Thames Valley Children & Maternity Strategic Clinical Network Steering Group: 4 th December Dr Anne Thomson Michaela Firth Rebecca Furlong

Version Control 2 Owner:Michaela Firth Author:Michaela Firth, Rebecca Furlong Input:Dr Anne Thompson, Fefe Ma Version:V02 Status:For presentation on 4 th Dec 2013 NHS England - Thames Valley SCN ; Children & Maternity Services Steering Group 2013

What is the SCN? SCNs bring together those who use, provide and commission the service to make improvements in outcomes for complex patient pathways using an integrated, whole system approach. SCNs work in partnership with commissioners (including local government), supporting their decision making and strategic planning, by working across the boundaries of commissioner, provider and voluntary organisations as a vehicle for improvement for patients, carers and the public. In this way, SCNs will: reduce unwarranted variation in health and well being services encourage innovation in how services are provided now and in the future provide clinical advice and leadership to support their decision making and strategic planning. Cardiovascular (including cardiac, stroke, renal and diabetes); Maternity, Children and Young People; Mental Health, Dementia and Neurological Conditions Cancer. 3

NHS | Presentation to [XXXX Company] | [Type Date]4 Thames Valley Strategic Clinical Networks: Purpose & Structure

New NHS England 5 Regional Office Dept of Health Secretary of State NHS England Regional Office Regional Office Regional Office 27 Area Teams 211 Clinical Commissioning Groups

Governance 6 Senate Council Senate Assembly

NHS Outcomes Framework Domain 1Preventing people from dying prematurely Domain 2Enhancing quality of life for people with long term conditions Domain 3Helping people to recover from episodes of ill health or following injury Domain 4Ensuring that people have a positive experience of care Domain 5Treating and caring for people in a safe environment; and protecting them from avoidable harm

Domain Improvement areas and indicators 8 Domain 1 – reducing deaths in babies and young children Indicator- infant mortality, neonatal mortality and stillbirth Domain 2 – reducing time spent in hospital by people with LTC Indicator- unplanned hospitalisation for asthma, diabetes, epilepsy in under 19s Domain 3 – preventing lower respiratory tract infections in children from becoming serious Indicator – emergency admissions for children with LRTI NHS England - Thames Valley SCN ; Children & Maternity Services Overview 2013

Where SCN could add value to Maternity & Children services Share expertise across the patch Share the evidence for good practice Agree a common approach to improved standards Influence and inform commissioning Improve quality and effectiveness of the services locally Facilitate new networks, build on the existing ones Learn from the best of what we have, create the best in the new 9NHS England - Thames Valley SCN ; Children & Maternity Services Overview 2013

NHS | Presentation to [XXXX Company] | [Type Date]10 Local Perspective: Children & Maternity in Thames Valley Section number

Thames Valley 10 CCGs (Bucks, Berks & Oxon) 11 NHS Bracknell & Ascot NHS Newbury & District NHS Aylesbury Vale CCG NHS South Reading CCG NHS North & West Reading CCG NHS Oxfordshire CCG NHS Chiltern CCG NHS Slough NHS Windsor, Ascot & Maidenhead NHS Wokingham

Atlas of Variation: Detail for Thames Valley the variation in emergency admission in children aged 17 years and under with asthma is nearly five-fold there is a three-fold variation in the number of children having their tonsils removed there is a four-fold variation in the emergency admission rate for children with epilepsy variation in stillbirths and new-born mortality across PCTs is greater than twofold variation across England in the rate of attendance to A&E departments in persons aged four years and above is three- to four-fold there is a seven-fold variation in inpatient admission for children with mental health disorders 12

Children & Maternity Services: CCG priorities NB: All priorities below appear in at least 5 of the 10 CCG plans 13 Increase breast feeding rates at 6-8 wks. C-section reductions Reduce unplanned / urgent care activity in children & young people Reduce unplanned / urgent care activity in maternity Reduce unplanned hospitalisation for LTC eg asthma & epilepsy in under 19s Develop and sustain the Health Visitor and Family Nurse Partnership programme Prevent deaths in babies & young children Develop and sustain early years interventions

NHS | Presentation to [XXXX Company] | [Type Date]14 Draft Composite Work plan Maternity & Children: Feedback on Priorities from Network Development Day on 10 th July 2013

Question 1: Please Indicate Your Interest

Question 2 : If your interest is in children and young people : please choose your top 3 priorities

Question 3 : If you interest is in maternity: please choose your top 3 priorities

Maternity ‘Dot Voting’ Priorities for Children & Maternity (taken from 'dot' voting from C&M Event 10th July) VotesRankNotes Maternity Improve breastfeeding rates234 Ante natal care pathway devleopment195 improve / offer birthchoice89 improve data collection208 reduce unnecessary admissions195 lower C- section rates243 reduce smoking410 reduce stillbirths281 midwife-birth ratio217 adequate capacity311 postnatal depression/ perinatal MH252 workforce re-design311 18NHS M&C SCN Thames Valley – Stakeholder Priorities from Development Workshop 10 th July 2013

