Improving the health of children and young people in Wessex Sanjay Patel Project Lead, Wessex Healthier Together Consultant paediatrician

Quality of care

Urgent care demands Gill PJ et al. Arch Dis Child 2013,98:

Invasive bacterial infections- trends over time: meningococcus

A fragmented healthcare system

Patient at home General practitioner Paediatric assessment unit A+E Local out-of-hours primary care services Paediatric ward NHS 111 Community nursing team

A collaborative effort CommunityHospital GPs / OOH GPs Ambulance / paramedics Health visitors / school nurses Pharmacists NHS 111 Urgent care centres PAU / PMU ED Community paediatrics Midwives Voluntary sector CAMHS Community nurses

Sanjay Patel, Consultant in Paediatric Infectious Diseases – Project Lead Lesley Ayling, Clinical Director for Children and Families, West Hampshire CCG Jason Barling, Paediatric ED Consultant, Southampton Sophie Clayton Baker, Parent Representative Lorraine Cole, GP Winchester / Southern Health Lesley Coles, Head of Nursing for Women and Children’s Services, Portsmouth Parvin Damani MBE, Senior Public Health Specialist Olivia Falgayrac-Jones, Education Commissioning Manager, Wessex Andrea Havey, Senior Commissioning Manager for Children and Maternity, SE Hampshire and Fareham &Gosport CCGs Becky Hepworth, Community Nursing Team, IoW Hilary Kelly, MCYP SCN Manager, Wessex SCN Karen Kirkham, CCG Programme Chair - Maternity and Family services, Dorset CCG Kate Slater, Clinical Modern Matron for health visiting and school nursing, Solent Duncan Linning-Karp, Child Health Care Group Manager, Southampton Children’s Hospital Madeleine Litchfield, GP and Children’s Services Lead, SE Hampshire CCG Phil Lovegrove, Commissioner, Southampton Integrated Commissioning Unit Louise Millard, Clinical Director, Portsmouth Oliver Morris, GP with interest in paediatrics Mary O'Brien, Consultant in Public Health, Public Health England (Wessex) Julian Sandell, Consultant Paediatric Emergency Medicine, Poole Sally Stanley, Quality Improvement Lead, Wessex SCN Jo Wall, Quality Improvement Lead, Wessex SCN Peter Warren, Clinical Quality Assurance Lead, South Central Ambulance Service COLLABORATION - Project Steering Group

User views

Parental opinions The decision to consult a healthcare professional is not taken lightly by parents:- – seeking peace of mind, – being judged to do the wrong thing – worrying about failing to recognise a serious illness GPs are trusted by parents to deliver urgent care to children BUT being able to access health services without difficulty or delay is also important to parents Parents receiving consistent, explicit safety- netting advice are less likely to re-attend

The voice of young people Young people want:- to have a say and to be listened to in decisions about their health, and to take a lead where able; care by professionals who have had training in working with children and young people; good, child friendly information about what is available and how they can access it Children and their families have concerns about: poor and delayed diagnosis of conditions impacting on outcomes; general practice, the key and most frequent point of contact, is not meeting the needs of children and young people; Report of the children and young people’s health outcome forum (CYPHOF), 2012

Aims Parents – Resilience / confidence – Accessing appropriate services / signposting – Consistent messages from healthcare professionals Healthcare delivery – Integration / collaboration between different providers – Shifting care closer to home when safe and appropriate – Up-skilling of healthcare staff

Information for healthcare professionals

Information for parents

Approaches to antibiotics Cluster randomised trial 61 GP practices UK/Wales (558 children) Re-consultation rate 12.9% versus 16.2% Ab prescriptions 19.5% versus 40.8% Future re-consultation ratio 0.34 ( ) BMJ 2009;339:b2885

Education of healthcare staff Working with Health Education Wessex to embed WHT material into core undergraduate and postgraduate training:- – Health visitors – Nurses (adult and paediatrics) – Midwives – Paramedics – Pharmacists – Doctors (post-graduate courses for GPS)

The real challenge - implementation Requires effective marketing to parents AND Buy-in/engagement from health and social care staff CCGs Healthcare staff (GPs, hospital staff, pharmacists, health- visitors, midwives, school nurses) – Healthcare professionals signposting parents to website Local authorities / public health – Parents and young people – Schools Education (undergraduate/postgraduate/parents) Communications teams

Evaluation NHS 111Ambulance Primary care (HHR) HES (Acute Trusts)

Thank you “The whole is greater than the sum of the parts”