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  1. Children and Young People’s Health Outcomes Forum and Strategy Why we need a Strategic Clinical Network with a national focus Improving Health Outcomes in Children and Young People Ian Lewis Children and Young People’s Forum Co-Chair Aintree 5th September 2013

  2. Mortality in Childhood UK compared to European 12

  3. Children & Young People’s Health Outcomes Strategy Why the need? If UK healthcare was equivalent to best in Europe • 5 children /day would survive • 1600+ / year would not die • >100,000 life years saved each year Most of which would be as productive adults

  4. Children and Young People’s Health Outcomes Forum – Commission by SoS • In January 2012 SoS for Health established the Independent Children & Young People’s Health Outcomes Forum • 3 key outputs : • 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

  5. Children & Young People’s Health Outcomes Strategy Why the need? • 26% of deaths - “identifiable failure in the child’s direct care” 43% of deaths – “potentially avoidable factors” (CEMACH 2008) • Half of children subsequently found to have meningococcal infection are sent home from the first primary care consultation • Diabetic control is poorer and deaths from DKA higher in UK • 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 managed in the community

  6. Children & Young People’s Health Outcomes Strategy – Why the need? • Key indicators in the wrong direction: • Impact of deprivation; inequalities in outcomes • Obesity prevalence in Yr6 increasing 2010/11 - 17.4% of girls and 20.6% of boys • Rising sexually transmitted infections eg chlamydia has increased by 25% over the past 10 yrs • Hospital admissions associated with diabetes, asthma or epilepsy among 11 – 19 yr olds has increased by 26% since 2002/03 • NPSA - >10,000 medication errors/year • peaks in children under four • x10 errors • Gentamicin and opiates

  7. Children & Young People’s Health Outcomes Strategy – Why the need? Unexplained variation • 3 fold variation in term babies admitted to neonatal units • 4 – 6 fold variation in children attending ED from equivalent general practices • 4 – 6 fold variation in admissions for bronchiolitis or asthma • 3 fold variation in tonsillectomy rates Nationally – 45% of GP trainees receive direct in-hospital paediatric experience 8 fold variation in investment in community services; Children’s Community Nursing Teams patchy across England

  8. NHS Atlas of Variation in Healthcare for Children & Young People The report highlights: • Need to reduce unwarranted variation to increase value and improve quality • Cheshire and Mersey position within national data • Variation within Cheshire and Merseyside

  9. Children & Young People’s Health Outcomes Forum – Some key messages from Children & Young People • Lack of join up around health, social care and education • Poor and delayed diagnosis of conditions impacting on outcomes • General Practice, the key and most frequent point of contact not meeting the needs of CYP • Outcomes need to take a whole family approach because the health and wellbeing of families (carers) directly impacts on CYP and affects their resilience • Ensure outcomes are included for different ages (life cycle) • Transition to adult services often very disjointed and planning needs to involve family

  10. Children & Young People’s Health Outcomes Forum– More key messages from Children & Young People • 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 children to adult services • CYP want to have a say and be listened to in decisions about their health and take a lead where able

  11. Children & Young People’s Health Outcomes ForumRecommendations - Outcomes & Indicators Forum recommended 3 categories. • Strengthening of existing indicators • Adaptation of current indicators to make them more relevant to children • New outcomes and indicators Aligned proposed outcomes and indicators with the domains in the NHS and PH Outcomes Frameworks

  12. Children & Young People’s Health Outcomes Forum Recommendations – 8 Themes • Patient voice - Putting children; YP and families at the heart • Integration and partnership • Acting early and intervening at the right time • Safe and sustainable services • Workforce; education and training • Knowledge; evidence and research • Leadership, accountability and assurance • Incentives and levers for service improvement

  13. “We are committed to improving the health outcomes of our children and young people so that they become amongst the best in the world” February 2013

  14. ‘The Chief Medical Officer will lead a new national Children and Young People’s Health Outcomes Board, bringing together key system leaders to provide a sustained focus and scrutiny on improving outcomes across the whole child health system’ February 2013

