RCPCH Safe and sustainable integrated health services Partners in Paediatrics Wolverhampton 9 th July 2009

1. RCPCHSafe and sustainable integrated health servicesPartners in Paediatrics Wolverhampton 9th July 2009 Simon Lenton

2. Overview • MtF I + MtF II = MtF III Key messages (10) • Application to current services (15) • Actions needed for success (15) Discussion (30)

3. MtF I + MtF II = MtF III Key messages

4. Problems • Changing epidemiology • Fragmented services • EWTD workforce MtF I MtF II MtF III Future Present Actions

5. Problems • Changing epidemiology • Fragmented services • EWTD MtF I MtF II Solutions 1. System design 2. Quality improvement 3. Workforce/reconfiguration MtF III Future Present Actions

6. Problems 1. Not enough trainees 2. Too many rotas 3. T/C imbalance MtF I MtF II MtF III Future Present Actions

7. Problems 1. Not enough trainees 2. Too many rotas 3. T/C imbalance MtF I MtF II Solutions 1. Fewer inpatient units 2. Consultant expansion 3. Trainee contraction/skillmix MtF III Future Present Actions

8. Problems 1. Not enough trainees 2. Too many rotas 3. T/C imbalance • Problems • Changing epidemiology • Fragmented services • EWTD MtF I MtF II Solutions 1. System design 2. Quality improvement 3. Workforce/reconfiguration Solutions 1. Fewer inpatient units 2. Consultant expansion 3. Trainee contraction/skillmix MtF III Future Present Actions

9. Application to current services

10. Recent policy • NHS Review • Public Service Agreements • Operating frameworks • Child Health Strategy • Transforming Communities Services • World-class commissioning • Quality accounts, QIPP quality, innovation, productivity and prevention

11. Providers NEEDS Health Community Private sector Local Authority Criminal justice system ACTIONS Policy makers Commissioners OUTCOMES Regulators

12. NEEDS prevention identification assessment interventions Health Community Private sector Local Authority Criminal justice system MtF III • Systems • pathways • networks OUTCOMES

13. NEEDS prevention identification assessment interventions Health Community Private sector Local Authority Criminal justice system MtF III • Systems • pathways • networks 2. Workforce skill-mix sustainability teams Teams OUTCOMES

14. Health Community Private sector Local Authority Criminal justice system NEEDS MtF III prevention • Systems • pathways • networks identification assessment 2. Workforce skill-mix sustainability interventions teams Teams measures 3. Quality improvement measures methods OUTCOMES standards improvement learning

15. Relationship between acute and long-term pathways interventions interventions ACUTE Prevention assessment LONG-TERM assessment identification identification

16. Application to current services

17. Public health • Health promotion • poverty/inequalities • environment • Health protection • exposure to hazards • injury prevention • Health education • family nurse partnership programme • evidence based, evaluated

18. Acute services • Urgent and emergency care pathways • 8 till late – reduce inpatient rotas • commissioning • Workforce • first contact practitioner training • medical-nursing skill-mix and sustainability • Improvement • short-stay paediatric assessment units • transport

19. Neonatal services • Neonatal networks • right capacity, right place • shared protocols, training, staff • Workforce • neonatal resuscitation • skill-mix – medical and nursing staff • Improvement • transport systems • commissioning

20. Specialist services • Specialist networks • co-location of interdependent specialist services • commissioning – what and where • Workforce • medical and nursing skill-mix • expert patient programmes • Improvement • telemedicine • outreach support

21. Long-term condition services • Alignment • clarity of responsibilities between health education and social care • commissioning arrangements • Workforce • children’s community teams • skill-mix • Improvement • transitions • funding arrangements

22. Vulnerable children’s services • Systems alignment • pathway based thinking • commissioning/regulation • Workforce • capacity • competence • Improvement • NHS network • access to psychological interventions

23. Children’s mental health services • Systems • roles, responsibilities and boundaries • commissioning • Workforce • capacity and competence • schools based • Improvement • prevention • transition

24. Actions needed for success “Coming together is a beginning; keeping together is progress; working together is success”.

25. Future Present Actions Systems alignment Workforce sustainability Quality improvement • Local • Commissioners • Providers • Families • Regional • RGO • SHA - planning • SHA - workforce • National • Government • Professional orgs. • Regulators

26. National • Government • A. Between government departments • W. Sustainable medical workforce • Q. Roles and relationships of regulators/improvement organisations • Professional organisations • A. Shared policy/strategy • W. Agreed skill-mix • Q. Shared approach to improvement • Regulators • A. Shared approach and methodologies • W. Capacity • Q. Greater emphasis on improvement

27. Regional • Regional Government Office (RGO) • A. Sustainable development agenda • W. Economic regeneration • Q. Health promotion programmes • SHA – planning • A. Leadership NHS Review implementation groups • W. Clear service delivery model • Q. Organisational performance management for improvement • SHA – workforce • A. Medical, nursing, allied health professional, • W. Commissioning training programmes • Q. Quality improvement leadership

28. Local • Commissioners • Adopt pathway/network approaches across different agencies • Work with SHA is on local workforce plans • Commission for improvement • Providers • Alignment of teams to pathways, shared protocols/training etc • Ensure competence within teams at all times • Reward improvement – individuals, teams, departments • Families • Involved in service design • Invest in health, expert patient programmes • Participating in quality improvement

29. Conclusions • A challenging agenda and then 2011! • Systems alignment and reconfiguration • Workforce capacity • Continuous quality improvement

30. Thank you Simon.Lenton@banes-pct.nhs.uk

31. Discussion

32. Standards framework

33. Life course epidemiology Quality of life (QoL) QoL gap QALY gap Years gap Years of life Birth Prenatal Mat education Stable relation Antenatal care Adult Social capital Employment Lifestyle Infant Genetics Nutrition Safe home Child Parenting Education Health prom Young person Peer group Marketing Higher education Determinants of health and well-being and their impact on quality and length of life at different stages in childhood

34. Primary criteria The proposed consultant expansion must: • Improve service quality • Patient safety • Clinical effectiveness • Patient experience • Contribute to sustainable solutions to the European Working Time Directive • Trainee hours • Work-life balance • Job satisfaction • Improve quality of training • Service-training balance • Access to formal and informal training opportunities

35. Secondary criteria The proposed consultant expansion must also: • Provide a solution that strengthens networks • Creates leadership • Enables outreach or rotations • Spreads good practice • Consider the skill mix/competence within teams • Between members of the medical team • Within the health team • Within the multiagency team • Enable appropriate reconfiguration • Within units • Between services • Across units, sometimes across regions