The new NHS and the Children’s Strategic Clinical Network Tracy Parr SCN Lead Children and Maternity Leaders for London January 28 th 2014 London Strategic Clinical Networks

Structure of Presentation Overview of new NHS structures National initiatives General Children-specific Strategic Clinical Networks – overview Children’s health in London Children's strategic clinical network London 2

The NHS in England structure and responsibilities Health and Social Care act 2012 changed Structure Accountabilities Funding arrangements Working arrangements 3

Health and Social Care Bill

Health and Social Care from April

6

Structures up to April

NHS in England Apirl

New funding Arrangements 9

Regulation and Accountability - providers 10

Commissioners – performance management and guidance 11

Patient and public involvement 12

13 Expectations of how £95billion will be spent

Children in the UK 14

Word acquisition - inequalities 15 Hart and Risley 1995

C and YP Health Outcome Forum 16

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NHS Outcomes Framework 18

Outcomes for Children Domain One – Preventing people from dying prematurely Reducing deaths in babies and young children Infant mortality Neonatal mortality and stillbirths Five year survival from all cancers in children Domain Two – Enhancing quality of life for people with long term conditions Reducing time spent in hospital with long term conditions Unplanned hospital admissions for asthma diabetes and epilepsy in under 19s 19

Outcomes for Children Domain Three – Helping people to recover from episodes of ill health or following injury Preventing lower respiratory tract infections (LRTI) in chidlren from becoming serious Emergency admissions for children with LRTI Domain Four – Ensuring people have a positive experience of care Improving C and YP experience of healthcare C and YP experience of outpatient services 20

Outcomes for Children Domain Five – Treating and caring for people in a safe environment and protecting them from avoidable harm Delivering safe care to chidlrne in acute settings Incidence of harm to chidlren due to “failure to monitor” 21

Adult Social Care Outcomes Framework 22

Public Health Outcomes Framework 23

Public Health Outcomes Framework 24

London’s Children Population of London 7.8 million (ONS 2011) 2,049,576 children aged 0 – 19 in London Approx 1.7 million children in Kent Surrey Sussex, and East of England many of whom access tertiary services in London 134,186 live births in London 2012 (ONS) 25

Why a Children’s SCN? UK has a higher all-cause childhood mortality rate compared with Sweden, France, Italy, Germany and Netherlands 26

London has higher than expected mortality for 1 – 19 year olds 27 Data courtesy of London Health Programmes

Hospital mortality for children in London is rising compared to other areas of UK 28

There are low rates of consultant review of paediatric emergency admissions within 12 hours 29

78% of London trusts undertake elective surgery on less than two children per week 30

Most surgery on children is being undertaken by adult surgeons 31

What is a Strategic Clinical Network (SCN)? Area requiring large scale change Resistant to previous attempts at improvement (or not examined holistically) Strategic pan-London approach Provide expert advice to commissioners Contrast with Operational Delivery Networks 32

Over 50% of hospitals do not have a paediatric anaesthetist available 33

Attendance at A & E by children is very high in London London boroughs have A and E attendance higher than the national average for children Data courtesy of ChiMat

Some boroughs have high rates of admission to hospital for asthma 35

Thematic examination of SUIs involving children in London 36 Aim To identify themes and learning from Serious Untoward Incidents (SUIs) to help inform the work of the Children’s SCN Methodology SUIs involving children requested from STEIS Those indicating system failure identified n = 86 Full report requested from Trusts/PCT/CCG 59 responses received from 29 organisations Common themes identified and collated

Thematic examination of SUIs involving children in London 37 Lack of recognition of sick child Inexperience/lack of expertise Worlklaod Communication Failure to escalate to consultant/senior review Documentation Transfer to tertiary centre

Failures of Care 38 Half of all children subsequently found to have meningococcal infection are sent home from the first primary care consultation Approximately 75% of admissions of children with asthma could have been prevented with better primary care Over a third of short stay admissions in infants are for minor illnesses that could have been better managed in the community

Clinical areas covered by SCNs 39

SCN core elements Comprehensive networks of clinical expertise Leadership for accelerated change at pace Agreed priorities for improvement Holistic view of health and social care Widespread engagement Meaningful and effective patient involvement

What is a Strategic Clinical Network (SCN)? Area requiring large scale change Resistant to previous attempts at improvement (or not examined holistically) Strategic pan-London approach Provide expert advice to commissioners Contrast with Operational Delivery Networks 41

London’s Children Population of London 7.8 million (ONS 2011) 2,049,576 children aged 0 – 19 in London Approx 1.7 million children in Kent Surrey Sussex, and East of England many of whom access tertiary services in London 134,186 live births in London 2012 (ONS) 42

