NETWORKS IN COMMUNITY CHILD HEALTH Jo Sibert ( Immediate Past Chair of BACCH). n Local networks, n Networks in Child Protection, n Networks in Disability.

STRENGTHENING THE CARE OF CHILDREN IN THE COMMUNITY - A REVIEW OF COMMUNITY CHILD HEALTH Alan Craft, Jo Sibert, Neil McLellan. n The question was not whether CCH was relevant or important but rather how these services ought to be provided in the future and what the training implications would be?

Community Child Health Review n We found that there were examples of modern services working in partnership but: n We also found that there were examples of single handed community paediatricians working in isolation from colleagues.

Community Child Health Review n Community child health cannot be considered in isolation from the whole future delivery of services to children at a primary/secondary level. n Tertiary services have also to be considered where these impact on community services.

Possible Structure n Each locality (total population ,000) will relate to a DGH serving a district. n A typical district might have 3-5 localities and have districtwide staff of consultant paediatricians most of whom are also linked to a locality. n The function of the DGH will be to concentrate inpatient resources (including high dependency provision and level 2 neonatal care); provide specialist investigation

Possible Structure n Each locality will have a team of paediatricians who have generic competencies. n However, we envisage that all paediatricians will develop a special interest and that for their particular expertise they will link both “horizontally” and “vertically”.

Combined Child Health Service in the Vale of Glamorgan n We have been working in similar team to that was envisaged in the Community Child Health Review for the last six years. n We work in partnership within our District and with the Tertiary Centre

Combined Child Health Service in the Vale of Glamorgan n The Vale of Glamorgan has a population of 125,000. n It is the area just West of Cardiff with Penarth, Barry, Llantwit Major and Cowbridge the main towns. n It has an identical social class mix than the UK as a whole.

Combined Child Health Service in the Vale of Glamorgan n The main Hospital is Llandough Hospital where there is a Children’s Ward and a separate Paediatric Oncology Unit. n When the Combined Child Health Service was set up we were in one NHS Trust with a co-terminus Local Authority. n We now are in one Combined Trust with Cardiff.

Combined Child Health Service in the Vale of Glamorgan Consultants: n We have 3 Paediatricians (2.5 wta) working predominately undertaking Ward, Neonatal Out-Patient work (one Designated Doctor). n We have 4 Paediatricians (1.8 wta) working in the Community (2 Academics).

Our Special Interests n Respiratory and International Child Health n Nutrition and Gastroenterology n Child Protection and Disability n Child Protection, Disability and ADHD n Audiology n Child Protection Management n Child Protection, Clinical Director (for whole Trust).

Combined Child Health Service in the Vale of Glamorgan Other medical staff: n We have 3.5 Specialty Registrars, n We have one Lecturer (Associate Specialist) 3 sessions special interest Autism n We have 3 Staff Grade Paediatricians (1.8 wta) working in the Community.

Combined Child Health Service in the Vale of Glamorgan Other medical staff: n We have 3.5 Specialty Registrars, n We have one Lecturer (Associate Specialist) 3 sessions special interest Autism n We have 3 Staff Grade Paediatricians (1.8 wta) working in the Community.

Combined Child Health Service in the Vale of Glamorgan n We do find working together easy. n Individual patients often change consultants, or have joint care, in the course of their illness. n Community Paediatricians work on the Ward. n General Paediatricians do ‘community work’: clinics special schools, nutrition in children with special needs.

Combined Child Health Service in the Vale of Glamorgan: The difficulties n A failing local Authority. n Trust re-organisation. n The pending closure of the In-patient ward n But we will continue with an Ambulatory Unit.

Networks in Child Protection n Increasingly we are realising that we all need help with these difficult cases. n In Wales we are beginning to develop networks.

Networks in Child Protection n We have a local network of 6 consultants and 3 Associate Specialists in Cardiff and the Vale. n This has been approved by the Trust and is making links with other parts of Wales and the West Country. n This is linked with academic projects.

Networks in Child Protection n We have a Network particularly concerned with Audit and Training in Child Sexual Abuse. n This has linked with the Wales and the South West and has now involved several forensic courses and the police.

Networks in Child Protection: Sub-dural Haematoma in Infants n We have an on-going Research Programme on sub-dural haematoma: the Severnside Group: Dr Alison Kemp. n This has produced diagnostic criteria and has linked now with paediatric neurologists, radiologists, intensivists, social services etc in an informal network.

Networks in Child Protection:Fabricated Illness Syndrome n We have an informal network in dealing with these rare and difficult problems. n Two consultants have a special interest in these cases and work in partnership with the local paediatrician.

Networks in Disability n Just as in Child Protection there is great scope in developing Networks in Disability. n There are two possible models, looking at disability as a whole or looking at individual problems such as Autism or Muscular Dystrophy.

Networks in Disability: Examples n Autistic Spectrum Disorder. n Audiology. n Duchenne Muscular Dystrophy. n Cerebral Palsy.

Networks in Disability n We would like to develop these networks in Wales to a greater extent. n Links between community paediatricians and neurologists are clearly very important.

NETWORKS IN COMMUNITY CHILD HEALTH n The Potential is Huge, n Much good work is being done, n It needs to be formalised and recognised. n It needs to link with academic work both in Teaching and Research.