1. Progress on the National Model of Care Prof Alf Nicholson ICHN Study Day 18 th May 2016

2. Has anything really changed?

3. Absolutely !  changes in disease priorities for child health  improved standards of living  many ‘killer’ diseases have disappeared  chronic and complex disabilities more prevalent  emotional and behavioural problems affect 10 – 20%  changes in parental expectation  loss of confidence in primary care provision  faster access to specialist care  Intolerance of uncertainty  changes in healthcare provision  reorganisation of infrastructure

4.  The Future of child health services : new models of care. February 2016 Nuffield Trust ‘ Is one that understands children, young people and their families’ specific needs and is designed to address them with access to high quality paediatric expertise in hospital and the community with linked up timely information, communication, data and care processes. It should allow for continuous quality improvement and for health education for children, young people and families’.

5. Background issues  Capacity in primary care  Access to paediatric expertise in the community  GP training in paediatrics  Linkage between primary care and hospital care  Use of emergency departments to manage acute illness  Child health primarily influenced by broader determinants and not the system of health care

6. The journey so far  Visits to all paediatric departments in Ireland  Regular WG meetings and CAG meetings  Framework document in 2013  Visits to all tertiary specialties  3 volume model of care document with drafts on designated website for consultation (200,000 words)  ‘Town Hall ‘ meetings – January and September 2015  Final MOC passed by SMT in February 2016

7. Stake-holder dialogue

8. Core Pillars  Infrastucture – emergency department, inpatient and outpatient facilities  Staffing – including nursing and HSCPs (we need accurate national data)  Processes – pathways and standardisation of care processes  Outcomes – need robust dataset

9. General Paediatrics  A key enabler of the Model of Care  General paediatrician cares for the ‘undifferentiated child’  Interface between general practice, emergency department and hospital  Areas of special interest

11. Next steps  MOC formally passed by HSE senior management team  Evolution into integrated care programme  Prioritise for implementation  Engagement with Group senior management teams  National workforce plan for medical / nursing / HSCP’s  Annual re-evaluation of progress  Formal costing of the MOC

12. Paediatric Consultant Delivered Now the exciting phase commences

13. Priorities for 2016/17  Costings analysis for each subspeciality + overall model  National PEWS implementation  Close collaboration with primary care (GP algorithms / antibiotic prescribing / national care pathways / laboratory and radiology back up )  Development of retro-transfers for newborns  PETS + agreed paediatric critical care MOC  Criteria for prioritisation

14. Criteria for prioritisation  save life and prevent disability  Better integration with primary care  Improve patient flow  Improve longterm health  Provide the greatest benefit to the majority of children  Specific requirements relating to the NCH  Remove ‘ post-code ‘ disadvantage

15. Urgent and Ambulatory Care Centres – Key principles (Willett 2013)  Provision of better support with self care  Helping people with urgent care needs to get the right advice in the right place, first time  Provision of highly responsive urgent care services so that people do not have to wait in emergency departments  Ensure that those people with more serious or life-threatening emergency needs receive treatment in centres with the right facilities and expertise in order to maximise chances of survival and good recovery  Connection of urgent and emergency care services so that the overall system becomes more than just a sum of its parts

16. Proposed Model of Care for Urgent Care Centres