Title: CHILDRENS INTEGRATED HEALTHCARE
1CHILDRENS INTEGRATED HEALTHCARE
2Policy and clinical context
3Policy context
- Childrens NSF
- Every Child Matters
- Improving the Life Chances of Disabled People
- Choosing Health White Paper
- Laming report
- Children Act 2004
- Our Health, Our Care, Our Say White Paper
- HM Treasury Children Young People Review 2006
4Paediatric Workforce Dilemmas
5Why start with doctors??
- Show stopper or rate limiting function
- Issues are exemplars for other professional
groups - Deadline is bearing down on us
- NWP is supporting the project!!
6Current situation - UK
- Junior grades
- 60 of junior paediatric rotas are not 2009 EWTD
compliant - Consultants
- Medium DGH - needs 8 consultants per paediatric
rota. Current average approx. 5 - Consultant expansion has fallen off from 7.3
(2001-3) to 4 (2003-5)
We are short of doctors at all levels
7Requirement to achieve consultant WTD
- Modelling for DGH services only
- If all doctors gaining a CCT in paediatrics were
employed by 2009 (9.5 growth), we would still be
approx. 400 short to achieve compliance - Real shortfall will be greater we will not have
9.5 growth
We can only staff 75 of current hospitals
8What is happening on the ground?
- At continuing consultant expansion of 4 and
average retirement 61 (as per last census) we
will have 300 unemployed consultants by 2009 (not
factoring in European competition for posts) - Paediatrics has become a low competition
speciality, although still retaining high fill
for run-through posts. HOWEVER gaps in FTSTA
posts and in middle grade.
9What do workforce figures tell us?
- Planning on consultant requirements (based on WTD
compliance) - We need to EXPAND numbers entering training
- Modelling expansion against current rate of
consultant growth - NHS cant afford to employ the consultants we
will produce
10Conclusion from workforce figures
- Middle grade numbers will have to reduce
- AND / OR
- CCT holders (specialists) will need to deliver
the service currently delivered by middle grades - Is this sustainable?
- Where front-line consultant-delivered model has
been running for some time (e.g. Basingstoke)
there are problems of sustainability
11Mind the gap!
12Childrens Healthcare Needs
13The Primary-Secondary Gap
14Incomplete fill by Secondary Care
SECONDARY CARE
15Incomplete fill by Secondary Care
GAP SET TO WIDEN SECONDARY CARE MODEL NOT
SUSTAINABLE!
SECONDARY CARE
16Is sustainability just a numbers game?
- Sustainability is not about
- Having enough staff to hang on by fingernails
- Services must
- Meet quality standards
- Be child / young-person friendly
- Utilise appropriately trained staff
- Be part of functional pathways and networks
- Produce demonstrably good and improving outcomes
17Developing Out-of-Hospital Services
OUT-OF-HOSPITAL PAEDIATRICS
HOSPITAL CARE
18Why deliver care on or off a hospital site?
- Hospital site needed for conditions that are.
- Serious
- Rare
- Need high tech equipment
- Need inpatient care
- Hospital site not needed for conditions that
are... - Minor
- Common
- Do not need technical equipment
- Need local access
SITE MAY BE DETERMINED BY CHOICE, NOT JUST UTILITY
19Enter Sir Ara Darzi
Londoners will view their polyclinics as their
main stop for healthcare well-being and support.
GP practices will be based at polyclinics.but
the range of services will far exceed that of
most existing GP practices.
20Enter the polyclinic.?
POLYCLINIC
HOSPITAL CARE
21Its integration, not site that matters!
INTEGRATED CHILDRENS CARE
HOSPITAL CARE
22Reconfiguration the answer to all our problems??
23Is reconfiguration the answer?
- Current medium-sized DGH serving 300,000
- Most units managing on single rota for
consultants SpRs, double rota for SHOs - Move to large hospital serving 500,000
- May tip into double consultant, SpRs, and SHO
rotas - May require paediatric cover for non-inpatient
sites - Can therefore increase staffing requirement
24Limitations of reconfiguration
- Solutions that are best for adult services are
not necessarily best for childrens services - Solutions that are best for financial
sustainability are not necessarily best for
childrens services - In worst case scenario reconfiguration can
exacerbate childrens workforce problems
25Solutions
- One size will not fit all (urban versus rural
models) - Reconfiguration is not the whole answer
- Consider completely new models
26New models of care Integrated
childrens provision in urban settings
27Unplanned care
- What unplanned care services are delivered on
hospital site by secondary care team? - Emergency and inpatient care 30
- Urgent care (high percentage of primary care)
70
28Planned care
- What services are delivered on hospital site by
secondary care team? - Planned investigation and treatment
- Outpatient work (mix of primary and secondary)
29Organisational structure
Hospital
PCT
Childrens Integrated Healthcare Centre
Single Childrens Healthcare Provider or
Consortium
30Services provided
Childrens Integrated Healthcare Centre
Urgent care up to 6-7pm Health promotion,
immunisation etc. Long-term condition management
including children with disabilities, diabetes,
eczema etc. Other non-urgent care - e.g. skin
lesions, constipation, tummy aches etc.
31How many and where?
GP
GP
Extended School
CIH
GP
GP
Childrens Centre
CIH
GP
GP
GP
GP
DGH
GP
GP
CIH
GP
GP
CIH
GP
GP
GP
32Key features
- Joint working between primary and secondary care
staff - Single integrated provider, integrated funding
streams - All practitioners appropriately trained to manage
childrens care - Shared governance
- Shared space
- Shared learning
33What is not planned
- For work currently done by the majority of GPs to
move into the proposed centres - For paediatricians and secondary care
practitioners to take over existing primary care
practice
34Advantages for children
- Right care in right place
- Right professional in right place
- Services closer to home
- Better long-term condition management
35Advantages for Trusts
- Shared venture, single provider shared income
and no winners and losers based on where child
seen - Buffer for acute trusts as care moves into the
community, workforce can follow through
incrementally selling sessions to the
consortium
36Advantages for workforce sustainability
- Economy of scale through vertical integration
between primary and secondary care - Better sharing of child-skilled
multiprofessional team - Allows career development, with possible move
from more to less acute roles
37Advantages for training
- Shared learning environment
- Better environment for all GP trainees to gain
basic paediatric experience .and for some GPs to
gain more specialist paediatric skills - Opportunity for supporting advanced nurse
practitioners and other professionals to gain
relevant skills (e.g. non-medical prescribing)
38Birth of the National Collaborative
39How do we all come to be here?
- Meeting 24th July
- Follow on from previous project led by Hilary
Cass in North Central London - Supported by National Workforce Projects.
- Chaired by Wendy Reid (Postgraduate Dean, London)
- Strong input from Sheila Shribman (NCD)
- Group of interested clinicians and managers
- Suggestion to form National Collaborative to
scope the proposals - Chair Jonathan Smith (CEO, Cheshire Merseyside
Child Health Development Programme) - Steering group set up
- Project dual reporting lines to NWP and DH
40But would it really work?
41What are the essentials?
42Can we get there incrementally?
- Not easily needs a leap of faith!?
- Aim of modelling and planning is to make the leap
safer and shorter!!
43Three key elements
- PPI work if children and families dont support
the model, its not viable - System dynamics modelling to help with safe
leaping! - Scoping of logistics to ensure well prepared
leaping.