1. Healthier Together Committee in Common Maternity, Children & Young People SCN Update 20 May 2015

2. Community Children’s – Next steps Introductions:  Dr Carol Ewing – CYP Clinical Advisor (SCN)  Mr Jim Bruce – Children’s Surgical Clinical Lead (SCN)  Dr Mark Robinson – CYP Clinical Lead (SCN)  Julie Flaherty – C&YP Clinical Project Lead (SCN)  Miss Karen Bancroft – Maternity Clinical Lead (SCN)  Julie Cheetham – Deputy Associate Director (SCN)  George Kissen – Children’s Community Clinical Advisor (HT)  Sophie Hargreaves – Associate Director (HT)

3. VISION: The health and wellbeing of local people, and the care they receive, will be comparable with the best in the world (SCN, NHS England – established 2013)

4. THE STRATEGIC CLINICAL NETWORK WILL HELP TO ACHIEVE THIS BY: Influencing commissioners and providers to adopt policies and pathways which can deliver the best quality healthcare and outcomes Striving towards equity of outcomes by reducing unwarranted variation in health care Ensuring clinicians guide health policy and pathway development Ensuring wide clinical ownership of policies and pathways so that if problems develop, clinicians who have developed them will sort out the problems Facilitating multi-disciplinary consensus – but not the lowest common denominator

5. Child Health Data  Across GM, 23.3% of children under the age of 16 years live in poverty, which is significantly higher than the England average of 19.2%. 1  In 2011/12, the rate of A&E attendances (among the population aged 0-4 years) per 1,000 population was 652.1 in Greater Manchester, significantly higher than the England average of 510.8. 2  In 2012/13, the rate of emergency hospital admissions for asthma (among the population aged 0- 18 years) per 100,000 population was 384.5 in GM, significantly higher than the England average of 219.1  Diabetes was 62.0 in GM which was not significantly different to the England average of 59.9 equivalent  Epilepsy was 89.6 in Greater Manchester which was significantly higher than the England average of 74.8. 3  Within Greater Manchester, life expectancy at birth varies from 75.5 years in Manchester to 79.9 years in Trafford for men, and from 80.0 years in Manchester to 83.5 years in Trafford for women. 1 within local authority areas, the differences in life expectancy between the most and least deprived areas are much more pronounced. source: CHIMAT Data

6. Maternity Data: Stillbirth rate in Norway 1967- 2011

8. Stillbirths Rate 1 in 200 3700 stillbirths per year in England 250-350 intrapartum stillbirths per year Rate in England is ranked 31st out of 33 high income countries worldwide Risks are well known 38% are normally formed but growth restricted 1/3 occur at or near term when delivery feasible

9. Community Children’s – next steps

10. Joined-up Care for Children and Young People Do you agree or disagree that children and young people should be cared for closer to home where appropriate? Consultation questionnaire

11. Background Making it Better – completed in 2012  Reduction of 12 to 8 co-terminus obstetric and paediatric inpatient units (5 local neonatal units)  2 to 3 NICUs (level 3 care)  Expansion of CCNTs  Close working clinical community across GM through CYPFN  Service specifications for CCNTS, surgical and anaesthetic services  Consultant delivered care - complying with EWTD and other standards  Surgical and anaesthetic network model  Post implementation evaluation of MiB (has it made a difference and improved outcomes?) not published Health and Social Care Act 2012 Maternity and Children’s SCN, NHS England established in 2013 National Drivers – RCPCH and Surgical standards, CYPH Outcomes Forum 7 day working

12. MCYP SCN response to the HT Consultation Children:  Status quo for children’s services is not safe and sustainable – all hospital sites unable to meet mandated professional and service in patient standards at present  Reconfiguration of children’s primary care and out of hospital services essential  GM adult services reconfiguration needs to give due consideration of the parallel impact on children’s services: acute children’s surgical services patient flows, pathways and outcomes

13. MCYP SCN response to the HT Consultation Maternity:  Obstetric Led Maternity Units depend on many co-located services to deliver high quality maternity care, preferably on a specialist site  Maternity clinical community requires confirmation and assurance that access to appropriate services will be maintained on all current maternity sites  An agreed assurance process both pre and post implementation of the decisions made to ensure current quality standards are not compromised but improved

14. What’s the evidence base?  SCN clinical community for Children and Maternity has given a consistent message to HT in ‘future model of care Women & Children’s services’  Review of existing RCPCH hospital standards – not achieved across GM  Updated RCPCH standards – further stretch for units to achieve and not viable long term  Workforce impact - Paediatrics (medical and nursing), EM, Surgical and anaesthetic, primary care

15. What have we been doing post consultation  SCN has re-established a Paediatric Surgical network to audit existing surgical / anaesthetic standards  Further meetings and discussions taken place between SCN and HT team  Currently co-developing a ‘next steps’ document to address issues raised at consultation

16. What’s the evidence base?  Review of CCNT 2014/15 Report – shows significant variation across GM  Children’s A&E Peer Review and Observation and Assessment Unit standards shows current standards not being achieved across GM  Critical Care & HDU interdependencies significant for maternity with implications for Neonates and paediatrics – Kirkup/Maternity Review  SCN clinical community for Children and Maternity has given a consistent message of their ‘aspiration to improve maternity and children's services’

17. What’s the solution? Children’s Out of Hospital (Community) Services: Build on work started with HT (must join up in-hospital and out-hospital work as one service) across primary, secondary and community care Build on the RCPCH revised Facing the Future and FtF Together standards – children cared for closer to home and in hospital Upskill the workforce – paediatricians, nurses, school nurses, GPs, HVs Lessons learnt from MiB

18. What’s the solution? Children’s Emergency Department: Emergency standards not currently met - how do we improve? HT go-live readiness assurance of RCPH standards for CYP in emergency settings Further detail on HT emergency model - EM on specialist sites, ‘walk in’ services on locality sites CCNT & Primary Care should be of a consistent standard across GM to prevent admissions and receive children from EM Following the CCNT report – could this be a single service or sector offer to reduce variation?

19. What’s the solution? Children’s General Surgery: An agreed mandate for the SCN & HT to develop a children general surgery/anaesthetic model across GM for planned and emergency surgery No children’s in patient elective surgery done on sites with no paediatric in-patient units Need to pool adult site surgical/anaesthetic expertise and skill up to manage children Improve governance and outreach to local sites from specialist units to upskill workforce Improve surgical/anaesthetic standards – GM audit underway Must have a safe and sustainable solution for children’s surgery across GM

20. What’s the solution? Maternity Clear transparent and robust assurance process undertaken pre & post implementation Maintaining interdependency of maternity, neonatal and paediatric services Improved quality of maternity and neonatal services Consequence for maternity and neonatal services will be dependent on the DMBC High risk women have appropriate access to critical care, surgery, anaesthetics other support services

21. Questions to CiC “Given our presentation what does the CiC consider to be the next steps required to ensure safe and sustainable maternity and children service for GM?” Further questions for consideration?  Do all of the current work streams e.g. workforce, patient experience take into account the views of CYP and their families?  How do the primary care and integrated work streams align with HT and what is their position on children’s services?  If so how will this align with the timeframe for HT, how will the risks to children and maternity services be mitigated against?  Given the nature of the changes needed for children i.e. system wide is Devo Manc an opportunity to further this work? If so how?

22. References:  British Association of Paediatric Surgeons [BAPS] [2014] ‘Commissioning guide: For general Paediatric surgery.’ http://www.rcseng.ac.uk/healthcare- bodies/docs/provision-of-childrens-surgeryhttp://www.rcseng.ac.uk/healthcare- bodies/docs/provision-of-childrens-surgery  Children’s Surgical Forum [CSF] Surgical Standards for children [2013] https://www.rcseng.ac.uk/publications/docs/standards-in-childrens-surgery https://www.rcseng.ac.uk/publications/docs/standards-in-childrens-surgery  Royal College of Paediatrics and Child Health [2012] ‘Standards for Children and Young people in Emergency Care Settings’ http://www.rcpch.ac.ukhttp://www.rcpch.ac.uk  Royal College of Paediatrics and Child Health [RCPCH] [2010] ‘Facing the Future: Standards for Paediatric Services’ http://www.rcpch.ac.uk/sites/default/files/page/RCPCH%20Facing%20the%20Fu ture%20- %20Standards%20for%20Paediatric%20Service%20April%202011%20V2_1.pd f http://www.rcpch.ac.uk/sites/default/files/page/RCPCH%20Facing%20the%20Fu ture%20- %20Standards%20for%20Paediatric%20Service%20April%202011%20V2_1.pd f  Royal College of Paediatrics and Child Health [RCPCH] [2010] ‘Facing the Future: Standards for Paediatric Services’ revised standards http://www.rcpch.ac.uk/improving-child-health/better-nhs-children/service- standards-and-planning/facing-future-standards-ac http://www.rcpch.ac.uk/improving-child-health/better-nhs-children/service- standards-and-planning/facing-future-standards-ac  NICE 2014 Intrapartum Guideline Update Consultation document www.nice.org.uk www.nice.org.uk

23. Thank you for listening