Newham CCG case study: Transforming children’s health services Satbinder Sanghera, Director of Partnerships and Governance, Newham CCG Dr Goodyear, Clinical Lead, Children’s and Maternity Services, Newham CCG 6 October 2016

What we will cover Where we started Approach & Philosophy Health – East London Integration Vision/Outcomes LBN Journey

Background – 2014 “As commissioner for the youngest population in England, Newham CCG will secure leading quality maternity and paediatric services and a healthy start in life for children & young people” Currently governance and funding for these areas is split across multiple organisations and committees, and the 2014/15 CCG budget contains no commissioning intention projects focused on children and maternity In April, the CCG initiated a 6-month foundational exercise to establish a dedicated children and maternity agenda

Foundation work (April to September 2014) brief Establishing the foundations for leading quality maternity and paediatric services and best outcomes for children and mothers: Establishing a dedicated commissioning team for maternity and children Initiating a review of existing maternity and paediatric services and service specifications, taking account of national policy and models of best practice, enabling the stretch ambition for quality to be appropriately set Engaging with CCG member practices to help them consider the implications of the CCG’s ambition for the role of GPs and the services provided in primary care and to identify how they might be better connected with the work of other public service providers so that support for children and parents is more coherent and effective as a whole Informed by these activities, engaging fully with Borough colleagues, with Health and Wellbeing Board oversight, to reach a shared understanding of health needs, develop a comprehensive public service pathway for children and parents and set of target outcomes, and to develop strong working relationships at all levels. Overseeing a programme of quick wins for 2014/15 Supporting the CCG Clinical Lead for Children and Maternity, Dr Elizabeth Goodyear, and the Director of Partnerships, Satbinder Sanghera, and representing the CCG in meetings, particularly with the London Borough of Newham (LBN).

Aims Improve health, social care and education outcomes Improve access and equity of services, reducing duplication Reduce demand on specialist and statutory interventions Integrates health, educational, social care service delivery Secure the best provider of quality and outcomes

Objectives Whole system integrated care for children and young people in Newham Seamless movement between tiers and across Universal, Targeted, Specialist and Acute Requires strong partnership and joint commissioning between CCG and Local Authorities which brings together the acute and community health, social care and education systems

TST/WELC Group has agreed priority areas for collaboration across the region, Workstreams include: Asthma Diabetes Allergy MDT working for CYP with complex care/continuing care needs, including end of life care (integrated care) General paediatrics referrals will be considered as a core principle in all pathway work The group has agreed the first three areas of action for 16/17: Asthma, Allergy, Diabetes System wide change will be an underlying principle to consider in the review of each pathway Aiming to agree pilot approach to test collaborative working

Asthma

Vision and Outcomes Framework Over 85,000 children and young people live in Newham. We are committed to ensuring each one of them grows up happy, healthy, and with an excellent education which prepares them for the next stage in their lives. At the heart of our vision is the simple premise that the best way to help families is to support them to identify strengths and build on what works. We believe children, young people and families will do better if we focus together on developing strong relationships which enable us to build networks and resilience, building on the power of connections between families, neighbours, learning, jobs and communities. Strategic Outcomes: Health and Wellbeing, Learning and Achievement Safety and Stability, Resilience and Responsibility

Learning & Achievement OUR VISION Over 85,000 children and young people live in Newham. We are committed to ensuring each one of them grows up happy, healthy, and with an excellent education which prepares them for the next stage in their lives. At the heart of our vision is the simple premise that the best way to help families is to support them to identify strengths and build on what works. We believe children, young people and families will do better if we focus together on developing strong relationships which enable us to build networks and resilience, building on the power of connections between families, neighbours, learning, jobs and communities. OUR PRINCIPLES Early Help & Safeguarding Right support, right level, right time Children and young people are safe from harm Integrated Working Seamless services from the point of view of families Strong partnerships and integrated leadership building on our strengths Making a difference A solution-focused approach Getting the most from every £ that we spend Doing what works, based on the evidence Continuous improvement Listening to children, young people and their families Valuing and developing the children’s workforce Health & Wellbeing Learning & Achievement Children and young people are physically and emotionally healthy Children and young people are successful learners and confident individuals Children and young people reach appropriate developmental and social milestones Children and young people access positive community activities and social networks Children and young people access positive community activities and social networks Children have the best start in life Young people reach adulthood with the skills and aptitude for work Safety & Stability Children and young people make positive life choices Children and young people in need, or with a disability, have improved life chances Children and young people develop resilience and achieve independence Children and young people are safe from harm Children and young people are responsible citizens Children and young people do not harm others Resilience & Responsibility

Key Characteristics of new service Outcomes driven – focus on impact – “did it make a difference” Integration at every level Accessible and equitable Making every contact count Early recognition of difficulties and earlier intervention, support and advice Full participation and involvement in delivering care for children, young people Seamless delivery that minimises duplication Effective use of staff skills and expertise – workforce innovation Offer a menu of service delivery that supports self care, and personalised approaches Robust transition planning and step-down care Safeguarding is paramount and inherently part of all delivery and workforce responsibility

Transformation and Innovation (1) Full Integration that shares success, risk and accountability across whole system - different financial and business model Balancing growing demand and complexity vs clinical governance & safety Increasing role of schools in locality/ community working Addressing the current 16 -19 provision gap and more seamless transitions Flexibility of workforce with focus on appropriate skill-mix - changes in cultural practice Integrated service delivery models - hubs and single point of access – hubs model organised around the 4 primary care hubs New model for school nursing through Integrated Neighbourhood delivery ( 4 areas) which will be part of the new comprehensive universal and targeted local health model  

Transformation and Innovation (2) Joined-up clinical and care pathways (health, care and education) Care Closer to Home, promoting personalisation and self care Effective partnership relationships with stakeholders, including VCS ‘Telling the story once’ – more seamless delivery for the child Through Future Generation – taking a collaborative coproduction approach that involves everyone in the development and influencing of children's health and wellbeing in Newham – this way secures buy-in at every level, enables sustainable projects and activities whether they be quick-win, cultural changes or major re-commissioning exercises. 

Quality Our vision is that we work collaboratively with all other teams/functions – Commissioners, Quality, Contracts and Finance Need to understand the offer from ‘Quality’, needs to be realistic Embed the ‘quality’ approach within the Children’s Programme Need to reduce Forums/Committees to have one conversation All work to the same outcomes

Specification –Interdependent elements Outcomes – high emphasis on the outcomes to be achieved for children and the difference the service will make to lives Experience – focus on what children and families should experience when they interact with the service Performance – assurance provided by robust KPIs and super KPIs Activity – understanding and monitoring of baseline activity Integration –brings together the requirements of LBN and NCCG, while still allowing for clear service-specific requirements to be made. Maximises value added elements of a joint approach. Innovation – encourages providers to bring innovation to their approach, adding value commissioners alone may not have anticipated, while still allowing for prescription of mandatory elements

Future Care Model – key principles Ensures children and young people are seen as an integrated service with no gaps, which is provided close to where the users are living or learning and has streamlined access Ensures that service provision is consistent and accessible across the CCG / local authority area, while still allowing flexibility to meet need at community neighbourhood area and primary care cluster level Ensures children and young people are safeguarded, including early identification and co- ordinated support of emerging need Emphasises early help to reduce the need for children and young people to access intensive or statutory services Develops close working relationships and integration with social care, education and other health partners as paramount to creating a seamless service Supports children and young people to be able to self-care where possible and appropriate Develops a fully integrated information technology system that allows the seamless transfer of/access to appropriate clinical and non-clinical information across all services Is able to deliver efficiencies with no compromise in service quality