Safe transition for young people to adulthood - Jackie Cornish


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Safe transition for young people to adulthood

Dr Jacqueline Cornish,
National Clinical Director Children, Young People and Transition to
Adulthood - NHS England

NHS Improving Quality held an event in London on 31 July 2013 to progress the children and young people transition to adult services work with a focus on turning the rhetoric into practice entitled “Working to Define a Generic Service Specification for Transition”

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  • An overview of how the new system works. (Still a bit simplified – e.g. doesn’t show NICE or Information Centre)
    DH allocates £ and sets objectives for NHS CB. No longer any NHS HQ in DH
    NHS CB allocates to GP consortia
    Who commission services from a range of providers
    Who are regulated on a consistent basis (no longer some of them managed by SHAs): by CQC as now for quality and by Monitor as economic regulator (3 functions: 1 promote competition, 2 regulate prices, 3 ensure continuity of essential services)
    Meanwhile LAs have new role shaping NHS commissioning
    LAs also feed into new public health service, with their role taken from PCTs of promoting local population health improvement. And Public Health England itself is now part of DH, with a separate, ring-fenced budget. More details published in Healthy Lives, Healthy People White Paper
    Then adult social care: no change to structure (the debate is about financing – Dilnot commission)
    Finally, HealthWatch, nationally and locally
    So DH does strategic coordination at national level; LAs at local level.
  • From 1 April 2013, with the formal introduction of the Health Act changes, there will be various and new types of clinical networks in the NHS . You may not need to understand the differences as what unites networks is much greater than what differentiates them. However, if you do feel the terminology is confusing this is an attempt to clarify matters.
    Networks are differentiated by their focus and their governance arrangements. It is the role of the host to ensure that the network itself is effective and meeting members’ needs. There is more information about each type of network on subsequent slides.
    Some such as strategic clinical networks focus on broader strategic issues, whereas local professional networks and operational delivery networks are more operational. However strategic networks will at times address operational issues and sometimes an ODN will have the right members to address a particular strategic issue.
    Some are hosted and funded by commissioners and some by providers, but all sit between commissioners and providers in their way of functioning, as described earlier.
    Some are nationally mandated; some only exist in some parts of the country in line with local need. Eg local respiratory networks hosted by CCGs
    Some networks, such as academic health science networks and research networks focus on the innovation ‘end’ of the improvement spectrum as opposed to the dissemination and spread of acknowledged best practice.
  • Safe transition for young people to adulthood - Jackie Cornish

