1. 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

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

3. 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

4. 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).

5. 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

6. 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

7. 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

9. Asthma

12. 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

13. 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

14. 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

15. 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 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

16. 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. 

17. 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

18. 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

19. 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