1. The Balance of Care Approach A whole-systems framework to support paediatric commissioning Paul Forte, Su Bunn, Steve Cropper, Andy Spencer

2. Issues in developing and commissioning services Taking a whole-systems perspective Developing a needs-led rather than service-driven view Quantifying resource implications Developing a common language between clinical and non-clinical stakeholder interests

3. Balance of Care Paediatric Gastro patients Cystic Fibrosis Failure to thrive Small Bowel Crohns

4. Balance of Care Paediatric Gastro patients Cystic Fibrosis Failure to thrive Small bowel Crohns Specialist nurse Paediatric nurse Voluntary & Private sector NHS Local Authority Dietitian Social worker Care worker Play specialist

5. Balance of Care Paediatric Gastro patients Cystic Fibrosis Failure to thrive Small bowel Crohns Specialist nurse Paediatric nurse Voluntary & Private sector NHS Local Authority Dietitian Social worker Care worker Play specialist Option 1 option 2 option 3

6. Example care options

7. Example scenario

8. Key results of pilot project Development of patient categories Specification of workforce inputs Initial quantification of demand and supply Local health economy focus Highlighting of baseline data issues

9. The value of the Balance of Care approach A workable whole systems approach Patient focused across organisational and professional boundaries Supports development of a vision and strategy for commissioning Provides a basis for operational plans and business case development Communication and involvement: enables meaningful dialogue

10. Challenges ahead… National level –data definition, information systems –routine/ special data collection Network level –moving from aggregate analyses to tailoring services more appropriately across a clinical network