1. Children’s Palliative Care: National Policy Context and the Child Health Strategy
Liz Morgan
Professional Advisor – Children and Young People
Department of Health
January 2009

2. Setting the Context….

3. The NHS Next Stage review: High Quality for All (DARZI)
Working with NHS staff to ensure that clinical decision-making is at the heart of the future of the NHS and the pattern of service delivery
Improving patient care, including high-quality, joined-up services for those suffering long-term or life-threatening conditions, and ensuring patients are treated with dignity in safe, clean environments
Delivering more accessible and more convenient care integrated across primary and secondary providers, reflecting best value for money and offering services in the most appropriate settings for patients
Not much to say here.
[NB - People are fully immersed in the Next Stage Review and will have just presented findings from their regional work]

4. Defining Quality (NSR)
Three elements:
Patient Safety
Effectiveness of Care
Patient Experience

5. Principles of Change Co-production – working together
Subsidiarity – decisions made as close to patients & the community as possible
Clinical Leadership
System alignment – same goals

6. Key Policy Messages translated to Children & Families
Listening to the child & family
Developing services around the family
Care closer to home/at home
Integration of the workforce
Partnership working – across health, education & social care

7. Children’s Policy Drivers….

8. The Children’s Plan: Building brighter futures
Children’s Plan sets out the vision for children & young people, and trailed development of a Child Health Strategy.
Government’s 2020 ambition for all children and young people is to:
Secure the wellbeing and health of children and young people;
Safeguard the young and vulnerable;
Achieve world class standards in education; and
Close the gap in educational achievement for children from disadvantaged families
Ensure young people are participating and achieving their potential to 18 and beyond
Keep children an young people of the path to success.

9. Health & NHS Policy (incl. Darzi)
Vision of Health Services shaped to promote health and care for ill health or vulnerability in childhood
Cross- Govt plan outlines how DCSF will work with other Govt Departments, families, communities and front-line staff to improve the lives of children over the next decade
Health & NHS Policy (incl. Darzi)
Child Health
Strategy
Children's
Plan
Key points:
Children’s Plan reflects existing vision for child health as set out in Every Child Matters and the Children and Maternity National Service Framework.
The Children’s Plan aims to provide a roadmap for Government policy on children, young people and families. It aims to set out both 10 year ambitions and specific new policies to accelerate progress over the CSR period.
As a key partner we are fully committed to ensuring the NHS plays its part in improving the health outcomes for children.
By 2020 Govt has set out ambitions to see:
families able to grow up free of blight of child poverty, with child poverty halved by 2010 and eradicated by 2020
children enjoying healthy lifestyles and outcomes, with the proportion of overweight and obese children back to 2000 levels
all children with the social and emotional capabilities that they will need for a successful adult life; and
all children able to enjoy an active childhood.
Plan trailed further work in the next year including:
Publishing h an Obesity Strategy
Undertake a review of Child and Adolescent Mental Health Services
Publishing a child health jointly between DCSF and DH.

10. The Child Health Strategy must respond to the specific challenges faced by vulnerable groups and ill children, as well as promoting healthy behaviour by all children and young people
We need to ensure services are sufficiently:
Integrated
Personalised
Preventative
Targeted
We are struggling to meet many of today’s biggest public health challenges and there are worrying trends.
Health promotion is critical.
All
Ill
Vulnerable
Children with long term conditions or disabilities do not get the support needed to fulfill their potential.
Key issues around access to specialists and age-appropriateness of settings where treatment is received.
We do not consistently undertake risk assessments and target support.
Groups suffer disproportionately poor health outcomes
Miss opportunities to intervene early
The challenges we face for children and young people’s health vary depending on which group is being considered.
The Child Health Strategy must seek to improve:
Health promotion for all children and young people (blue) e.g. rising rates of obesity and binge drinking
The early intervention necessary for those who are vulnerable to poor outcomes (pink) – we know that Look after children have pooper health outcomes than their contemparies
And the management of illness and access to specialist care for those children who are ill (yellow).
Of course there are links between the needs of all three groups, but the Strategy would be remiss if it did not reflect the needs of all of these groups.
In terms of the health outcomes that we want to promote….[next slide]

11. Child Health Strategy Emerging themes:
Health promotion and prevention (eg informing families and supporting healthy lifestyles)
Early intervention
Personalised and integrated services (accessible and designed around the needs of users)
Effective, targeted access to specialist services

12. Child Health Strategy Key Challenges to address:
Unwanted variability in outcomes and
effectiveness of services
Poor co-ordination of services – a barrier to personalisation and a shift to prevention
Nature of public health challenges

