Paediatric Quality Indicators Workshop Introduction to developing and commissioning pathways

1. Paediatric Quality Indicators Workshop Introduction to developing and commissioning pathways Simon Lenton, Children’s & Young Peoples Outcome Forum

2. CYP HOF Scope • Identify the health outcomes that matter most for children and young people. • Consider how well these are supported by the NHS and public health outcomes frameworks • Set out how different parts of the health system – DH, NHSCB, PHE, HEE and others will contribute to delivery of these outcomes, and how they will work with each other and with other partners to this end.

3. Systems thinking A health system has been defined as “all organisations, people and actions whose primary intent is to promote, restore or maintain health.” Its purpose is to “improve health and health equity in ways that are responsive, financially fair and make the best use of available resources”. (WHO)

4. Integrated care – a culture "integrated care demands a culture of its own, one that spans differing organisational and professional mindsets, eliminates boundaries and biases. It shares a common space to facilitate a much needed interagency collaboration and interdisciplinary teamwork on behalf of the patient" (Kodner 2009) Ref: BACCH – “the meaning of integration”

5. Right interventions Right children Right professionals Right place Right time Right support Right cost What do we all want? Safety, good experience, great outcomes “All in place and working well together”

6. Partnerships - key criteria • a collaborative relationship among multiple organisations in which risks and benefits are shared in pursuit of a shared goal. plus shared • values – principles – practice plus • leadership to create synergy and alignment

7. Commissioning “the process of allocating public resources to achieve the greatest gains in health within a defined population”. Truly effective commissioning requires strong collaboration between commissioners, providers and regulators, with integration of functions whenever possible

8. Start here Not Here With thanks to Charlie Keeney

9. What is the CFHC approach? • Distil the Conventions into simple concepts • Easily understandable framework for change • Transcend the concept and language issues • Adopted and adapted by health care systems • The new model must create alignment • at a high level between politicians • planners and financiers, between agencies • between patients, clinicians and managers • Drive learning and improvement CFHC = Child Friendly Health Care

10. Development of the CFHC approach Human rights Children’s rights Principles CFHC approach Needs Outcomes Services

11. Principles for children’s services • Participation • Promotion • Protection • Prevention • Provision • pathways

12. Promotion and protection a new framework Health and illness What creates illness? What creates health? SALUTOGENIC APPROACH - Individual - Family - Community - Society PROMOTION • PATHOGENIC APPROACH • - Individual • - Family • - Community • - Society • PROTECTION Slide: adapted from Fabrizio Simonelli

13. Promotion Healthy eating Screening 20 disability Competent staff Prevention Primary Secondary Tertiary Quaternary • Protection • Fluoridisation • Domestic violence • Poverty • Drug errors

14. Alignment and synergy health harming lifestyles health promoting lifestyles lifestyle interventions needs services outcomes health harming determinants health promoting determinants community interventions Society

15. Provision based on pathwaysPurpose, values, evidence and learning. p r a i needs outcomes

16. Short term condition pathway Surgical Condition Medical Promotion Screening Child Psychiatric Recognition Assessment Interventions Prevention Outcomes Health Equity Sustainable Protection Concern Family Social Needs Child Family Community Community Educational Behavioural

17. Pathway componentsPurpose, values, evidence and learning. Principles Purpose participation prevention provision health equity sustainable p r a i needs outcomes

18. Pathway componentsPurpose, values, evidence and learning. Values/rights Purpose participation prevention provision health equity sustainable p r a i needs outcomes measures feedback improvement quantitative qualitative econometric Learning Learning Evidence

19. Long term condition Environment Transition pathway Initial pathway Review pathway Needs Condition Family Community Outcomes Effectiveness Efficiency Equity Network of services Initial, review and transition pathways

20. Myriad of measures!!! Environment Acceptability Determinants Child Family Efficiency Equity Outputs outcomes c c c c c needs Harm Affordability Accessibility Exposure Components Community Effectiveness c = component Structure Process

21. Health service measures Health service outcome measures Health measures Public service measures Health service impact measures Life course outcome measures Health impact measures Key measures Determinants and lifestyle measures

22. Commissioners NHS CB Workforce Research Innovation ??? CCG Whole pathway Needs Outcomes Academies Personal budgets Health insurance ‘CJS’ LA PH

23. Commissioning pathway components p r a i outcomes needs

24. Commissioning – what should it look like in the future? • a shift from contracting services towards commissioning programmes of care • supported by a series of measures that reflect quality and can identify the weakest link in the pathway • commissioning for quality improvement being integral to the contracting process • a pooled commissioning budget and the capacity to vire resources within a network. • network collaboration by different service providers whether NHS Trusts/social enterprise/private sectors • a reduction in the number of commissioners involved or integrated working of the commissioners involved.

25. Thank you

26. Bringing outcomes together Life course pathway Life course pathway Life course pathway Service pathways Public health outcomes Sustainable Health service outcomes Review cycle Review cycle Equity Social impact Environmental impact Health impact Health outcomes Health outcomes

27. Quality Compass Efficacy Effectiveness Efficiency Equity Acceptable Accessible Affordable Appropriate Safety, experience and outcomes Quality, innovation, prevention, productivity

29. Managed networks • “Linked groups of health professionals from primary, secondary and tertiary care, working in a co-ordinated manner, unconstrained by existing professional and Trust/Health Authority boundaries, to ensure equitable provision of high quality and clinically effective services.” A later definition describes the function of managed networks is being • "a group of organisations, services and professionals working collaboratively to continually improve the services they provide through a process of learning from innovation and quality improvement".

30. CYP HOF Purpose The strategy will aim to maximise health outcomes for all children and young people, showing how all parts of the health system, with partners, will contribute to enabling every child and young person to reach their full potential

31. Providers NHS Social Enterprise ‘Public health’ Network Needs Outcomes LA Private ‘CJS’

32. Regulators Quality Economic Network Needs Outcomes Professional Organisational

33. Implications of integrated pathway based networks (1) • Combined commissioning strategies across health, education, social care and criminal justice systems. • Provider organisations sharing the same knowledge base and approach to implementation of evidence- based guidelines. • Shared governance systems across organisations. • A shared approach to measurement and improvement • Financing systems where resources follow patients through pathways and networks - introduction of program budgeting.

34. Implications of integrated pathway based networks (2) 6. Workforce planning based on the right skill mix to ensure competent teams working in networks. 7. Integrating public health approaches to prevention across all pathways. 8. Greater emphasis on both equity of access and outcomes. 9. Combining regulation to ensure effectiveness, efficiency and equity bringing together quality and economic regulators and a greater emphasis on equity