    1. 1. NHS England – Safe Transition for Young People to Adulthood Dr Jacqueline Cornish, National Clinical Director Children, Young People and Transition to Adulthood July 31st 2013
    2. 2. National Context Children lose out to demands of adults in NHS, says report Failure to provide more than 'mediocre services' argues Sir Ian Kennedy - 2010
    3. 3. Children & Young People Health Outcome Forum: Role The Forum was launched on 26 January 2012 and reported to the Government with independent advice in July 2012 on: •The health outcomes that matter most for children and young people •How well these are supported by the NHS and Public Health Outcomes Framework •How the different parts of the health system will contribute and work together in the delivery of these outcomes
    4. 4. Children & Young People’s Health Outcome Forum: ‘No decision about me without me’ Key Themes Promoting Health Acute illness Long term conditions Disability Mental Health Palliative Care Life Course Premature/ LBW Early Years School child Teenager Young Adult Cross cutting Issues 1 Cross cutting Issues 2 Integrating services General Practice Safeguarding Looked after children Inequality Transition to adult services Choice Information and data Technology Education & Workforce development Clinical leadership Aligning NHSE and PHE care outcomes Levers of funding – PbR / CQUINs Networks – local / hub; specialised; national
    5. 5. The NHS Outcomes Framework will be organised around 5 national outcome goals/domains that cover all treatment activity for which the NHS is responsible. Networks will support local clinicians to deliver the Framework in local systems Domain 1 Preventing people from dying prematurely Domain 2 Enhancing quality of life for people with long-term conditions Domain 3 Helping people to recover from episodes of ill health or following injury Domain 4 Ensuring people have a positive experience of care Patient experience Domain 5 Treating and caring for people in a safe environment and protecting them from avoidable harm Safety Effectiveness
    6. 6. NHS Outcomes Framework NCD Children, YP and Transition - Objectives Preventing people from dying prematurely Reducing avoidable deaths – perinatal/neonatal, infant, focus on injury, childhood cancers Enhancing quality of life for people with long-term conditions Reducing time spent in hospital Unplanned hospitalisation asthma, diabetes , epilepsy Helping people to recover from episodes of ill health or following injury Emergency admissions for conditions not usually requiring hospitalisation, improving recovery from injuries & trauma, Ensuring people have a positive experience of care Improving Children, YP and Families experience of healthcare (GP, OOH’s, A&E, acute IP care, end of life care) Treating and caring for people in a safe environment and protecting them from avoidable harm Harm due to ‘failure to monitor’, delivering safe care to children in acute settings Medication errors, infections
    7. 7. NCD Additional Objectives • Generic Framework for consistent approach to Transition to adult services, & measurable outcome indicators to inform commissioning • Mental Health on a par with physical health, measurable progress towards parity of esteem, roll out of CYP IAPT programme. • Acutely sick child – supporting urgent care through Primary/Secondary Care Interface and OOH services, with appropriate workforce needs assessment • LTC’s, Disability and Palliative Care in children – support and develop integrated care pathways, and enhanced community nurse support • PbR – Lead commissioning support of tariff for directly and CCG commissioned services for CYP and Fetal Medicine • Work with DH and DfE from NHS England to support response to Pledge, working also through Children’s Health and Wellbeing Partnership and EIF • Identifying and addressing inequalities in vulnerable children: looked after, adopted, travellers, those in criminal justice system
    8. 8. The New System Department of Health NHS Public Health England NHS England (Local health improvement in LAs) Clinical Commissioning Group Monitor (economic regulator) CQC (quality) HealthWatch Primary Care Specialised Providers Local authorities (via health & wellbeing boards) Local HealthWatch
    9. 9. Medical Genetics Mental Health Paediatric Surgery Paediatric Medicine Women and Children Paediatric Cancer Services Paediatric Cardiac Services Blood and Cancer Metabolic disorders Paediatric Intensive Care Trauma Neonatal Critical Care Paediatric Neurosciences Internal Medicine Complex Gynaecology Specialised Maternity Fetal Medicine Multi-system disorder
    10. 10. Women’s and Children’s Programme of Care •Specialised Service status achieved for Paediatric Palliative Care •35 Service Specifications and 5 Policies delivered across 12 Clinical Reference Groups – all clinicians committed and enthusiastic to ensure safe commissioning of whole pathway, from primary and secondary to tertiary care •Children’s Services described in 43 of the former SSNDS •Need identified for a Generic Paediatric Service Specification, to be appended to all Service Specifications where Children described. This could also have potential as guidance for CCG commissioning of Children’s Services, work in progress •Develop work programme for 2013-14, Transition a priority •Work alongside SCN’s
    12. 12. Geography North East, north Cumbria, and the Hambleton & Richmondshire districts of North Yorks • 12 senate Greater geographical areas Manchester, Lancashire and • One core support team south Cumbria Cheshire & per senate Mersey • Number and size of West Midlands each network is locally determined, to take Thames Valley account of patient flows and clinical South West relationships Yorkshire & The Humber East Midlands East of England London Wessex NHS | Presentation for SCN Development Day| [21 st May 2013] South East Coast
    13. 13. Proposals for CYP SCN Work Programme •D1 – 40% premature babies hypothermic, temp< 36.5 •D2 – LTC’s – Depression - poorly defined and diagnosed Diabetes - poor HbA1c levels Asthma - only 7% of patients have management plan Disability – on 50% hav •D3 - Paediatric Surgical Networks, particularly GPS Transition to Adulthood Policy •D4 – Palliative Care, end of life plans, choice of place of death •D5 – DNA Policy, present, adhered to? Safeguarding implications Medication errors Paediatric safety thermometer – the deteriorating child
    14. 14. Different Types of Network NHS Outcomes Framework Senates [12] Strategic Clinical Networks Local Professional Networks Operational Delivery Networks Other Local Networks “The conscious and guiding intelligence” “Engines for change and improvement across complex care systems” “Gathering frontline knowledge and expertise” “Mapping patient pathways to ensure access to specialist support” “15 AHSNs: Masters of science and evidence based practice” Multiprofessional i.e. Cancer; CVD; Maternity and Children’s; Mental Health / Dementia / Neurological Conditions i.e. Pharmacy; Eye health; Dental e.g. Adult Critical Care; Neonatal Intensive Care; Trauma; Burns; Paediatric NM; Paediatric IC e.g. Academic Health Science Networks, Research Networks NHSCB Network Support Teams (AT-based) Annual national priorities from the NHSCB Medical and Nursing Directorates All supported by Improvement Body and Leadership Academy
    15. 15. Young People’s Transition to Adulthood • Opportunity - Uniform commissioning – Direct and CCG National process with national engagement More equity, resulting in secure systems for delivery High level input from the NHS •Challenge - Service re-design moving towards integration Precise definitions of levels of skills and workforce needed Whole pathway approach with appropriate and timely Transition to Adult Services Absolute clarity in Service Specifications, define outcome indicators •Conundrum - To link all the parts of Transition service pathways from Primary to Secondary & Tertiary care, working with CCGs to commission a care continuum with SCN support. •Solution - SCN Work Programmes and Pathfinder Working Groups – eg developing guidelines for the CCG commissioned elements of the complex transition paediatric pathways - neurodisability/rehab pathway, paed diabetes, LTV, •Working Relationships – Close working vital with: CRG’s and other POC’s, Children and Young People Health Outcomes Forum Royal Colleges including RCPCH and RCP, RCN, RCGP, DH and DfE, PHE, HEE, NICE, CQC, Monitor, Charitable Sector.
    16. 16. Objectives for Today •To share learning from existing good practice – successes, challenges and barriers to implementing clinically and patient designed Transition models •To define the critical elements of an effective Transition model •Using the above, develop a generic Service Specification as a commissioning template, onto which all specialised and complex services can be bolted •Start to consider measurable outcome indicators against which successful Transition plans can be commissioned and monitored