Liz Morgan – Professional Advisor Children, Young People & Families Department of Health

1. Future Health Policy related to Children and Young People – The Contribution of Children’s Nursing Liz Morgan – Professional Advisor Children, Young People & Families Department of Health 13th November 2008

2. Improving health and well-being We value people We care about people and put their health and well-being at the heart of everything we do Setting direction and priorities Supporting delivery Leading health and well-being for Government Accounting to Parliament and the public Supporting DH staff to succeed We value purpose We focus our actions and decisions on achieving shared goals WHAT WE DO Better health& well-being Bettercare Better value WHY WE ARE HERE WHAT WE VALUE We value working together We work together as one department and with our partners and stakeholders FORALL We value accountability We take responsibility and are open to challenge Working with the NHS, social care and partners Working with Ministers

3. Setting Direction • … Strategy • Policy • Legislation and Regulation Setting Direction… • …Allocating Resources • NHS Operating Framework • Local Area Agreements Supporting Delivery… • … Performance monitoring and evaluation • Managerial and Professional Leadership for external groups • Building Capacity and capability • Ensuring value for money Purpose, Role and Values

4. Leading Health and Well-Being • Wider public sector; third and private sector organisations eg health protection, lifestyle choices, integrating health and well-being cross-Government • International partners eg EU; WHO; OECD Accounting to Parliament and the Public • Supporting Ministers • Answering Parliamentary Questions • Responding to enquiries from the public and MP’s • Communicating to the public – media, visits, speeches, stakeholder events Purpose, Role and Values

5. Children, Families & Maternity: Mapping to DH Strategic Objectives BETTER HEALTH & WELLBEING FOR ALL BETTER CARE FOR ALL BETTER VALUE FOR ALL Providing top quality public & parliamentary accountability for CF&M Health Policy Improving access to appropriate care for CF&M Improving CF&M’s experience of care Improving safety & quality of care for CF&M Providing continuity of Care across integrated care pathways Supporting the NHS and partners in the development of World Class Commissioning for CF&M services through provision of modelling and other tools; improved data and evidence Reducing inequalities in health outcomes for CF&M Delivering Top Quality partnerships & engagement with stakeholders

6. So…… The Challenges of Policy – Making for Children & Young People

7. The NHS Next Stage review: High Quality for All (DARZI) • Working with NHS staff to ensure that clinical decision-making is at the heart of the future of the NHS and the pattern of service delivery • Improving patient care, including high-quality, joined-up services for those suffering long-term or life-threatening conditions, and ensuring patients are treated with dignity in safe, clean environments • Delivering more accessible and more convenient care integrated across primary and secondary providers, reflecting best value for money and offering services in the most appropriate settings for patients

8. Defining Quality (NSR) Three elements: • Patient Safety • Effectiveness of Care • Patient Experience

9. Principles of Change • Co-production – working together • Subsidiarity – decisions made as close to patients & the community as possible • Clinical Leadership • System alignment – same goals

10. Key Policy Messages translated to Children & Families • Listening to the child & family • Developing services around the family • Care closer to home/at home • Integration of the workforce • Partnership working – across health, education & social care

11. The Children’s Plan: Building brighter futures Children’s Plan sets out the vision for children & young people, and trailed development of a Child Health Strategy. Government’s 2020 ambition for all children and young people is to: • Secure the wellbeing and health of children and young people; • Safeguard the young and vulnerable; • Achieve world class standards in education; and • Close the gap in educational achievement for children from disadvantaged families • Ensure young people are participating and achieving their potential to 18 and beyond • Keep children an young people of the path to success.

12. Joint DH/DCSF Child health Strategy - development Purpose of the Strategy: • Reinforce and capitalise on the existing vision and policy for child health • Profile and maximise impact of current commitments and activity over the current CSR period • Identify additional work required to underpin delivery of the long term vision set out in the Children’s Plan, NSF and Every Child Matters • Engage parents and families in the long term challenges and aspirations while focussing on mechanisms for delivery

13. All Ill Vulnerable The Child Health Strategy must respond to the specific challenges faced by vulnerable groups and ill children, as well as promoting healthy behaviour by all children and young people • We need to ensure services are sufficiently: • Integrated • Personalised • Preventative • Targeted • We are struggling to meet many of today’s biggest public health challenges and there are worrying trends. • Health promotion is critical. • Children with long term conditions or disabilities do not get the support needed to fulfill their potential. • Key issues around access to specialists and age-appropriateness of settings where treatment is received. • We do not consistently undertake risk assessments and target support. • Groups suffer disproportionately poor health outcomes • Miss opportunities to intervene early

