Priorities for Children & Young People’s Health & Wellbeing in Cumbria Dr Neela Shabde

1. Priorities for Children & Young People’s Health & Wellbeing in Cumbria Dr Neela Shabde Clinical Director – Children Cumbria CCG Cumbria Youth Alliance Planning conference 14th May 2014

2. Presentation will cover : Vision for Children & Young People The Pledge Commissioning arrangements in the new NHS Strategic Priorities for Children & Young People Partnership working Summary Tital

3. Vision Children and families of Cumbria should expect support to be healthy by having :- • Fair access to a range of support and services to ensure a healthy future, provide early intervention & when required have ready access to safe, sustainable high quality health services that are designed around their needs to achieve best possible outcomes. • Integrated services delivered as close to home as possible, provided by a team of healthcare professionals working together in partnership with children, their families and other agencies. Strategy V16

4. The Pledge In response to the report of The Children and Young People’s health Outcomes forum this pledge has been made and will be used to underpin all that we do across the health organisations in Cumbria. • Children, young people and their families will be at the heart of decision-making, with the health outcomes that matter most to them taking priority. • Services, from pregnancy through to adolescence and beyond, will be high quality, evidence based and safe, delivered at the right time, in the right place, by a properly planned, educated and trained workforce. • Good mental and physical health and early interventions, including for children and young people with long term conditions, will be of equal importance to caring for those who become acutely unwell. • Services will be integrated and care will be coordinated around the individual, with an optimal experience of transition to adult services for those young people who require ongoing health and care in adult life. • There will be clear leadership, accountability and assurance and organisations will work in partnership for the benefit of children and young people. (Better health Outcomes for Children and Young People, The pledge) Final version

5. Commissioning arrangements in the New NHS

9. Department of Health NHS England Public Health England NHS North Area Team Cumbria Clinical Commissioning Group Cumbria County Council Children’s Services Adult & Local Services Director of Public Health Health Services Commissioning Structure

10. PHE CCG AT CCC Health Visiting Family Nurse partnership HCP 0-5 Community Paediatrics Therapies Community Nursing CAMHS School Nursing HCP 5-19 Imms & Vacs Screening CPFT Commissioning community health services

11. Cumbria Clinical Commissioning Group North of England Commissioning Support Unit Allerdale Copeland Carlisle Eden Furness S Lakes Clinical Commissioning Group

12. National & International context Our work in Cumbria is set against the national context. In England; • all-cause mortality rate for children aged 0 – 14 years has moved from average to amongst the worst in Europe • 26% of children’s deaths showed ‘identifiable failure in the child’s direct care’ • more than 8 out of 10 adults who have ever smoked regularly started before 19 • more than 30% of 2 to 15 year olds are overweight or obese • half of life time mental illness starts by the age of 14 • nearly half of LAC have a mental health disorder & two thirds have at least one physical health complaint • about 75% of hospital admissions of children with asthma could have been prevented in primary care Strategy V16

13. Why do things need to change • Prevention, early intervention & high quality consistent services in childhood are crucial to child’s experience & set pattern for adulthood. • The way we live is constantly changing, resulting in a range of complex effects on health & wellbeing of children & their families -results in increasing pressures on healthcare e.g. increasing obesity & impact of social media on emotional wellbeing. . Strategy V16

14. Drivers for change • Health Needs • Outlier -young people and alcohol, mental health, emergency admissions for asthma and admissions for bronchiolitis for children under 2 • Higher rates of mortality in areas of significant economic & social deprivation • Quality & safety of services • CQC / Ofsted inspection 2011/2012 • Engagement • the three providers – this will enable both commissioning and provision of services to develop with the patient voice at the heart. • Health economy to develop a pathway approach to patient feedback across Tital Strategy V16

15. Drivers for change Rurality & Accessibility • More than half the population living outside a town or city. • Easy access to services based in local communities . • At times when very specialist help will warrant further travel to specialist centres. • Opportunities that tele- health can bring. Deprivation very different levels of income affecting health outcomes of people living in different communities. • improve the health outcomes of the poorest so that they get closer to those of the best off. Strategy V16

16. Drivers for change • Financial challenge & affordability- health economy limited amount of money • Commissioning environment- new arrangements hence multiple commissioners • Need for strategic whole system change- South of county : Better care together • Current model of provision: acute care model , unit size / national standards • Tertiary services- fewer more specialised centres commissioned

17. Drivers for change • Community services- under developed ,lack of defined community model, multiple sites, new investment , new social & education care plans • Mental health services- whole systems approach including Tier 1 & 2 • Access to tier 4 beds problematic • Public Health agenda: prevention & early intervention- now led by Cumbria county council • Integrated approach – Health Builders

18. What are strategic priorities?

19. Priorities for CYP :- • Embedding the voice of the child and family in all we do • Appropriate services for teenagers across all sectors • Age appropriate settings across all sectors • Improve effective transition • Effective Information Communication Technology support Standardisequality across settings and days of week • Developing a fully integrated children’s team - integrating across all sectors, departments, disciplines – NO BARRIER approach • Share information to keep children safe Strategy V16

20. CYP Priorities (2) • Develop sexual assault services • Whole systems model for emotional wellbeing and mental health • Reduce hospital admissions • Implement Health Builders pathways - • ADHD, • Autism • Diabetes • Diarrhoea • Enhance Childrens Community Nursing Services • Continue to monitor outcomes for children looked after • Strengthen safeguarding culture and processes • Improve quality of care for CYP admitted to paediatric wards with mental health issues

