Alf Nicholson, National Clinical lead in Pediatrics, RCPI
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Transcript of Alf Nicholson, National Clinical lead in Pediatrics, RCPI
Professor Alf Nicholson
April 2014
Paediatric Lead Programme –
The first 2 years
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
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
Prob
abili
ty o
f dea
th b
efor
e ag
e 5
yrs,
per
100
0 liv
ebirt
hs
Source: WHO Health statistics and the European HFA-DB
2008
The Clinical Leads on Tour
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
Background changes in disease priorities for child
healthmany ‘killer’ diseases have disappearedemotional and behavioural problems affect 10 – 20%
changes in parental expectationloss of confidence in primary care provisionfaster access to specialist care‘informed’ client group
changes in healthcare provisionreorganisation of infrastructure
Childhood cancer survival (Ireland) by deprivation category, 1994-2005 (Walsh PM et al Eur J Cancer 2011)
Childhood cancer survival to 5 years: Ireland (2000-2005) v Europe (2000-2002)
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%
Whole systems plan for child health
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
Visitation reports
Set proforma to each tertiary subspeciality
Following tertiary visits model of care document by June 2014
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
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
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