Using the to improve services for children, young people and their families

1. Using theto improve services for children, young people and their families FAMILY FRIENDLY FRAMEWORK BACCH/BACAPH September 2014

2. Structure Introduction Where are we? Systems - theory Family Friendly Framework Application - commissioning Application - provision Application – regulation Benefits

3. Introduction

4. Why is the FFF needed? • System reform - free market • Austerity – public service cuts • Unnecessary variations • Waste • Resource allocation

5. Biological systems Genetic coding in DNA Basic proteins plus encoded fractal formulae Iterative designs Control systems based on feedback loops Interaction with environment Innovation Communication ‘Survival of the fittest’ Learning “Simple rules” Innovation plus learning = survival Communication

6. FFF 4x4 overview Prevention Recognition Assessment Interventions Evidence Competence Settings Timing Pathways Basics Lifestyles Service Output Input Input Networks Systems Determinants Initial Review Transition Life course Purpose Values Leadership Learning

7. Where are we?

8. Recent Reports • UK • Berwick Report A Promise to Learn • England • Kennedy Report, Atlas of Variations • Children + Young People’s Health Outcome Forum • Scotland • GIRFEC (getting it right for every child) • Early Years Collaborative • Wales • Rights of Children and Young people Measure 2011, • ‘Flying Start’, ‘Families First’ • Northern Ireland • ‘Transforming Your Care’

9. Key themes Whole system approaches - culture Clear outcomes “Integrated care” = “pathway-based” Relentless focus on prevention Patient participation in the system Measurement – information - feedback Learning through innovation/improvement

10. Don Berwick “You are stewards of a globally important treasure: the NHS. In its form and mission, guided by the unwavering charter of universal care, accessible to all, and free at the point of service, the NHS is a unique example for all to learn from and emulate”.

11. Commonwealth Fund

12. Variations For PCTs in England, the emergency admission rate for children with asthma ranged from 38.7 to 732.6 per 100,000 population aged 0–17 years (19-fold variation). When the five PCTs with the highest rates and the five PCTs with the lowest rates are excluded, the variation is 5-fold. Action to reduce emergency admissions requires a whole pathway approach, including public health, and primary and secondary care. Parental education and school medication management are vital to good care.

13. Theory - systems CATWOE Types of systems Measures

14. A simple system Environment Change Output Input Input Environment

15. Soft systems methodology Actors Customer Environment positive Trans formation Output Input Input Environment negative Owner World view CATWOE Peter Checkland

16. Services for CYP + Families Actors Patients Clients Providers Environment positive Service Output Input Input Environment negative Owner World view Commissioners Politicians

17. Stakeholders-Partnerships Children Families Communities Health Education Social care Teams Users Lifestyles Service Output Input Input Managers Policy makers Determinants Providers Regulators Commissioners Government Private sector Voluntary sectors

18. Systems • Simple systems • Complicated systems • Complex (adaptive) systems • Chaotic systems

19. Complex adaptive systems • They are complex in that they are dynamic networks of interactions, not aggregations of the individual static components. • They are adaptive, in that the individual and collective behaviour mutate and self-organisedepending on the internal environment or adapt to the changing external environment. • Complex adaptive systems are systems that have a large numbers of components that interact and adapt or learn"JH Holland

20. Family Friendly Framework Service pathways Life course pathways Networks Whole systems

21. 4x4 Approach Prevention Recognition Assessment Interventions Evidence Competence Settings Timing Pathways Basics Lifestyles Service Output Input Input Networks Systems Determinants Initial Review Transition Life course Purpose Values Leadership Learning

22. Service pathways

23. Simple system Lifestyles Service Output Input Input Ill health Better health Determinants

24. Complicated pathway Lifestyles Prevention Recognition Assessment Interventions Outcome Needs Determinants

25. Basics Quantitative Qualitative Econometric Professional Cultural Improvement Competence Evidence Lifestyles Service Output Input Input Setting Timing Determinants Place Space Support Access Experience Outcome

26. Surgical Serous otitis media Medical Condition Promotion Screening Child Psychiatric Needs Family Social Outcomes Health Equity Sustainable Protection Concern Child Family Community Health Equity Sustainable Community Educational Behavioural

27. Long term condition Initial pathway Lifestyles Review pathway Outcomes Needs Determinants Transition pathway 27

28. Life course pathways

29. Life course pathways Neil Halfon Transforming Early Childhood Community Systems

30. Needs Services Specific programmes Lifestyles Determinants Pathogenesis Salutogenesis Protection Promotion Assets Life course pathway Infant Child Young person Hazards

31. Lifestyle hazards Substance misuse Lack of exercise Smoking Poor diet Lifestyle assets Stable family Good diet Creative play Friendships Assets Hazards Infant Promotion Child Protection Determinant assets Stable communities Sustainable economy Affordable homes Small inequalities Determinant hazards Poverty Poor housing High crime areas Inaccessible services Determinants Lifestyles Young person

32. Smoking cessation interventions

33. Networks Integrated care

34. Networks Review pathway Initial pathway Life course pathway Transition pathway 34

35. Systems

36. System Culture Values participation promotion protection provision Purpose health equity safe sustainable Lifestyles Determinants Values Purpose 1 1 2 6 Hazards Assets Leadership 5 3 Learning 4 Leadership integrity accountability transparency inclusivity Promotion Protection Learning measures feedback innovation improvement

37. Application planning and commissioning

38. Surgical Serous otitis media Medical Condition Promotion Screening Child Psychiatric Needs Family Social Outcomes Health Equity Sustainable Protection Concern Child Family Community Health Equity Sustainable Community Educational Behavioural

39. Planning otitis media services Commissioner Prevention Recognition Assessment Interventions Outcomes NHS England Breast feeding promotion in primary care Recognition of hearing impairment in primary care Br feeding rates @6/52 CCG Paediatric audiology assessment Hearing aids SaLT Parent support Access Timeliness LA Teachers for the deaf Hearing loops Language dev Educational achievement PH Smoking cessation Healthy Child Programme Rates of smoking in pregnancy. HCP uptake

40. Application - provision

41. Generic framework for providers

42. Initial pathway Transition pathway Review pathway Needs Child Family Community Outcomes Effectiveness Efficiency Equity

43. Applicationregulation

44. Inspectors for Safeguarding • Chief Inspector of Social Services • Director for Health Improvement, • Care Quality Commission • Her Majesty's Chief Inspector of Constabulary • Her Majesty's Chief Inspector of the Crown Prosecution Service • Her Majesty's Chief Inspector of the Magistrates' Courts Service • Her Majesty's Chief Inspector of Schools • Her Majesty's Chief Inspector of Prisons • Her Majesty's Chief Inspector of Probation

45. Informatics for improvement

46. A myriad of measures!!! Environment Acceptability Determinants Child Family Efficiency Equity Outputs outcomes needs Harm Affordability Accessibility Exposure Components Community Effectiveness Structure Process 46

47. Measures • Matter • Meaningful • Motivating • Monitor change

48. Service measures simplified Lifestyles + Determinants needs outputs outcomes impacts expectations effect benefit value

49. Life course and service pathway measures Health service measures Needs Service outcomes measures Health measures Public health service measures Service impact measures Health impact measures Life course outcomes measures

50. Benefits