Evelina London Child Health Programme Integrating services Claire Lemer 29 th April 2014

England is failing it’s children: Poor mortality UK child mortality rates among the highest in Europe Equivalent to 5 children per day excess deaths when compared to Sweden >132,000 person years of life lost Healthcare deaths with modifiable factors: 21% Poor morbidity –Even the best group of T1 DM have poorer control than Germany or Austria – 16% have HbA1C below 7.5% vs 34% Inequalities widening –Potential 59% reduction in psychological and behavioural problems, in children and young people with conduct disorders if all children had the same risk as the most socially advantaged Source: Our Children Deserve Better: Prevention Pays CMO’s Annual Report 2012

Disease is changing

Priorities HealthVariable and poor outcomes Fragmented inconvenient services Failure to maximise potential SustainabilityEscalating cost Increasing demand Workforce crisis Integration needs are different for children and young people Health +Education= 100% children Health + Social =2% children

2%

Aim of ELCHP To serve children’s best interests by improving quality and convenience of everyday care To serve the health economy’s interests by increasing workforce and financial efficiency

AIMS: to ensure that CYP are kept healthy and minor illnesses are managed in the most appropriate place INITIAL OUTCOMES: improved knowledge and use of healthcare AIMS: to improve healthcare use by providing a better balance between access and expertise in the community, preventing unnecessary trips to hospital. INITIAL OUTCOMES: fewer visits to hospital, fewer avoidable hospital admissions AIMS: to improve care of CYP to ensure that the right professionals with the right skills work in the right place to detect serious illness promptly and provide safe effective care INITIAL OUTCOMES: less time to diagnosis, reduced length of stay, improved patient experience AIMS: to improve the outcomes of children and young people with chronic conditions INITIAL OUTCOMES: fewer visits to A&E, fewer hospital admissions, more care meeting quality standards, improved patient experience AIMS: to improve quality and experience of care and to maximise health and wellbeing INITIAL OUTCOMES: improved integration between services, better patient experience supported by documented multi-professional care plans held by families. AIMS: to improve quality and experience of care and to maximise mental health INITIAL OUTCOMES: improved access to mental health services, better coordination between physical and mental health care, better patient experience Social Adversity and Vulnerability AIMS: to build resilience and emotional wellbeing Public Health and Health Education AIMS: to bring prevention and health education into all front line care

Feedback from CYP & families Feedback from Health Professionals, Partners & Stakeholders Provider Data, Reports & Services International Evidence National Evidence Local Evidence (Lambeth and Southwark ) Connect Communicate Collect How we are creating the case for change to reflect local context and experience …

Phase 1:Understanding the Local Situation- Where feasible by practice level / locality / category 1.Primary Care Data Visits adjusted by population by practice / locality / category 2. Nursing Review 3. GP A+E Referral Audit 4. A+E Attendances Visit trends national vs local Visits adjusted by population by practice / locality/ disease trends 5. A+ E Admissions Admission trends national vs local Admissions adjusted by population by locality / disease trends Less than 24 hour admissions adjusted by population by practice /locality / category 6. Admission audit 7. Length of stay data 8. Wellbeing data e.g. immunisations / mortality 9. Cost data 10. Health Visitor Data 11. Survey of families 12. Focus Group of BME families 13. Survey of HCW: Hospital, Community, GP 14. Out patient Visits Outpatient Audit Attendances adjusted by population/ locality 15. Long Term Conditions A+E visits by disease adjusted Admissions by disease adjusted Standard compliance (NICE e.g. Asthma) GP Database 16. Complex Needs Multiple service use audit Focus Group Long stayers 17. Post code of OPA 18. Integration Data 19. Additional Cost Data

Phase 1:Understanding the Local Situation- Where feasible by practice level / locality / category 1.Primary Care Data Visits adjusted by population by practice / locality / category 2. Nursing Review 3. GP A+E Referral Audit 4. A+E Attendances Visit trends national vs local Visits adjusted by population by practice / locality/ disease trends 5. A+ E Admissions Admission trends national vs local Admissions adjusted by population by locality / disease trends Less than 24 hour admissions adjusted by population by practice /locality / category 6. Admission audit 7. Length of stay data 8. Wellbeing data e.g. immunisations / mortality 9. Cost data 10. Health Visitor Data 11. Survey of families 12. Focus Group of BME families 13. Survey of HCW: Hospital, Community, GP 14. Out patient Visits Outpatient Audit Attendances adjusted by population/ locality 15. Long Term Conditions A+E visits by disease adjusted Admissions by disease adjusted Standard compliance (NICE e.g. Asthma) GP Database 16. Complex Needs Multiple service use audit Focus Group Long stayers 17. Post code of OPA 18. Integration Data 19. Additional Cost Data

3. GP A+E Referral Audit 80 GP referrals to A+E audited by team of professionals: –GP, GP trainee, Paediatrician, Paediatric Trainee, A+E Nurse, Paediatric Nurse Number of unanimously unavoidable (i.e. no health care professional thought interventions could prevent referral) 5% Range in unavoidable referrals by health professional 25%(paediatric nurse) to 99% (GP trainee). Of avoidable referrals, top 3 preventative interventions by health professional in order were: –Phone/ hotline, –GP education –Community nursing. 7/8 health professionals thought a phone hotline could avoid the highest percentage of unnecessary referrals

4. A+E Attendances National vs Local Trends – 7% increase over 3 years Visits by locality (unadjusted show considerable variation- adjusted awaited) Visits by practice – adjusted:

5. A+ E Admissions Admissions by disease by locality adjusted.

13. Survey of Health Care Workers: Hospital Trainees Trainees across 3 hospitals

13. Survey of Health Care Workers: Hospital Trainees -2 How often do trainees discuss health promotion?

13. Survey of Health Care Workers: Hospital Trainees -3 What do trainees discuss?

When discharging a child or young person form A&E, are they advised where to go if they have on-going concerns? 13. Survey of Health Care Workers: Hospital Trainees - 4

18. Integration Data -1

Acute Hub Non Acute Hub Primary Care plus Evelina Academy Supporting Primary Care Acute Hub Acute Assessment Centre Short Stay Unit Community Children’s Nursing Non acute hub Hub & Spoke Model (L&S) Single Point of Entry Family Education Sessions (pm) Primary care plus Lead by Primary Care (L&S) Reducing Admissions to hospital Direct Access to Diagnostics Supporting primary care Guidelines Protocols Standards The Evelina Academy Purpose: Education & Training for Professionals: Families: