Healthy London Partnership

Children & Young People’s Programme

PICH Programme

March 23rd 2016

Tracy Parr – Head of CYP Programme

https://www.myhealth.london.nhs.uk/healthy-london/children-and-young-people

2

Healthy London Partnership –

Children and Young People’s programme

Children’s services in London: Key facts

8.2 million people live in London

of which

2,049,576 are children aged 0-19

134,186 live births in

London in 2012

600,000 of London’s children

live in poverty

Mental Health

conditions affect

1 in 8 Children

Emotional and

behavioural

problems affect

1 in 5 Children

20% of 4-year-olds are overweight or obese

25% of 15-year-olds

First smoked

AGED 13 or younger

40% of 15-year-olds drink alcohol once a week

LESS THAN HALF of 11-15

year olds do an hour of

exercise each day

20% of 13-year-olds drink alcohol once a week

Healthy London Partnership –

Children and Young People’s programme

The most common malignancy is childhood

LEUKAEMIA at 41%, including lymphomas

Brain tumours account for

25% of all childhood

cancers

22% of the babies

who died were born at 37-40 weeks

gestation

1 in 10 of babies born in London are admitted to neonatal units — 13,596 each year

282 of those babies do not survive (2.1% of admissions)

Congenital heart disease (CHD) is the most common congenital abnormality

A recent survey of DGH service

provision shows that nearly half of hospitals operate

on less than 51 elective paediatric surgical cases per

year

4%

More than

29,000 children

in the UK have Type I diabetes. You would need

70 jumbo jets to take them all on holiday

South Asian and African Caribbean people

Are 3-5 times more likely to suffer kidney

failure requiring dialysis than white Caucasians

each year - even more quickly in children under five.

Incidence of Type 1 diabetes is increasing

by about

In London, there are more than

3000 with Type 1 diabetes

5,570 of babies born in

London admitted to neonatal units were born at 37-40 weeks

(gestational age)

679 children are on renal replacement therapy in the UK 212 of these are treated in London

3% of children have written asthma plans to prevent and manage exacerbations

3,600 paediatric surgical

procedures are performed each year

>50% of London hospitals report that they do not always have an anaesthetist with

paediatric Training on call for

paediatric emergency cases.

of all NHS expenditure on patients with IBD is for inpatient management (approximately)

1/2 11% are done at Evelina

There are

130 renal transplants undertaken on children in the UK each year

Whilst there are 13

tertiary centres across the UK, just

10 of those 13

provide renal transplantation

25% of UK transplants for children are done at GOSH

What do children, young people and families think?

5

I need rapid

access to

someone I can

talk to when I

feel depressed

We need

easier

access to

healthcare

Services are

not joined

up

I want to know

that my GP is

experienced

in caring for

children

Make sure

the school

can look

after my son

when he has

an asthma

attack

I am worried

about what will

happen next

year when I am

too old for the

children’s

clinic

Case for Change

6

7

London Health Commission

Healthy London Partnership –

The delivery arm of the London Health Commission

Goal – London to be world’s healthiest global city

8

10 programme aims from London Health Commission

Each SPG and majority CCGs have lead for CYP

9

Healthy London Partnership Children and Young People Programme Governance

10

HLP C&YP Transformation Board

London Transformation Group

(London’s CCGs and NHS England) London Health

Board

CYP Clinical

Leadership

Group

CYP

Commissioning

Advisory

Group

Accountable

Information sharing/

endorsement

Programme alignment

Critical Care

Clinical

Leadership

Group

Surgery Clinical

Leadership

Group

Asthma Clinical

Leadership

Group

Out of Hospital

Care Clinical

Leadership

Group

CAMHS Clinical

Leadership

Group

Primary Care Board

• CCG SRO & SEL SPG (Martin Wilkinson) • NHSE SRO (Will Huxter) • CYP Clinical Director (Russell Viner) • CCG Clinical Lead (Nicola Burbidge) • SPG rep SWL (Adam Doyle) • SPG rep BHR (Louise Mitchell) • SPG rep WELC (Satbinder Sanghera) • SPG rep NCL (Sarah Price) • SPG rep NWL (Matthew Hannant) • DPH (Dagmar Zeuner) • PHE (Marilena Korkodolis) • DCSS (Linzi Roberts-Egan) • CYP/family rep (Emma Rigby) • Programme Manager (Tracy Parr) • GP lead (Eugenia Lee) • Strategic Lead CAMHS (Steve Ryan) • NHSE asthma lead (Dave Finch)