Children & Young People ‘Dot Voting’ 19 Priorities for Children & Maternity (taken from 'dot' voting from C&M Event 10th July) Improve MH services452 develop & sustain HV & Family nurse programme274 reduce unplanned admissions ( epilepsy & asthma)38 1 NB these combined would be 54 and therefore number 1 priority reduce unplanned admissions ( All LTCs)16 reduce mortality265 improve standards in hospitals98 pallative care pathway196 children diabetic service211 improve transition to adult services293 school nurses127 health choice lifesytle69 deliver safer care69 paediatric surgery model410 paediatric radiology211 NHS M&C SCN Thames Valley – Stakeholder Priorities from Development Workshop 10 th July 2013

20 Overall Summary of Results from different tools used at M&C Event Children Table Vote (Top 3) Improve Children's Mental Health Services Reduce unplanned/emergency admissions Obesity Survey Monkey (Top 3) Reduce Unplanned/urgent activity in children and young people Delivering safe care Prevent deaths in babies and young people Individual Vote (Top 5 as so close) Reduce unplanned admissions (epilepsy/asthma/LTC) Improve Mental Health services Develop and sustain HV and family nurse programme Improve transition to adult services Reduce mortality

The Priorities that fit into the CCG plans Children Improve CAHMs (8CCGs) Reduce emergency admissions for children (10 CCGs) Reduce deaths in babies and young children (3 CCGs) Reduce Childhood obesity (3 CCG) Develop and sustain HV and family nurse programme (4 CCGs) Improve transition to adult service ( 2CCGs – 1 transition CAHMs ) NHS | Presentation to [XXXX Company] | [Type Date]21

NHS M&C SCN Thames Valley – Stakeholder Priorities from Development Workshop 10 th July Overall Summary of Results from different tools used at M&C Event Maternity Table Vote (Top 3) Reduction in Emergency admissions Increase Breastfeeding 6-8 weeks Perinatal Mental Health Survey Monkey (Top 3) Improve Data Collection Reduce Unplanned/urgent activity in Maternity Reduce Caesarean section rate Individual Vote (Top 4 as so close) Reduce still births Perinatal Mental Health /Postnatal depression Reduce Caesarean section rate Improve breast feeding

The Priorities that fit into the CCG plans Maternity Reduce Caesarean sections (8 CCGs) Increase uptake breastfeeding – 6-8 weeks (4 CCGs) Health promotion in pregnancy -Improve detection postnatal depression (4 CCGs) Reduce deaths in babies (3 CCGs) Improving the maternity pathway :to reduce unscheduled admissions, improve shared care (5 CCGs) Not highlighted in Maternity & Children Event Identify cause of low birth weight baby (2CCGs) 23

NHS | Presentation to [XXXX Company] | [Type Date]24 Maternity Proposed Work Plan

National Maternity Information The birth rate continuing to rise, approx. 2% each year : nationally up 22% in the last 10 years locally up 5% in the last 3 years, figures starting to plateau The risk profile of pregnant women is increasing older women, overweight or with significant existing medical conditions 17 babies are stillborn everyday in England Approx. 25% of births are Caesarean Sections – more costly than natural birth Maternity care costs the NHS on average £2800 per woman for whole pathway The average CCG with a population of 300,000 - maternity costs approx. £9m a year 25

Maternity work plan for Thames Valley SCN Optimise the maternity pathway for woman and babies; Midwife/ birth ratio / improve capacity Reduce number of still births Reduce Caesarean Sections – normalise birth Improve choice for pregnant woman Reduce number of ‘low birth weight’ babies Reduce unplanned admissions for pregnant women Improve the mental health of pregnant woman, post natal mums Improve breast- feeding rates Improve data collection / dashboard

NHS | Presentation to [XXXX Company] | [Type Date]27 Children & Young Adults's Proposed Work Plan

Children Work plan for Thames Valley SCN Reduce Emergency admissions Pathway Optimization – Hospital avoidance Proposal meeting of Paediatric teams who have lead for acute care to understand pathways and data. Proposal Ensure that every child diagnosed with asthma has a personalized asthma management plan – consider linking to GP facilitator model for domain 1. CAMHs Link with National review of Tier 4 CAMHs Proposal Scope CAMHs provision across Thames Valley across all Tiers January/Feb CAMHs workshop Transition Proposal Small working group to look into transition pathways / different models of good practise Consider focussing on specific patient groups : children with complex needs

Dr Anne Thompson; mobile TBA Michaela Firth; mobile Rebecca Furlong; mobile