Why a Children’s SCN? UK has a higher all-cause childhood mortality rate compared with Sweden, France, Italy, Germany and Netherlands 43

London has higher than expected mortality for 1 – 19 year olds 44 Data courtesy of London Health Programmes

Hospital mortality for children in London is rising compared to other areas of UK 45

There are low rates of consultant review of paediatric emergency admissions within 12 hours 46

78% of London trusts undertake elective surgery on less than two children per week 47

Most surgery on children is being undertaken by adult surgeons 48

Nearly half of children are not reviewed by a consultant surgeon within 12 hrs of admission 49

Over 50% of hospitals do not have a paediatric anaesthetist available 50

Attendance at A & E by children is very high in London London boroughs have A and E attendance higher than the national average for children Data courtesy of ChiMat

Some boroughs have high rates of admission to hospital for asthma 52

Thematic examination of SUIs involving children in London 53 Aim To identify themes and learning from Serious Untoward Incidents (SUIs) to help inform the work of the Children’s SCN Methodology SUIs involving children requested from STEIS Those indicating system failure identified n = 86 Full report requested from Trusts/PCT/CCG 59 responses received from 29 organisations Common themes identified and collated

Solutions to the care of children 54 “Children’s services should be seen as a whole system, designed within a framework of pathways and networks which enable the right things to be done, at the right time and place, using teams that work together within a managed network.” RCPCH 2013

Issues across healthcare systems 55 “It is clear that in relation to service failure, problems often occur at the borders between one organisation or team and another” Learning from Investigations Healthcare Commission February 2008

PATHWAYS London Strategic Clinical Networks December 2013 Children’s Strategic Clinical Network Children’s Commissioning Group Strategic Clinical Leadership Group Patients and public SCN Oversight Group Governance Clinical Senate Assurance Children’s Network STANDARDS Primary care Tertiary care Secondary care Cardiology Pathway Group Chair: Owen Miller SCN Lead: Andy Martin Neuroscience Pathway Group Chair: TBC SCN Lead: Andy Martin Diabetes Pathway Group Chair: Peter Hindmarsh/Martha Ford- Adams SCN Lead: Sara Nelson Nephrology Pathway Group Chair: Lesley Rees SCN Lead: Sara Nelson Surgery Pathway Group Chair: Simon Eccles SCN Lead: Suzanne Sweeney Critical Care Pathway Group Chair: Duncan MaCrae SCN Lead: Andy Martin Oncology Pathway Group Chair: Julia Chisholm/Darren Hargrave SCN Lead: Caroline Moren Asthma Pathway Group Chair: John Moreira SCN Lead: Sara Nelson Gastrointestinal Pathway Group Chair: Ian Sanderson SCN Lead: Suzanne Sweeney Neonates Pathway Group Chair: Sandy Calvert SCN Lead: Suzanne Sweeney Patient and Public Involvement (PPI) SCN Lead: Andy Martin Mental Health SCN Lead: Andy Martin Health in the Justice System SCN Lead: Sara Nelson Commissioning SCN Lead: Sara Nelson Immunisation, Healthy Child and Safeguarding SCN Lead: Suzanne Sweeney Data and Information SCN Lead: Andy Martin Programme Management SCN Lead: Andy Martin Information Technology SCN Lead: Sara Nelson Education & Workforce SCN Lead: Sara Nelson Communications SCN Lead: Suzanne Sweeney Community care Collaborating with: ► Academic Health Science Networks ► Clinical Commissioning Groups (CCGs) ► Health and Wellbeing Board ► Local Education and Training Boards ►Public Health England ► Regulatory bodies ► Royal Colleges ► Voluntary sector PATHWAYS ENABLERS

Initial work programme - Networks 57 Subgroup of SCLG developing network model Chaired by Professor Russell Viner, UCL/ICH Networks of care across all children's providers Currently considering 3 based on AHSNs, LETBs, LATs, Population based view of children’s health Linkage with public health Governance pathway through commissioners linked into commissioners Funding identified to establish networks

Initial work programme - Standards 58 Subgroup of SCLG chaired by Tina Sajjanhar, Paediatric ED Consultant, Lewisham Hospital Identify standards of care within the networks collating existing standards: Service specifications for specialised services All existing standards for children in-hospital care (eg RCPCH, London Health Programmes, RCA, RCS) General practice outcome standards

Initial work programme - pathways 59 A number of pathway groups Some illustrative of issues in primary secondary and tertiary care settings High volume

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