14. Child Health Strategy – development contd. Key Challenges to address: • Unwanted variability in outcomes and effectiveness of services • Poor co-ordination of services – a barrier to personalisation and a shift to prevention • Nature of public health challenges

15. Child Health Strategy – development contd. Emerging themes: • Health promotion and prevention (eg informing families and supporting healthy lifestyles) • Early intervention • Personalised and integrated services (accessible and designed around the needs of users) • Effective, targeted access to specialist services

16. What are the Current Priorities of Policy Colleagues • Delivering Maternity Matters and CHPP in appropriate settings • Supporting the Neonatal Taskforce • Supporting School Health Services • Delivering Care for sick children and young people (Acute care, care closer to home, long term conditions) • Need for more health staff (including nurses) working with other members of the wider children’s workforce in the community and in school settings • Need for common core training for those working with children and young people early in their training • Need to keep a focus on the sick child and workforce issues for acute services (including doctors) and complex care • Need for Skills for Health to expand to include more on children and young people

17. Current Children’s Workforce Issues • Darzi Next Stage review including review maternity, the new born and children’s services as well as the review of workforce planning - ‘High Quality for All’ • Primary Care Strategy • Inequalities Agenda • DSCF long term Workforce strategy to support 10 year Children’s Plan • PCT & LA Joint Needs Assessments – joint commissioning and workforce planning • SHA role • National Neonatal Taskforce (including workforce sub-group) • Maternity – current and future services, access to help and advice within 12 weeks of pregnancy • Adolescent health

18. Nursing Workforce Priorities • Health visiting • School nursing • Neonatal nursing and paediatric medicine • Community Children’s Nursing • Speech and Language Therapy

19. Making it Happen……

20. Child Health and Wellbeing is a priority for the Government – this is reflected in the NHS Operating Framework and related Vital Signs and NIS indicators • NHS Operating Framework • Children and maternity services are identified as part of the national priority areas for 2008-09 • Supporting this 5 of the 12 PSA indicators focus on child health, & 4 are reflected in the Vital Signs indicators for PCTs • 3 of these PSA indicators – breast-feeding at 6-8 weeks, obesity among primary aged children, and CAMHS – are national priorities for local delivery i.e. all PCTs required to include in local plans • There is also a PSA priority on services for disabled people & therefore includes CYP – PCTs working with communities and local partners prioritise for themselves

21. 2008/09 Operating Framework • ‘five key Areas where PCTs are expected (working with local partners) to pay particular attention: • Improving cleanliness and reducing HCAI’s • Improving access through the 18 week referral pledge & access to GP services • Keeping adults & children well, improving health and reducing health inequalities • Improving patient experience, staff satisfaction and engagement • Preparing to respond in a state of emergency, such as an outbreak of pandemic flu’

22. Commissioning is the Key • World Class Commissioning • Transforming Community Services • Outcomes focussed • Data & evidence

24. Red Relationships • Absolute dependency, requiring co-location • Oncology (including haematological oncology) Red relationships • Clinical haematology • Specialised surgery* • Paediatric critical care* • Paediatric anaesthesia* • * relates to the “core” services, required by 16 of the 23 services in the grid. • Changes agreed at the last Steering Group: differentiate neuro oncology which has a red relationship with neurosurgery, from neurology which has an amber 3* relationship with neuro surgery.

25. Amber relationships Amber 1: Planned intervention Timescale – as required Amber 2: Visit by a consultant specialist, or transfer of care Timescale – next working day Amber 3: An integrated clinical service Visit by consultant paediatric specialist / transfer of care Timescale – available within 4 hours Co-location desirable but may not be practical in all configurations

26. More Amber • Amber 3* co-location is essential to provide a full specialised service, but a decision not to co-locate may be made to ensure optimum access to service centres. If an Amber 3* relationship is not co-located the medical specialty would not be able to provide a full specialised service and a very close clinical network with the relevant surgical specialty would be essential.

27. Contribution of Nursing…

28. Nursing Related Policy Modernising Nursing Careers: • Review of pre-registration education • Post-registration Careers Framework • Nurses in Society • Assistant Practitioner • Nursing Metrics

31. Thank you Questions? liz.morgan@dh.gov.gsi.uk