Healthy StartImplementation Process

Eulalee GreenHealth Development Manager

Registered Dietitianeulalee.green@nhs.net

07939 831 821

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Implementation Process 2

Overview

Background The Project Plan Future Plans

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Implementation Process 3

Background

2005-2008: 35 children with rickets 2007-2009: 20/22 children with tuberculosis had vit D

deficiency 2004-2007: 17 hypocalcaemic seizures at 1-2 months old

2 required PICU, 1 long term complications

2008: 2 infant: cardiac failure due to vit D deficiency 20% of paediatric fracture patients are vit D deficient

Source: Dr Michie, Consultant Senior Lecturer in Paediatrics, Ealing Hospital

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Implementation Process 4

Background

Rates over 5 years (2003 – 2008)

23 electoral wards

Average Number Congenital

Malformations Children 0-5 yrs old In Each

ElectoralExpected 14

(range 9 - 23)

Actual 70(range 41 -

114)

Ratio Actual: Expected

5

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Implementation Process 5

Healthy Start Project

Early 2009: DoH identified high seizure rates in

Ealing June 2009: HS project started Aim:

Reduce neonatal hypocalcaemic seizures (vitamin D)

Reduce congenital malformation rates (folic acid)

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Implementation Process 6

Milestones

1. Baseline data2. Stakeholder Interviews3. Map current processes4. System redesign5. Implement and monitor6. Health Staff training 7. Community Publicity8. Monitoring 9. Outcome evaluation 10. Roll-out to non-PCT sites

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Implementation Process 7

Baseline Data

8 sites over 3 neighbourhoods

20,750 Children: 0-4 yrs

11,000 women: pregnant or with a child <12mths old

Uptake 2007 – 2008

AreaAdult Sold

Adult Free

Child Sold

Child Free

Acton, Central Ealing & Hanwell 1 0 42 224Northolt & Greenford 5 10 27 133

Southall 0 0 140 170Total for Ealing 6 10 209 527

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Implementation Process 8

Stakeholder Interviews

Public Health – Strategic Lead Universal Children Services – client advice Maternity Services – client advice Family Nurse Partnership GP Services & Paediatricians – client advice Health Centres – supplement sales & budget Children Centres – client advice Supplies Department – distribution to centres Accounts Department- reporting to DoH &

reclaim funds

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Implementation Process 9

The Process (July 2009)

Account Department had unwritten process

Centres had different processes Quarterly returns not submitted Monies banked incorrectly Wrong account and supply codes used Staff confused about recommendations GP & MW not involved

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Implementation Process 10

System Redesign (Aug 2009)

Draft: Flow Chart, FAQ, Leaflet Key stakeholders meeting Prepare final documents Pilot at one site Roll-out to other PCT sites Deliver training for Reception Staff Implement system and monitoring

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Implementation Process 11

Health Staff Training (Sept 2009)

Practice Managers – 25 managers Pharmacists – 2 sessions, about 40 pharmacists Health Visiting Team – 4 neighbourhood meetings

– 40 staff Midwives –Queen Charlottes & Ealing Hospital –

about 30 staff Ealing Hospital – 45 minute presentation hour

from 9:00 am to 6:00 pm - up to 135 staff Clinic administrators – 10 staff Children Centre Staff (delivered by the Children

Centre Dietitians) Corum outreach team – 30 staff

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Implementation Process 12

Community Publicity (Sept 2009)

Baby TV film Poster Two articles a year, in Ealing Matters,

Team Talk Core Brief, and Nutrition Today Weaning Groups 6x a week – CCD Breastfeeding Peer Supports – CCD Switch-Script on GP system

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Implementation Process 13

Monitoring(2009 – 2010)

PH collates HS uptake Vouchers held by the centre for 12

months Every month figures and copies of

banking slip Compile quarterly sheets Quarterly figures sent to Accounts

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Implementation Process 14

Uptake Data

Uptake 2007 – 2008

AreaAdult Sold

Adult Free

Child Sold

Child Free

Acton, Central Ealing & Hanwell 1 0 42 224Northolt & Greenford 5 10 27 133

Southall 0 0 140 170

Total for Ealing 6 10 209 527

Uptake 2009 – 2010

AreaAdult Sold

Adult Free

Child Sold

Child Free

Acton, Central Ealing & Hanwell 49 144 437 378

Northolt & Greenford 39 73 164 327

Southall 661 83 819 309

Total for Ealing 749 300 1,420 1,014

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Implementation Process 15

Outcome Evaluation

Difficult to obtain and time consuming

Hospital coding errors, so need to hand search patient records

Hypocalcaemic seizures – only 2 between 1 Sept 2010 to 28 Feb 2011

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Implementation Process 16

Process in 2010

Written Process (FAQ & Flow Charts) Distribution sites submitting correct

information HV, CNN & MW understand vitamin

recommendations Accounts Department – some problems GP – some problems Not distributing from non-PCT sites

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Implementation Process 17

Problems

Process monitoring Outcome monitoring Accounts department not including

HS as one of its priority Distribution of refund HS vouchers – infant vitamin voucher

not from 1 mth

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Implementation Process 18

Future Plans

Investigate how families are using vouchers Access GP training programme Re-look at non-PCT sites Write in to the SOP for:

GP antenatal booking 1st Antenatal appointment New birth visit

Training staff at birth registration offices Children Information Services website Local library services

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Implementation Process 19

Plea to the DoH

Children vitamin vouchers from 1 mth Constant messages on HS sites and

leaflets to include drops from 1 month for African, Afro-Caribbean, Middle Eastern and Asian babies

Request hospitals to remove ‘paediatric’ as diagnostic code

Request GP, midwifery and health visitor IT systems, include auditable fields for vitamin D, folic acid, and breastfeeding