1. 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

2. 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

3. 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

4. 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

5. 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

6. 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)

7. 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

8. 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

9. 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

10. 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)

11. 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

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