CYP & Families Engagement throughout

U and EC Board

Mental Health Board

Prevention Board

Specialised Services Board Young

People’s

Steering Group

V0.9 Jan 2016

Primary Care

Clinical

Leadership

Group

11

12

Priority A

Develop Population Based Networks

• Develop guidance for model of population based CYP networks across SPGs

• Understand data requirements to describe needs analysis in population based

networks

• Develop data set and data dictionary to enable effective needs analysis CYP

• Work with SPGs to support development and implementation of population

based network

• Undertake evaluation of population based networks and disseminate learning

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Priority B

Reduce variation in care Standards and models of care

• Acute care (completed)

• Asthma (completed)

• Surgical networks (completed)

• HDU (level 1 critical care)

• Out of hospital care - directory of models and financial modelling

• Develop model of primary care to meet needs CYP

Implementation

• CAMHs – support for implementation of CAMHS transformation plans

• Baseline assessment of trusts against standards based on peer review

• Asthma – implementation plan at pan-London, SPG and CCG level

• Community pharmacy engagement plan

• Surgical networks – support pilot in SW London linked into 111 DoS

• HDU –funding and co-commissioning models

• Develop workforce strategy for implementation of CYP programme

Acute Care Standards

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• Collation of all acute standards from Royal

Colleges, DH, RCN, LQS into one document

• Currently being revised with new surgical

standards

• Peer review process to be undertaken 2016 –

2017 to share best practice and describe

baseline

Asthma mortality and children with wheeze

Ingrid Wolfe, Lancet, Mar 2013

15

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Mortality

6-7 age group

13-14 agegroup

Asthma Mortality in London under 19 years

16

• 4 deaths per million population aged < 19 years

• Estimated 8 asthma deaths aged <19 per year in London

• 24 Maternal deaths London 2014 – 2015

• 2 direct

• 21 indirect

Coroner’s Letter Regulation 28

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London Asthma Standards

18

• 14 ambitions across specific areas

• System-wide

• Patient and family support

• Schools

• Acute and high risk care

• Integration and co-ordination

• Discharge planning

• Transition

• Effective and consistent prescribing

• Workforce education and training

• All settings

• Primary care

• Secondary and tertiary care

• Community pharmacies

• Schools

• Self care

Asthma Community Pharmacy Audit

Interim results

19

9,462 responses

1,858 Community pharmacies

across the whole of London

were invited to a take part

1,101 Pharmacies

responded

48% Do have an

asthma action

plan or wheeze

plan

70% Had a inhaler

technique

assessment in

the last 12

months

64% Have a spacer

device

96% Do not smoke

23% Live with

someone who

smokes

64% Did not have a

flu jab last year

25% Had to make an

emergency request

for an inhaler in the

last 12 months

60% of the total

number of

pharmacies

32 boroughs

(all) took

part

Campaign

extended to 10 weeks

till 2 October

9.4 Average age

of participant

9 Average

entry per

pharmacy

1 in 4 Entries were

using a smart

device

Participation per

borough

Results

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

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CYP Asthma Implementation Toolkit

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Self Care Primary

Care Schools

Secondary

Care

Community

Pharmacies

School Asthma

Policy

Persons responsible

for annual

review_____________

Review date

CYP Mental Health and Well Being

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• Supporting CCGs in developing local CAMHS transformation plans

• Producing pathway for crisis care in conjunction with U and E care

• Delivering workshops on specific areas of concern – eating disorders/learning difficulties

• Working with DCO team to support assurance process

• Working with voluntary sector to support collaboration with CCGs

• Team expertise expanding – Steve Ryan, CAMHS commissioners, clinical advisor

• Future work • Continue to support CCGs

• Develop KPIs and informatics solutions

• Linking in and supporting IAPT

• Looked after children

• Linking with schools pilots

Other priority deliverables

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• Level 1 critical care standards (DGH HDU)

• Surgical networks pilot

• Population of MiDoS (111 directory of services) for CYP services

• Directory of out of hospital models of care for CYP and economic modelling

• Primary care model of care for CYP

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Priority C

Integration of care

▪ Develop integrated models of care for CYP based on other workstream outputs)

▪ Undertake scoping of models in relation to CYP care

– Multispecialty community providers

– Primary and acute care systems

Link in with Vanguard bids and work within HEE

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Priority D

Improve commissioning

• Develop CYP commissioning programme structure(completed)

• Procure educational provider (Feb – Mar 2016)

• Recruit first cohort (commence May 2016)

• Support development of new commissioning models for CYP services (2016-17)

• Support CCGs to develop commissioning strategies to implement:

• Level 1 critical care (HDU in DGH)

• CAMHS

25

Priority E

Innovative Access

• Development of young-person friendly app using validated content from NHS

Choices

• Development of materials to illustrate when medical advice should be sought

• Establishment of pan-London steering group

Engaging with CYP

26

Engaging with CYP

27

What does it mean to be strategic?

28

Exercise