What does it mean for Service Delivery? Alf Nicholson. Institute, Public, Health, Ireland, North, Northern, South, Southern, Dublin, Belfast, Wood, Quay, Longstanding, Conditions, Children, Three, Year, Old, Illness, Asthma, Symptoms, Eczema, Skin, Allergy, Inequalities, Cooperation, Sight, Hearing, Problem, National, Prevalence

1. Professor
Alf
Nicholson
Presentation
6th
October
re
Model
of
Care
Building
a
clinical
network
for
paediatrics
in
Ireland

2. Has
anything
really
changed?

3. Background
䡧 changes
in
disease
priorities
for
child
health
▪ improved
standards
of
living
▪ many
‘killer’
diseases
have
disappeared
▪ chronic
and
complex
disabilities
more
prevalent
▪ emotional
and
behavioural
problems
affect
10
–
20%
䡧 changes
in
parental
expectation
▪ loss
of
confidence
in
primary
care
provision
▪ faster
access
to
specialist
care
▪ ‘informed’
client
group
䡧 changes
in
healthcare
provision
▪ reorganisation
of
infrastructure

4. Longstanding
health
conditions
in
3
yo’s
䡧Population
prevalence
estimates
by
IPH
䡧Health
inequalities
are
evident
at
an
early
age
䡧Boys
>
girls
䡧Parental
smoking
is
important

5. A
succesful
and
sustainable
health
system
–
how
to
get
there
from
here
Fineberg
NEJM
2012
;366:11:1020-­‐1027
䡧Redouble
efforts
to
enhance
the
quality
and
safety
of
health
care
䡧Keep
patients
out
of
hospital
䡧Find
out
what
families
want
and
honour
it
䡧Smooth
patient
flow
through
the
system
䡧Learn
from
peers
and
the
evidence
䡧Value
accountability
above
autonomy
䡧Adopt
many
strategies
to
reach
one
big
goal

6. Stake-holder dialogue

7. Guiding
principles
for
a
national
model
of
care

8. Smooth
patient
flow
through
the
system
䡧Senior
decision
maker
availability
䡧Paediatric
assessment
units
䡧Rapid
response
clinics
䡧Strengthen
role
of
ANP’s
,
CNS’s
and
AHP’s
䡧OPD
referrals
from
primary
care
to
general
paediatrics
in
the
first
instance
䡧 Improve
radiology
access
䡧Nurse-­‐led
discharge
from
time
of
admission

9. Keep
children
healthy
䡧Promotion
of
breast
feeding
䡧 Immunisation
uptake
>
95%
䡧Healthy
eating
+
exercise
䡧Screening
(IEM’s
,
CF
,
pulse
oximetry
,
Universal
hearing
screening
+
DDH
screening)

10. First
contact
care
䡧 Improve
primary/secondary
interface
䡧GP
training
in
paediatrics
(at
least
6
months)
䡧Maternal
and
child
health
nurses
䡧Web-­‐based
parental
education
䡧GP
algorithms
in
app
format
for
common
paediatric
conditions

11. Strengthen
regional
+
local
care
via
integrated
networks
䡧Agreed
national
guidelines
implemented
across
the
system
䡧Regional
centres
with
paediatric
radiology
,
non-­‐specialist
surgery
,
paediatric
pathology
and
paediatricians
with
a
special
interest
䡧Outreach
from
tertiary
and
regional
centres

12. Listen
to
children
and
families
䡧National
Charter
for
children
and
young
people
䡧Meaningful
involvement
in
planning
of
future
healthcare
䡧Hospital
in
the
Home
concept

13. Quality
improvement
䡧Local
leadership
+
commitment
to
QI
and
data
collection
䡧National
PEWS
with
education
of
staff
䡧Quality
indicators
in
Paediatrics
䡧Adverse
event
reporting
with
shared
learning

14. Pivotal
role
of
general
paediatrics
䡧Acute
unscheduled
care
䡧Rapid
response
clinics
+
hotlines
for
GP’s
䡧Holistic
care
of
children
with
complex
problems
䡧Scheduled
care
for
a
broad
range
of
conditions
䡧Areas
of
special
interest

15. Retrieval
services
䡧24/7
neonatal
transport
a
great
success
䡧PETS
an
urgent
priority
䡧Transfers
and
retro-­‐transfers
䡧Additional
intensivists
required

16. A
future
workforce

17. Vulnerable
and
disadvantaged
groups
䡧Community
supports
(eg
Triple
P
Parenting
Programme)
䡧Higher
mortality
from
injuries
and
higher
emergency
department
attendances

18. Child
protection
䡧A
responsibility
for
all
who
look
after
children
䡧Child
sexual
assault
services
䡧National
guidelines

19. Learn
from
international
experience
䡧Look
to
the
Swedish
model
䡧Close
links
between
primary
and
secondary
care
with
co-­‐location
with
paediatricians
and
community
nurses
in
health
centres
䡧Significant
nursing
role

20. Plan
for
the
future
䡧 Telemedicine
and
smart
phone
technology
䡧 Changing
morbidity
with
ongoing
allergic
disease
surge
in
incidence
䡧 Increased
mental
health
and
psychosomatic
illness
䡧 Improved
survival
of
extremely
preterm
infants
,
complex
heart
disease
,
childhood
cancer
and
chronic
renal
disease