Caring for Children Closer To Home Early Help Health Matters Conference 19 June 2014 Workshop

1. Caring for Children Closer To HomeEarly Help Health Matters Conference19 June 2014Workshop Fiona West, Commissioner for Children, Young People and Maternity Maria Wogan, Commissioning Programme Manager Please contact Maria Wogan if you have any queries about the information in this pack. Tel: 01908 278721 email: maria.wogan@miltonkeynes.nhs.uk

2. Agenda • Background to the project • Feedback from MK parents and carers • What the data is telling us about MK • Examples of good practice • Workshop activity • Summary and project next steps

3. Caring for Children Closer to Home Project - Background Outcome: More children are cared for closer to home when they are unwell. Supporting objectives: • Develop health information and education provision for parents and carers to support self-care and the appropriate use of services. • Reduce avoidable A&E presentations and avoidable emergency admissions at MKHFT. • Build up paediatric expertise in MK to enable care to be provided closer to home • Implement high impact paediatric care pathways to enable safe and effective care for children to be provided closer to home. • Agree a specification for MKHFT’s community paediatric nursing team • Evaluate the impact of the project and continuously improve on the basis of evidence • Establish an on-going effective mechanism for joint-working between commissioners and providers to provide the best possible care for children and young people in MK.

4. The approach to engagement with parents/carers • Qualitative research approach with some quantitative data from two questionnaires • Visited seven children’s centres across MK • Focus groups and one to ones using a scenario to test parent decision-making and experience and share ideas for improvement • Majority of participants were women • Ethnic origin of the participants: White British, Chinese, Eastern European, Western European, Asian, North African and South American.

5. Geographical spread of the engagement = Children’s centre

6. Summary of feedback from parents • Good awareness of the need to avoid inappropriate use of A&E – but not always reflected by parents’ decisions about where to take their child • Awareness and understanding of the role of NHS Choices, 111, health visitors and pharmacies could be improved • Lack of access to GP appointments and lack of confidence in some GPs is driving activity to MKUCS and (less so) to A&E. In some areas serious difficulties getting calls through to GP reception. • Some parents are going to A&E if they think there is a long wait at MKUCS • Parents want their concerns about their child to be listened to and if they take their child to a clinician they want the clinician to look at/examine their child • Parents want to increase their knowledge of and confidence in caring for their children when they are ill

7. Feedback from Parents – Variation between areas

8. Feedback from Parents – ideas for improvement • Focus on first time parents • Listen to parents’ concerns • Dedicated children’s telephone line at GP surgeries, increase GP appointments • Walk-in-Centrefor children • Extend health visitor access and promote health visiting • Improve access to mental health support for parents and children • Use children’s centres as a base for training and support • Minorillness and service informationin red book &useful number card • Improve facilities for children in MKUCS and GP surgeries • Promote 111 • Give clear advice on going to MKUCS & A&E & reduce waitingtimes

9. A&E questionnaire conclusions • The majority of children whose parents completed the survey had attended A&E because of trauma (physical injury) (76%) • The largest reason given by parents (29%) for attending A&E was because they believed their child needed an x-ray. 50% of children presenting to A&E in 2013/14 as ‘minors’ received x-rays. • The majority of parents (44%) had not sought any advice before attending A&E. This appeared to be because they believed their child needed an x-ray / specialist advice, only available at A&E. • The majority of children had been unwell for less than 4 hours • 6 out of 154 reasons given for attending A&E was because parents could not get a GP appointment

10. Data analysis Paediatric Assessment Unit (PAU) at MK Hospital

11. Data analysis PAU

12. Examples of Good Practice • Sunshine Children’s Centre – first aid training for parents of 0-1 year olds & 1-5 year olds • Bedfordshire – training and education for parents via health visitor training pilot • Luton – rapid response children’s community nursing team & high impact pathways • St Mary’s, London – Child Health GP hub – closer working between acute & primary care • Nottinghamshire– health visiting helpline promoted by children’s centres • Liverpool – Children’s Walk-in-Centre • Doncaster – quicker access to GP advice and appointments for children • Sunderland – health information sessions to deliver in schools as part of PHSE • Newcastle – school assemblies about local GP services • North Hertfordshire – 4US clinics delivered in schools

13. Workshop • Group discussion – do you have anything to add to the feedback based on your experience? • In pairs – what could you/ your service do to contribute to this project? • Put name/type of service and each idea on a post-it note • Stick it on the target – most powerful ideas nearest the bulls eye! • In two groups – draw a picture to represent the project’s desired outcome of more children being cared for closer to home? • What does success look like? • What should we be aiming for? • How can we get there? • Be creative!

14. Caring for Children Closer to Home Project - Next Steps

15. Thank you • Please sign up if you would like to be involved with this project