Improving Children and Young People’s Health Outcomes - A System Wide Response Flora Goldhill Director for Children, Families & Maternity and Health Inequalities, Department of Health

Our System Wide Pledge We are committed to improving the health outcomes of our children and young people so that they become amongst the best in the world We all have a part to play in promoting the independence of the health of our children and young people System wide leadership – for system wide change Signed up: AMRC, ADCS, CQC, Faculty of Public Health, Healthwatch, MHRA, NHS CB, HEE, NHS Information Centre, PHE, RCGP, RCN, RCPCH, RCPYSCH, Solace, Trust Development Authority (TDA) Purpose New health and care system – opportunity to ensure focus on outcomes includes children and young people explicitly, from conception to adulthood ‘We pledge to work in partnership as a health system, both locally and nationally, with children, young people and their families’ Shared ambitions Heart of decision making 2. Services – high quality, evidenced based, safe, right time and place, properly planned, educated and trained workforce 3. Good mental & physical health and early interventions 4. Integrated services, coordinated care, optimal experience of transition 5. Clear leadership, accountability & assurance Joint commitment and efforts

The health outcomes that matter most Actions taken New outcomes indicators Data – 5 year age bands Work underway Developing new outcome measures The Forum identified the health outcomes that matter most for children, young people and their families. The system’s response: NHS Outcomes Framework - new indicators: potential years of life lost CYP AND cancer survival for children all data presented in 5 year age bands up to 25 (monitor transition) placeholder – developing indicator to measure CYP’s experience of care Public Health Outcomes Framework 19 out of 66 indicators – primary focus maternity, children, young people Further 21- young age groups Data – quality timely data is critical – to assess effectiveness of services for CYP Development work underway. For example: measures of women’s experience of maternity services purpose of the pledge CYP’s experience of healthcare child development 2-2 ½ years school readiness Surveys We will trial a local level health and wellbeing survey - Continue to fund WHO Health Behaviour of School Aged Children study – and introduce new questions e.g. CYP views & experience of health services Commitments DH commitment to disaggregate date for NHS & PH OF by inequalities and equalities characteristics where possible PHE committed to continuing to produce Atlas of Variation in Healthcare for CYP PHE life stage focus A new clinically led NHS will focus on outcomes not process targets Local authorities – enhanced role – health improvement Shared leadership of the system – HWBs Strong consumer voice – local Healthwatch Commitments made Surveys Disaggregating data by inequalities & equalities PHE Atlas of Variation for Children and Young People

Leadership, accountability & assurance Clear and accountable system leadership Children and Young People’s Health Outcomes Forum & Board CQC thematic reviews Accountability for safeguarding New Forum – provide expertise and constructive challenge - Annual summit (involving CMO) – monitor progress & make recommendations for improvement 2. National Clinical Directors (NHS CB) - Maternity and Women’s Health Children and Young People, and Transition to Adulthood Deputy National Director – responsibility for health inequalities duties in quality and access to services 3. Public Health England - Director of Child Health and Wellbeing & Chief Knowledge Officer 4. CMO - Children and Young People’s Health Outcomes Board - Key system leaders in children’s services – met 1st time October 2012 5. CQC – exploring how thematic reviews / themed inspections can be used to make judgements about quality & safety of health services from children and families perspective. 6. Safeguarding - Accountability and Assurance Framework - Child protection – information sharing project – to be introduced in NHS hospitals in 2015

At the heart of what happens Listening to the voice of children and young people to improve health outcomes NHS Constitution – accessible and relevant Healthwatch Putting at the heart DH supports “You’re Welcome” quality framework for making health services young people friendly NHS CB – committed in Securing Equity and Excellence in Commissioning Specialised Services – patients should be able to express their views on services they’ve received and their experiences – using their chosen technology. Clinical Reference Groups – produced set of common standards for specialist services where children or young people are in hospital CQC developing an approach to involving CYP in inspection activity And joint approach with Ofsted NHS Constitution – DH working on alternative versions to make more accessible and relevant for different groups and communities. Healthwatch England – Christine Lenehan - leading advocate for Children Local Healthwatch from April 2013 – ensure views and experiences of CYP influence services

Acting early and intervening at the right time Providing the best start in life Improving health across the life course Start4Life – redeveloped – pregnancy to age 5 Change4Life - over 500,000 families have joined. Over 1million mothers say their families have changed their behaviour as a result of the campaign Physical activity – School Games – over 16,000 schools signed up Change4Life sports clubs – 3,000 in secondary, over 4,500 in primary Call to action on obesity - National Child Measurement Programme will continue Government commissioned independent review – good food in English schools and education to understand food and nutrition Public Health Responsibility Deal – early industry signatories to new pledge to increase fruit and veg uptake; working on new salt reduction strategy The School Food Plan – SofS Education appointed independent reviewers DfE – setting up new drug and alcohol information and advice service for practitioners working with young people DfE finalising contact for Early Intervention Foundation DH will develop new strategy for using marketing to improve health outcomes among young people New health inequalities duties for SofS for Health, NHS CB and CCGs NHS CB has appointed Deputy Medical Director with responsibility for health inequalities – further appointment planned with specific focus on these issues in CYP Work programme to improve outcomes for vulnerable children, including looked after children DH & DfE – urgent action to reform children’s residential care Work to develop national currency and tariff for statutory health assessments for looked after children (SHAs, DH, Monitor, Royal Colleges, other partners) NICE developing health and social care quality standard for health and wellbeing of looked after children and young people Voluntary sector DfE have commissioned a consortia of voluntary organisations to support schools in playing their part play in promoting good mental health for all children and young people, for example through strengthening their commissioning capabilities Reducing health inequalities Improving outcomes for vulnerable children (including looked after children and young people)

Integration and partnership New health system – duties to support integration of care Partnership board on children and young people’s health Health and Social Care Act: - duties on national bodies to ensure their work supports integration of care HWBs – JSNAs & JHWSs NHS Outcomes Framework – placeholder – developing indicator for measuring improvements in people’s experience of integrated care – NHS CB Chief Nursing Officer is Senior Responsible Officer reflecting focus on patient experience Partnership Board on children and young people’s health established – NHSCB, PHE, LGA, SOLACE, ADCS NHSCB part of single Integrated Care Collaborative programme with key national partners (DH, LGA, Monitor) Defining ‘integrated care’ from patient/ user perspective – National Voices leading this work – involving CYP the developing narrative for person centred, coordinated care. DH and DfE joint working: to secure a solution to linking health and education data effectively measure outcomes of integrated commissioning for children with SEND prioritise improvement outcomes for CYP with challenging behaviour best support young people with complex needs in making transition to adulthood RCGP, RCPCH and RCN to publish a guide to commissioning a good child health service Care and Support Bill – new provisions on transition from children’s to adult care Ofstead will develop two new frameworks for integrated inspection Looked After Children - CQC Child Protection Services - CQC, HMI Constabulary, HMI Probation, HMI Prisons Joint Commissioning Panel for Mental Health – produced guidance for commissioners of mental health services for young people making transition from CAMHS to adults services (2012) Will publish guidance for commissioners of CAMHS Sharing information Joint working

Safe and sustainable services Strategic clinical networks, local networks & partnerships Service reconfiguration to meet the needs of children and young people Strategic Clinical Network for Maternity and Children – NHS CB will launch in April 2013 NHS CB – will lead development of children and young people’s safety strategy Local networks and partnerships Children’s neuroscience networks will be established across England Service reconfiguration – NHS CB will prioritise service reconfigurations that strike a balance between specialisation / centralisation of services versus care closer to home 4 newly designated children’s epilepsy surgical services – started Autumn 2012 7 new congenital heart networks across England and Wales by 2014 Cancer services – service improvement changes being developed for teenagers and young adult cancer pathways Medication errors – reporting & reducing drug errors NHSCB developing medicines ‘safety thermometer’ Chief Pharmaceutical Officer and President of RCPCH – jointly chair Board to oversee development of programme to optimise use of medicines in children. Will report to CMO and CEO of NHS CB – will be sub committee of CMO’s Children and Young People’s Health Board. MHRA taking work forward with partners: Encourage increased paediatric adverse event reporting Paediatric Risk management plans – developed for newly authorised medicines (where appropriate) To develop active surveillance schemes Chief Pharmaceutical Officer is investigating potential action to address issue that many medicines brought into market before 2007 are not licensed for use in children Reporting and reducing drug errors

Workforce, education and training Safe & sustainable workforce for children & young people Health Education England Lead LETB for children and young people Centre for Workforce Intelligence – future work General practice workforce Named medical & nursing lead Common competency framework Adequate training Health Education England HEE agrees in principle with the recommendations and will work with DH on the steps needed to provide a safe and sustainable healthcare workforce for children and young people. LETB A lead LETB will be selected to coordinate education, training and workforce development for CYP Centre for Workforce Intelligence CfWI has identified CYP workforce as are of work in next business year (subject to agreement of Commissioning Group) RCGP proposal: extension GP training paediatrics child health & mental health DH supportive – looking into economic and affordability cases with partners General Practice RCGP supportive of named medical and nursing lead for children– committed to working with NHS CB, DH and General Pharmaceutical Council to consider proposal in more detail RCGP and RCPCH: 1) opportunities to experience acute childhood illness in specialist setting during GP specialist training programme. 2) Common competency framework with appropriate training – physicians providing adolescent and young adult care RCN to revise, with RCGP, ‘Getting it right for children and young people. A self-assessment toolkit for practice nurses NHS CB – will directly commission or support CCGs to commission services for CYP that are delivered by professionals with appropriate knowledge and skills

Knowledge and evidence Electronic health records Health intelligence network for children and young people New national maternity, child and CAMHS dataset Quality standards for children and young people Electronic health records Mandate to NHS CB – online access to own health records by March 2015 NHS CB will promote implementation of electronic records in all health and care settings RCGP – project to establish patient online access to own health records PHE establishing health and intelligence network for children and young people Will report indicators that extend to CYP and young adults in age-group bandings requested by forum Specific CYP health outcomes will be published Through strong partnerships with the voluntary and academic sectors, NHS commissioners and providers, and, critically, children and families themselves, the network will exploit information to influence the wider determinants of health, drive up standards in healthcare and improve health and wellbeing outcomes and reduce health inequalities on an on-going basis Maternity and children’s dataset Currently in implementation phase – data specified for collection from all NHS organisations from April 2013 NICE quality standards programme Antenatal quality standard has been published – postnatal quality standard in development Further 10 quality standards for children in development Further 32 referred as a library of topics – to be developed in due course NHS CB – trialling quality dashboards in 2012/13 for 20 prescribed service areas – 4 particular to CYP – paediatric neurosciences, paediatric intensive care, neonatal critical care, congenital heart services (paediatric cardiac services)

Incentives for driving service improvement National tariff: DH, NHS CB and Monitor working closely to manage transition Strategic work on pricing NHS CB and Monitor CQC’s use of data to target regulatory activity National tariff DH, NHS CB and Monitor working closely to manage transition from existing arrangements undertaken by DH and review clinical priorities and approach to the first National Tariff in 2014/15 NHS CB and Monitor – undertaking strategic work in pricing Focus – how payment mechanisms can be used as a key tool for clinically-led commissioning to incentivise and support improved health outcomes Monitor currently developing its strategy and proposals on pricing alongside the NHS CB, including tariffs that are independent of the provider setting CQC uses data and intelligence to target regulatory activity, including a Quality and Risk Profile for each registered provider. Where relevant will use any new data sources or information about children and young people’s experiences of care

Working with the voluntary sector What are the opportunities? What are the priorities? How best to engage the voluntary sector?