1. Paediatric Quality Indicators Workshop Introduction to developing and commissioning pathways Simon Lenton, Children’s & Young Peoples Outcome Forum

2. CYP HOF Scope 1.Identify the health outcomes that matter most for children and young people. 2.Consider how well these are supported by the NHS and public health outcomes frameworks 3.Set out how different parts of the health system – DH, NHSCB, PHE, HEE and others will contribute to delivery of these outcomes, and how they will work with each other and with other partners to this end.

3. Systems thinking A health system has been defined as “all organisations, people and actions whose primary intent is to promote, restore or maintain health.” Its purpose is to “improve health and health equity in ways that are responsive, financially fair and make the best use of available resources”. (WHO)

4. Integrated care – a culture "integrated care demands a culture of its own, one that spans differing organisational and professional mindsets, eliminates boundaries and biases. It shares a common space to facilitate a much needed interagency collaboration and interdisciplinary teamwork on behalf of the patient" (Kodner 2009) Ref: BACCH – “the meaning of integration”

5. What do we all want? Right interventions Right children Right professionals Right place Right time Right support Right cost Safety, good experience, great outcomes “All in place and working well together”

6. Partnerships - key criteria a collaborative relationship among multiple organisations in which risks and benefits are shared in pursuit of a shared goal. plus shared values – principles – practice plus leadership to create synergy and alignment

7. Commissioning “the process of allocating public resources to achieve the greatest gains in health within a defined population”. Truly effective commissioning requires strong collaboration between commissioners, providers and regulators, with integration of functions whenever possible

8. Start here Not Here With thanks to Charlie Keeney

9. What is the CFHC approach? Distil the Conventions into simple concepts Easily understandable framework for change Transcend the concept and language issues Adopted and adapted by health care systems The new model must create alignment –at a high level between politicians –planners and financiers, between agencies –between patients, clinicians and managers Drive learning and improvement CFHC = Child Friendly Health Care

10. Development of the CFHC approach Human rights Children’s rights Principles CFHC approach Needs Services Outcomes

11. Principles for children’s services Participation Promotion Protection Prevention Provision –pathways

12. PATHOGENIC APPROACH - Individual - Family - Community - Society PROTECTION SALUTOGENIC APPROACH - Individual - Family - Community - Society PROMOTION Promotion and protection a new framework Health and illness What creates health?What creates illness? Slide: adapted from Fabrizio Simonelli

13. Promotion Healthy eating Screening 2 0 disability Competent staff Prevention Primary Secondary Tertiary Quaternary Protection Fluoridisation Domestic violence Poverty Drug errors

14. Alignment and synergy needs services outcomes health harming determinants Society health promoting determinants community interventions health harming lifestyles health promoting lifestyles lifestyle interventions

15. Provision based on pathways Purpose, values, evidence and learning. needsoutcomes pra i

16. Needs Outcomes Health Equity Sustainable Prevention RecognitionAssessmentInterventions Protection Promotion Concern Screening Family Child Social Psychiatric Child Family Community Short term condition pathway Condition CommunityEducational Medical Behavioural Surgical

17. Pathway components Purpose, values, evidence and learning. PurposePrinciples needsoutcomes health equity sustainable participation prevention provision pra i

18. Pathway components Purpose, values, evidence and learning. PurposeValues/rights needsoutcomes health equity sustainable participation prevention provision Learning Evidence pra i quantitative qualitative econometric measures feedback improvement

19. Long term condition Initial pathway Transition pathway Needs Condition Family Community Outcomes Effectiveness Efficiency Equity Review pathway Network of services Environment Initial, review and transition pathways

20. Myriad of measures!!! needs c outcomes cc cc Child Community Family Determinants Harm Exposure Effectiveness EquityEfficiency AccessibilityAffordability Acceptability Outputs Components ProcessStructure Environment c = component

21. Key measures Health service outcome measures Life course outcome measures Health impact measures Health measures Health service impact measures Health service measures Public service measures Determinants and lifestyle measures

22. NeedsOutcomes Whole pathway NHS CB PHLA CCG Commissioners Academies Personal budgets Health insurance ‘CJS’ Workforce Research Innovation ???

23. Commissioning pathway components pra i NHS CB Pregnancy care CMV (primary) Cochlear Implants (specialist) Booking <12 w Timeliness CCG Genetic counselling Paediatric audiology assessment SaLT Parent support Yield Hearing@12m LA Hearing Advisers Hearing loops Language dev Ed achievement PH MMR immunisation Neonatal Screening Healthy Child Uptake needs outcomes

24. Commissioning – what should it look like in the future? a shift from contracting services towards commissioning programmes of care supported by a series of measures that reflect quality and can identify the weakest link in the pathway commissioning for quality improvement being integral to the contracting process a pooled commissioning budget and the capacity to vire resources within a network. network collaboration by different service providers whether NHS Trusts/social enterprise/private sectors a reduction in the number of commissioners involved or integrated working of the commissioners involved.

25. Thank you

26. Health service outcomes Public health outcomes Health outcomes Life course pathway Review cycle Social impact Environmental impact Health impact Review cycle Service pathways Sustainable Equity Life course pathway Health outcomes Life course pathway Bringing outcomes together

27. Quality Compass Efficacy Effectiveness Efficiency Equity Acceptable Accessible Affordable Appropriate Safety, experience and outcomes Quality, innovation, prevention, productivity

29. Managed networks “Linked groups of health professionals from primary, secondary and tertiary care, working in a co-ordinated manner, unconstrained by existing professional and Trust/Health Authority boundaries, to ensure equitable provision of high quality and clinically effective services.” A later definition describes the function of managed networks is being "a group of organisations, services and professionals working collaboratively to continually improve the services they provide through a process of learning from innovation and quality improvement".

30. CYP HOF Purpose The strategy will aim to maximise health outcomes for all children and young people, showing how all parts of the health system, with partners, will contribute to enabling every child and young person to reach their full potential

31. NeedsOutcomes Network NHS PrivateLA Social Enterprise Providers ‘CJS’ ‘Public health’

32. NeedsOutcomes Network Quality OrganisationalProfessional Economic Regulators

33. Implications of integrated pathway based networks (1) 1.Combined commissioning strategies across health, education, social care and criminal justice systems. 2.Provider organisations sharing the same knowledge base and approach to implementation of evidence- based guidelines. 3.Shared governance systems across organisations. 4.A shared approach to measurement and improvement 5.Financing systems where resources follow patients through pathways and networks - introduction of program budgeting.

34. Implications of integrated pathway based networks (2) 6. Workforce planning based on the right skill mix to ensure competent teams working in networks. 7. Integrating public health approaches to prevention across all pathways. 8. Greater emphasis on both equity of access and outcomes. 9. Combining regulation to ensure effectiveness, efficiency and equity bringing together quality and economic regulators and a greater emphasis on equity