21. What are high level objectives to deliver change? To develop whole system patient feedback across services for children and young people. To support children and young people to be healthy and safe by working with partners to strengthen prevention and early help. To standardise quality and provide better health outcomes providing more focussed and integrated services, including children with long term conditions and complex needs. To develop and implement services to reduce unnecessary hospital attendance and admission. Develop Comprehensive Emotional Wellbeing and Mental health services. Produce a workforce development plan that addresses the needs of the whole workforce. Develop ways to effectively monitor and support continuous improvement. Strategy V16

22. The healthy child – Public Health The provision of the Healthy Child Programme, including immunisation and screening Leadership for the delivery of both the Breastfeeding and Healthy Weight Strategy -within the Healthy Child Programme. Risk taking behaviour in children and young people remains everyone’s business but specific targeted services aimed at adolescents in the community. The Local Authority commissions 28 Children’s Centres from 3 organisations. The core offer -Child and Family Health &Wellbeing component that includes Ante Natal and Postnatal Support, Oral Health Improvement & Surveillance, Healthy Child Programme and other specialist support Strategy Delivery model v5

23. Children seen in Primary Care • All workforce ( GPs , Urgent Care, Out of hours) dealing with CYP – paediatric training • The NHS England Improving General Practice; A call to action phase 1 report (March 2014) identifies a number of actions particularly relevant to the provision of care to children and young people; Different ways of accessing services Person centred care for people with long term health conditions Pooling of clinical expertise, offering a greater range of generalist and more specialist services Local systems of extended primary care Strategy Delivery model v5

24. Children seen in Community Enhanced provision of children’s community nursing: • acute and short term conditions • long term conditions • disabilities and complex, including neonates • life-limiting and life-threatening illness, including those requiring palliative and end-of-life care Integrated Children’s Health Team: • Training & education • Outreach of consultant paediatricians into community settings,. • Pathways involving Health Visitors, School Nurses, and the Children’s Community • Integrated therapy support across hospital and community • Provision of care in settings that are age appropriate • Integrated care across providers Strategy Delivery model v5

25. Children with complex needs Children with complex needs will have their care planned in partnership with colleagues in the local authority. This will ensure that their educational, health and care needs are met in a co-ordinated way. Health professionals will provide training, advice and guidance to family and staff to enable them to become both competent and confident in meeting an appropriate level of the child’s health needs. On-going and Complex Care: Services for people ‘at risk ‘of/with on-going care needs whose needs are complex and require care and support on an on-going basis.  Principles: • Care should be delivered outside of hospital settings - safe, cost effective and provides improved patient experience • Specialist care at local or tertiary level • Services should be provided locally where possible • Services should only be provided in hospitals where necessary • Telephone or email advice and guidance for GPs • Other opportunities to increase interaction between primary care and paediatric Strategy Delivery model v5

26. Children - acutely unwell • Children will access the same unscheduled care services as adults, including GPs, GP Out-of-Hours Services, Urgent Care Centres, Minor Injury Services and A&E. • Paediatric consultant-led Short Stay Paediatric Assessment [SSPAs] • Community services will be supported by the increased presence of Consultant Paediatricians working in community settings. • Development of an integrated children’s nursing service • Integrated pathways for common conditions Strategy Delivery model v5

27. Children who need Emotional wellbeing and mental health services Emotional wellbeing and mental health of children and young people is everyones responsibility. Services will be provided locally – CYP will have a choice • The services offered will be described clearly so that everyone involved can understand them • Families will be included except when it is in the interest of the child not to do so • Expertise and good practice will be shared with all colleagues • Care will be co-ordinated with Partners • Care will be evidence based, have clear objectives and measurable outcomes • The voice of the child will always be heard • Transitions between services will be planned with support in place throughout • Risks will be understood and shared by partners • The additional needs of specific groups will be recognised and met. • Children on acute wards/ link to tier 4 services Strategy Delivery model v5

28. What would the model of delivery look like?

29. Integrated Children’s care in Cumbria Strategy Delivery model v5

30. Strategy Delivery model v5

31. Strategy Delivery model v5

32. The Child’s Journey Characteristics; • No barriers; a culture of ‘entitlement’ will underpin access to services. • Hearing the child’s voice; • Services will be provided in age appropriate settings. You’re Welcome standards will be applied throughout. • Communication with children, young people and their families • Services primarily aimed at meeting the physical needs will also include their emotional wellbeing • Services primarily aimed at meeting the emotional needs of the child will also include their physical wellbeing • All services will take full account of the long term benefits of prevention and early intervention • Transition; children receiving health services will experience a number of key transitions, for example between childhood and adulthood and between targeted and specialist services. Strategy V16

33. The Child’s Journey Amongst a number of other priorities DH response identified need for : four new outcome indicators for inclusion within the NHS Outcomes Framework: • time from first NHS presentation to diagnosis or start of treatment; • integrated care – developing a new composite measure; • effective transition from services for children and young people to those for adults; and • age-appropriate services – with particular reference to teenagers. Strategy V16

34. The Child’s Journey Issues identified by the Children and Young People’s Health Outcomes Forum : • understand that peer pressure and advertising can work against healthy choices; • need better information and advice about healthy lifestyles; • believe that too many public health campaigns are aimed at adults; • connect being healthy with ‘things to do’ in their area and access to public transport and sports facilities; • want involvement in design, development and evaluation of child friendly campaigns & services; • recognise and value role of school in encouraging healthy behaviour; & • recognise a place for social media. Strategy V16

35. Summary • Current NHS commissioning is clinically led • complex with multiple commissioners • Money is limited & need for stronger partnerships with health and social care • Innovative & integrated models of care to improve outcomes • Public health approach – prevention and early intervention

36. Thank you for your attention

37. Any Questions ? Neela.shabde@cumbriaccg.nhs.uk