13. Other Links and Dependencies
Darzi Next Steps Review
Maternity and neonatal services networks
Bercow review into services for children with speech, language and communication needs.
Healthy schools programme
Facing the future (Health Visitors)
Neonatal Taskforce
Child Health Promotion Programme (Healthy Child Programme)
Family Nurse Partnership
Care Closer to Home (Our Health, Our Care, Our Say)

14. Links and dependencies contd…
HR issues around the wide range of employers/organisations providing NHS services
Public Health
Long Term Conditions
Palliative Care (including End of Life Care)
‘Better Care: Better Lives’
“Aiming High” programme for Young People and Disabled Children
Modernising Careers (nursing, medical etc)
Working Time Directive (including more consultant Paediatricians)
Interdependencies of Specialist Services

15. Children’s Palliative Care

16. The Government’s Response:
“Better Care,
Better Lives”

17. The Vision…
“Every child and young person with a life-limiting or life-threatening condition will have equitable access to high-quality, family centred, sustainable care and support, with services provided in a setting of choice, according to the child and family’s wishes.”

18. Priority Areas Planning and developing an effective and responsive
Improved data
Planning and
developing
an effective
and responsive
workforce
Equality of access to universal services
Responsible and accountable leadership
Choice in preferred place of care
Better end-of-life care
Stronger commissioning & value for money
Successful transition – children’s to adult services
Expansion of respite/short break services
Investment in Community Children’s Nursing services

19. Current Children’s Workforce Issues
Darzi Next Stage review including maternity, the new born and children’s services as well as the review of workforce planning - ‘High Quality for All’
Primary Care Strategy
Inequalities Agenda
DSCF long term Workforce strategy to support 10 year Children’s Plan
PCT & LA Joint Needs Assessments – joint commissioning and workforce planning
SHA role
National Neonatal Taskforce (including workforce sub-group)
Maternity – current and future services, access to help and advice within 12 weeks of pregnancy
Adolescent health

20. What do we mean by the Children’s Workforce?

21. Workforce Directorate
Patients
DH Policy
RCOG,RCN,
CPHVA,RCGP
DH Clinical
leads
NMC
DSCF
Workforce Directorate
BMA, Unison and Unite
RCM
Children
Jointly agreed
approach
HVA
CSIP
SHAs/PCTs
& Providers
NHS
Professionals
???? HR
Services
Other stakeholders
e.g. CWN,CWDC
Workforce Directorate
Pay &
Pensions
Regulation
Skills for
Health
Workforce
Review
Team
Education
&
Training
NHS
Employers
National
Workforce
Projects

22. Workforce Priorities Health visiting School nursing Neonatal nursing
Community Children’s Nursing
Paediatric medicine
Speech and Language Therapists

23. Making it Happen:
Levers and Initiatives to drive change……..

24. Child Health and Wellbeing is a priority for the Government as reflected in a Number of Public Service Agreements:
The Children, Families and Maternity Branch has a structured Programme of work in Support:
PUBLIC SERVICE AGREEMENTS:
PSA 12: Improve the Health and Wellbeing of Children and Young People;
PSA 13: Improving Children and Young People’s Safety
PSA 14: Increase in the Number of Young People on the Path to Success;
PSA 18: Promote better Health and Wellbeing for All;
PSA 19: Better Care for All

25. Child Health and Wellbeing is a priority for the Government – this is reflected in the NHS Operating Framework and related Vital Signs and NIS indicators
NHS Operating Framework
Children and maternity services are identified as part of the national priority areas for
Supporting this 5 of the 12 PSA indicators focus on child health, & 4 are reflected in the Vital Signs indicators for PCTs
3 of these PSA indicators – breast-feeding at 6-8 weeks, obesity among primary aged children, and CAMHS – are national priorities for local delivery i.e. all PCTs required to include in local plans
There is also a PSA priority on services for disabled people & therefore includes CYP – PCTs working with communities and local partners prioritise for themselves

26. 2009/10 Operating Framework
‘five key Areas where PCTs are expected (working with local partners) to pay particular attention:
Improving cleanliness and reducing HCAI’s
Improving access through the 18 week referral pledge & access to GP services
Keeping adults & children well, improving health and reducing health inequalities
Improving patient experience, staff satisfaction and engagement
Preparing to respond in a state of emergency, such as an outbreak of pandemic flu’
A key vehicle for improving services within DH is the Operating Framework – published each year to set out key priorities for the next twelve months (?2 years) to which PCTs are expected to respond and take lead locally.
One of the five key areas for work this year has been improving health and well-being including children - a strong lever for arguing the case for improving investment in CF&M services especially improving services and experience for children with disabilities and their families.
(NB Emphasise that children are specifically mentioned in current doc – first time)

27. Making it Happen Responsibility for Local delivery……

28. Commissioning is the Key
World Class Commissioning
Transforming Community Services
Outcomes and quality focussed
Data & evidence

29. Clarity of components What needs to be done, based on best evidence.
Who needs to do it, based on competencies.
Where it needs to be delivered, based on safety and convenience.
With what additional resources e.g. equipment, investigation access, decision support.