  15. Improving Children and Young People’s Health Outcomes:a system wide response (February 2013) Some key commitments: • One of Four Strategic Clinical Networks - Maternity and Children (from April 2013) • Develop a Children and Young People’s patient safety strategy under Domain 4 • Children’s Medicines Programme Board – Chief Pharmaceutical Officer and RCPCH President • Health Education England agrees a Lead LETB for children’s workforce (with CfWI) • RCGP and DH support extension in GP training to include paediatrics for all • RCGP support in principle ‘All general practices that see children and young people should have a named medical and nursing lead’. • PHE establishing a CYP Health Intelligence Network (IJL to Chair) • DH Child Protection Information Sharing Project (Dec 2012) • Increased NICE Quality Standards (10 in development; 32 referred) • National Clinical Directors for CYP and Transition; and Maternity and Women’s Health • PHE – appointed Director of Child Health (Ann Hoskins) • Healthwatch England has appointed a leading advocate for children, Christine Lenehan (one of the Forum co-chairs), as one of its members. • A New CYP Health Outcomes Forum – to influence and advise ministers

  16. Will this response and the commitment of national leaders, result in improved outcomes for children and young people? February 2013

  17. Children & Young People’s Health Outcomes Forum – Factors associated with improved health outcomes • Be clear about the area / outcome to be improved • Robust information – measure what is important! • Evidence based prevention and early intervention strategies • Integrated / co- ordinated care around the patient • patient focused pathways • Managed Clinical networks - evidence based standards • Peer review against evidence based standards • Patient safety initiatives (some) • Quality improvement initiatives • Clinical decision support systems • Implementing evidence based research • Involve children young people and their families

  18. NHS Atlas of Variation in Healthcare for Children & Young Peoplefocus on Cheshire and Merseyside

  19. Rate of accident and emergency (A&E) attendances per population under 5 years by PCT, 2009/10Source: NHS Atlas Variation : Child Health Knowsley – 4th highest rate across England Liverpool – 6 Halton & St Helens – 7 Sefton – 34 Central Lancs. – 39 Warrington – 83 (151)

  20. Emergency admission rate for children with asthma per population aged 0-17 years by PCT, 2009/10Source: NHS Atlas Variation : Child Health Knowsley – highest rate across England Liverpool – 3 Sefton – 4 Wirral– 16 Central Lancs. – 17 Halton & St Helens – 20 Warrington – 69 (151)

  21. Emergency admission rate for children with epilepsy per population aged 0-17 years by PCT, 2007/08-2009/10 Source: NHS Atlas Variation : Child Health Knowsley – 3rd highest rate across England Liverpool – 23 C and E Cheshire– 33 Wirral– 40 Sefton – 43 Central Lancs. – 47 Warrington – 131 Halton & St Helens – 72 (151)

  22. CHILDREN & YOUNG PEOPLE’S HEALTH OUTCOME STRATEGY: ‘No decision about me without me’ Key Themes Promoting Health Acute illness Long term condition Disability Palliative Care Mental Health Looked after children Life Course Premature/ LBW Early Years School child Teenager Young Adult Cross cutting Issues 1 Integrating services General Practice Safeguarding Transition to adult services Technology Choice Information and data Cross cutting Issues 2 Education & Workforce development Clinical leadership Aligning NHS, PH and care outcomes Levers of funding – PbR / CQuiNs Networks – local / hub; specialised; national

  23. Children & Young People’s Health Outcomes Strategy Some early areas of focus Prevention / Early intervention Maternal / perinatal mental health The role of schools in managing long term conditions Mental Health Implementation of children and young people’s IAPT programme Long term conditions and disability Improvement programme for childhood diabetes Transition of young people with complex needs to adult services Acute Care Early recognition of illness – improving time to diagnosis Safe surgery for children (configuration)

  24. Children & Young People’s Health Outcomes Strategy Why the need? If UK healthcare was equivalent to best in Europe • 5 children /day would survive • 1600+ / year would not die • >100,000 life years saved each year Most of which would be as productive adults