The new NHS and the Children’s Strategic Clinical Network

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

2. 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

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

4. Health and Social Care Bill 2010

5. Health and Social Care from April 2013 2013

7. Structures up to April 20013

8. NHS in England Apirl 2013

9. New funding Arrangements

10. Regulation and Accountability - providers

11. Commissioners – performance management and guidance

12. Patient and public involvement

13. Expectations of how £95billion will be spent

14. Children in the UK

15. Word acquisition - inequalities Hart and Risley 1995

16. C and YP Health Outcome Forum

18. NHS Outcomes Framework

19. 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

20. 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

21. 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”

22. Adult Social Care Outcomes Framework

23. Public Health Outcomes Framework

24. Public Health Outcomes Framework

25. 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)

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

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

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

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

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

31. Most surgery on children is being undertaken by adult surgeons

32. 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

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

34. Attendance at A & E by children is very high in London 26 London boroughs have A and E attendance higher than the national average for children Data courtesy of ChiMat

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

36. Thematic examination of SUIs involving children in London 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 2008 - 2013 • 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

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

38. Failures of Care • 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

39. Clinical areas covered by SCNs

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

41. 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

42. 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)

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

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

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

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

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

48. Most surgery on children is being undertaken by adult surgeons

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

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