30. And finally…..
Transforming Community Services

31. Strategic Context
Key Messages from the Primary and Community Care Strategy
Community services are critical to the delivery of improved services for patients and communities
There is much good practice but too much variation in quality and outcomes
Investment in staff and infrastructure is required to develop and deliver excellent ‘out of hospital’ care
Clinical staff are central to driving change to improve quality, access and health outcomes
something like Staff need the business tools to support them commission and provide high quality community services.
DH is committed to driving the national improvement programme
DH is committed to working with and supporting clinicians working in the community to maximise the potential for
Best heath services and health outcomes
Rewarding clinical careers and opportunity in the community
Incentivising high quality and innovation
I was asked to be funny which I can not promise but I do promise to be to the point.
I want to start by looking at community services and what we know about them and what we do not know about them
Then I will cover the strategic goals and benefits that we expect to realise through out this project before looking at a broad overview of the work streams that make up the metrics project.
At the end of July a guidance document will be published based on a review of information models across the NHS and international examples and I will talk about 3 key messages from that review
I want to conclude on what can you be doing now to improve your services in regards to metrics
Just ask questions along the way

32. Our Vision : Primary and Community Care Strategy
sets out a vision for primary and community care
Where people shape services – giving people more say and more choice and more control in their own health care
Which promotes healthy lives and tackles health inequalities – working with key partners
we have a huge opportunity to deliver transformational change
Where services are continuously improving quality through effective clinical leadership ,new freedoms and improved infrastructure
I was asked to be funny which I can not promise but I do promise to be to the point.
I want to start by looking at community services and what we know about them and what we do not know about them
Then I will cover the strategic goals and benefits that we expect to realise through out this project before looking at a broad overview of the work streams that make up the metrics project.
At the end of July a guidance document will be published based on a review of information models across the NHS and international examples and I will talk about 3 key messages from that review
I want to conclude on what can you be doing now to improve your services in regards to metrics
Just ask questions along the way
Where public and clinical professionals are leading local change and developing best practice and joined up local services

33. Strategic Context Transforming Community Services Programme
High level aims
Transforming Community Services Programme
Clinical and service improvement
Development of clinical and leadership skills and resources to deliver high quality evidence based care and services that promote health and well being with action on inequalities. 1
Business improvement Strengthening business process. Reforming the provision and commissioning of community services. Enabling performance and outcomes to be demonstrated and benchmarked, driving-up quality and reducing variation in performance. 2
I was asked to be funny which I can not promise but I do promise to be to the point.
I want to start by looking at community services and what we know about them and what we do not know about them
Then I will cover the strategic goals and benefits that we expect to realise through out this project before looking at a broad overview of the work streams that make up the metrics project.
At the end of July a guidance document will be published based on a review of information models across the NHS and international examples and I will talk about 3 key messages from that review
I want to conclude on what can you be doing now to improve your services in regards to metrics
Just ask questions along the way

34. Clinical services improvement
Objectives and scope
Benefits
To determine action that is required at national level to enable local leadership and delivery of best practice, evidence based care and excellent patient experience in six key areas.
To enable change in community services through focus on six key areas by providing leadership, tool kits and approaches to quality and incentives at national level. Six key areas: Health improvement and health inequalities Children and Families Long term conditions Acute care and specific treatments to be delivered close to home Rehabilitation End of Life
Six high impact changes being developed for each area through clinical engagement.
I was asked to be funny which I can not promise but I do promise to be to the point.
I want to start by looking at community services and what we know about them and what we do not know about them
Then I will cover the strategic goals and benefits that we expect to realise through out this project before looking at a broad overview of the work streams that make up the metrics project.
At the end of July a guidance document will be published based on a review of information models across the NHS and international examples and I will talk about 3 key messages from that review
I want to conclude on what can you be doing now to improve your services in regards to metrics
Just ask questions along the way

35. Thank you for listening
Questions?