Alf Nicholson, National Clinical lead in Pediatrics, RCPI

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Paediatric Lead Programme

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  • This graph outlines the changes in U5 mortality rates for a number of different countries worldwide, between 1990 and 2008.
    Mortality rates in children under 5yrs of age, are an important indicator of a country’s health status.
    The United nations Millenium development goal 4 aims for a two thirds reduction in U5 mortality GLOBALLY between 1990 and 2015.
    Although globally progress in reaching MDG4 is insufficient, Ireland and the rest of central and eastern Europe are on track.
    In Ireland there has been a consistent gradual reduction, the probability of death dropping from 10 per 1000 livebirths in 1990 to 7 in 2000 and 4.5 per 1000 in 2008. (ie from 1% to 0.7% to 0.05%)
    Overall, the U5MR for Ireland is slightly less than the EU average of 5, but greater than that observed in the scandinavian countries and Japan.
    The highest rates and the smallest reductions have been in the united states.
    Rates of decline are have generally been faster in high and middle income countries than in low-income countries.
  • Alf Nicholson, National Clinical lead in Pediatrics, RCPI

    1. 1. Professor Alf Nicholson April 2014 Paediatric Lead Programme – The first 2 years
    2. 2. What is it all about ? “If I had to reduce my message … to just a few words, I’d say it all had to do with reducing variation.” Dr. W. Edwards Deming
    3. 3. 1990 2000 International trends in under 5 mortality rates. 10 9 7 9 12 6 11 7 6 4 5 7 5 9 4.5 6 3 3 5 3 8 0 2 4 6 8 10 12 14 Ireland UK Sweden Norway EU average Japan USA Probabilityofdeathbeforeage5yrs,per1000livebirths Source: WHO Health statistics and the European HFA-DB 2008
    4. 4. The Clinical Leads on Tour
    5. 5. A succesful and sustainable health system – how to get there from here Fineberg NEJM 2012 ; 366:11:1020-1027  Redouble efforts to enhance the quality and safety of health care  Keep patients out of hospital  Find out what families want and honour it  Smooth patient flow through the system  Learn from peers and the evidence  Value accountability above autonomy  Adopt many strategies to reach one big goal
    6. 6. Background  changes in disease priorities for child health many ‘killer’ diseases have disappeared emotional and behavioural problems affect 10 – 20%  changes in parental expectation loss of confidence in primary care provision faster access to specialist care ‘informed’ client group  changes in healthcare provision reorganisation of infrastructure
    7. 7. Childhood cancer survival (Ireland) by deprivation category, 1994-2005 (Walsh PM et al Eur J Cancer 2011)
    8. 8. Childhood cancer survival to 5 years: Ireland (2000-2005) v Europe (2000-2002)
    9. 9. Public Health Expenditure as % GDP 6.0 7.0 8.0 9.0 10.0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 % Source: DoHC Key Trends 2013, CSO National I&E Accounts., DoF Budget 2014. 2009 9.6% 2013 8.5% OECD Average 9.3%
    10. 10. Whole systems plan for child health
    11. 11. Hospital visits  Formal site visit to every paediatric department in year one  Visit to all (34) tertiary specialities in Paediatrics in year two  Extensive discussion across disciplines  Follow up visit if required  Immediate feedback and resume of all tertiary visits looking for common themes
    12. 12. Visitation reports  Set proforma to each tertiary subspeciality  Following tertiary visits model of care document by June 2014
    13. 13. Report card 2014  184 page visitation document now HSE policy  National Charter for children (in collaboration with patient reference group)  24/7 neonatal transport with additional appointments
    14. 14. Report card  25 algorithms developed for use by first responders and GP’s and launched at ICGP AGM  Visitation of 34 tertiary subspecialities in Paediatrics -> Model of care document  National diabetes audit and model of care for type 1 DM
    15. 15. A national model of care for children and young people  Avoid ‘postcode disadvantage’  Improve primary-secondary interface  NETS + PETS  Adolescence and transition  Strengthen regional care / networks and outreach clinics  New models for urgent care delivery  National manpower plan for Paediatrics

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