1. NSF:Issues relating to early transfer for the surgical neonate RCN March 2006

2. Purpose of NSF for Children 2004 Increase quality of care Decrease variations in care delivery Partnership with health, social care and education

3. Specific aim Care will be Quicker and easier to access More closely matched to individual needs Better co-ordination between professionals

4. Specific aim (cont) Involving parents in care and decisions Better at achieving good results and outcomes More closely reflect what children and young people want

5. NSF (Children) ‘all children and young people achieve optimum health and well being and are supported in achieving their potential’

6. Background Strong links – socio-economic disadvantage in the health of children and subsequent health as adults

7. Background Child poverty rates highest in wealthy nations (UNICEF 2000) In part, full time worker earns less than 2/3rds national average wage High proportion of households in which no adult is working (UNICEF 2000, Perry 2001)

8. Background Pakistani and Bangladeshi most disadvantaged ethnic minority group Travellers, refugees, asylum seekers Low paid, insecure jobs, unemployment

9. Ethnicity Worst health are Pakistani and Bangladeshi men Refugee children, ¼ are asylum seekers who have been exposed to violence and multiple losses Elder children better language skills 25% of children 3x national average of psychological disturbance

10. Health inequalities Eighth Report of the House of Commons Select Committee of Health (2003) Need more care for mothers and baby in pregnancy Early postnatal influence of later development in health

11. Health inequalities Links between childhood disadvantage and health later in life Health of infant – continued legacy later in life Particularly birth weight/ Ht Low income, overcrowding- affects relationships in family life

12. Family Family structures, changing labour markets Where both parents not working- affects child in the future- related to chronic illness

13. Housing Where housing is an issue Increased incidents/accidents/ headaches/ respiratory and gastro- intestinal problems

14. Gender Females, usually guardian of the health of the baby Most vulnerable Depression/ stress

15. Role of the Nurse Consultant for Neonatal Surgery Enable transfer of baby from the main surgical centre to the local hospital near the family home

16. Family Local services Visiting Financial expenditure Child care Building relationships

17. Professionals Teaching / Education of nursing/ medical and PAM’s Communication CCN, H/V, G/P, other

18. Clinical practice Audit and Research Feedback Changing practice

19. Issues relating to early transfer Increased numbers transferred Resources Different protocols and guidelines Investigations Dietetics/ stoma resources