The Balance of Care Approach

1. The Balance of Care Approach A whole-systems framework to support paediatric commissioning Paul Forte, Su Bunn, Steve Cropper, Andy Spencer

2. Issues in developing and commissioning services • Taking a ‘whole-systems’ perspective • Developing a ‘needs-led’ rather than ‘service-driven’ view • Quantifying resource implications • Developing a ‘common language’ between clinical and non-clinical stakeholder interests

3. Balance of Care Cystic Fibrosis Paediatric Gastro patients Small Bowel Crohns Failure to thrive

4. Balance of Care Specialist nurse Cystic Fibrosis NHS Paediatric nurse Dietitian Paediatric Gastro patients Small bowel Crohns Play specialist Care worker Local Authority Social worker Failure to thrive Voluntary & Private sector

5. Balance of Care Specialist nurse Cystic Fibrosis NHS Option1 Paediatric nurse Dietitian Paediatric Gastro patients Small bowel Crohns option 2 Play specialist Care worker Local Authority option 3 Social worker Failure to thrive Voluntary & Private sector

6. Example care options

7. Example scenario

8. Key results of pilot project • Development of patient categories • Specification of workforce inputs • Initial quantification of demand and supply • Local health economy focus • Highlighting of baseline data issues

9. The value of the Balance of Care approach • A workable whole systems approach • Patient focused across organisational and professional boundaries • Supports development of a vision and strategy for commissioning • Provides a basis for operational plans and business case development • Communication and involvement: enables meaningful dialogue

10. Challenges ahead… • National level • data definition, information systems • routine/ special data collection • Network level • moving from ‘aggregate analyses’ to tailoring services more appropriately across a clinical network