National Clinical Programme for Paediatrics and Neonatology Emergency Medicine Conference 10 th February 2016

Has anything really changed?

Absolutely ! changes in disease priorities for child health – improved standards of living – many ‘killer’ diseases have disappeared – chronic and complex disabilities more prevalent – emotional and behavioural problems affect 10 – 20% changes in parental expectation – loss of confidence in primary care provision – faster access to specialist care – Intolerance of uncertainty changes in healthcare provision – reorganisation of infrastructure

Paediatric Urgent and Ambulatory Care Centres Model of care developed by:  National Clinical Programme for Paediatrics and Neonatology  Emergency Medicine Programme

Urgent and Ambulatory Care Centres Five key features that will support change in urgent and emergency care (Willett, 2013):  Provision of better support with self care  Helping people with urgent care needs to get the right advice in the right place, first time  Provision of highly responsive urgent care services so that people do not have to wait in emergency departments  Ensure that those people with more serious or life-threatening emergency needs receive treatment in centres with the right facilities and expertise in order to maximise chances of survival and good recovery  Connection of urgent and emergency care services so that the overall system becomes more than just a sum of its parts

Model of care principles 1: Provide better support for children and families to self-care with accessible information about treatment options – Engagement with public and primary care at planning stage – Provide information via hospital website, apps, social media

Model of care principles 2: Ensure that children with more serious or life threatening illness in need of paediatric emergency care receive treatment in an emergency department with the appropriate facilities and expertise to maximise chances of survival and a good recovery

Model of care principles 3: Provide responsive urgent care services so that children can access services locally – Walk in minor injury and illness service – Short stay observation units – Rapid access and routine general paediatric outpatient clinics – Close links with primary care, including out of hours – Not appropriate place to attend with critically ill child – Supported by radiology and laboratory services

Model of care principles 4.Help children and families with urgent care needs access appropriate care and treatment close to home – the right advice in the right setting, first time – Inform GPs and families about available services, and when it is appropriate to attend urgent and ambulatory care centre: Targeted care for injuries and minor illness Significant education of GP’s and the public re what is on offer Not a ‘drop in’ emergency service Selected specialist paediatric outpatient clinics, e.g. fracture clinics, developmental clinics, chronic disease management

Model of care principles 5.Connect all paediatric services together so that the overall system becomes more than just the sum of its parts – Integrate emergency care networks with high quality, responsive retrieval and critical care services – Integrate community and hospital components with easy transfer of information between both settings – Standardise referral pathways and clinical guidelines nationally – Establish networks of care within, and between, hospital groups – Staff rotate from NCH to either satellite with NCH branding

Suggested casemix

Proposed Model of Care