

  • based in the community

  • designed to effectively –

    - ‘divert’ patients from hospital visits & admissions

    - ‘receive’ patients discharged from hospital

    - integrate specialist services for children with complex or chronic problems

  • where hospital-based specialists, community-based specialists and primary care children’s practitioners are “co-located”, to offer –

    - a ‘one-stop shop’ for families


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For Children with Healthcare“Targeted and Specialist” Needs:the NCCIH “Model”

But also offering a place for:

  • real integration with specialist staff in children’s services

  • ‘whole system’ education and training

  • peer advice and advocacy services for children and families

  • partnership working with the third sector

  • oversight of health services for children in care

  • an efficient place for commissioners to oversee the children’s pathways to care and treatment


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Finally Healthcare

  • We – the Child Health Development Programme – would welcome exploring whether a stronger partnership across our two areas could be mutually beneficial

    Thank you.

    jonathan.smith@knowsley.nhs.uk