Paediatric Lead Programme

1. Professor Alf Nicholson
April 2014
Paediatric Lead Programme –
The first 2 years

2. What is it all about ?
“If I had to reduce my message …
to just a few words, I’d say it all
had to do with reducing
variation.”
Dr. W. Edwards Deming

3. 1990
2000
International trends in under 5 mortality rates.
10
9
7
9
12
6
11
7
6
4
5
7
5
9
4.5
6
3 3
5
3
8
0
2
4
6
8
10
12
14
Ireland UK Sweden Norway EU average Japan USA
Probabilityofdeathbeforeage5yrs,per1000livebirths
Source: WHO Health statistics and the European HFA-DB
2008

4. The Clinical Leads on Tour

5. A succesful and sustainable health system – how to
get there from here Fineberg NEJM 2012 ;
366:11:1020-1027
 Redouble efforts to enhance the quality
and safety of health care
 Keep patients out of hospital
 Find out what families want and honour it
 Smooth patient flow through the system
 Learn from peers and the evidence
 Value accountability above autonomy
 Adopt many strategies to reach one big
goal

6. Background
 changes in disease priorities for child
health
many ‘killer’ diseases have disappeared
emotional and behavioural problems affect 10 – 20%
 changes in parental expectation
loss of confidence in primary care provision
faster access to specialist care
‘informed’ client group
 changes in healthcare provision
reorganisation of infrastructure

7. Childhood cancer survival (Ireland) by deprivation
category, 1994-2005 (Walsh PM et al Eur J Cancer 2011)

8. Childhood cancer survival to 5 years:
Ireland (2000-2005) v Europe (2000-2002)

9. Public Health Expenditure as %
GDP
6.0
7.0
8.0
9.0
10.0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
%
Source: DoHC Key Trends 2013, CSO National I&E Accounts., DoF Budget 2014.
2009 9.6%
2013 8.5%
OECD Average 9.3%

10. Whole systems plan for child health

11. Hospital visits
 Formal site visit to every paediatric
department in year one
 Visit to all (34) tertiary specialities in
Paediatrics in year two
 Extensive discussion across disciplines
 Follow up visit if required
 Immediate feedback and resume of all
tertiary visits looking for common themes

12. Visitation reports
 Set proforma to each tertiary
subspeciality
 Following tertiary visits model of care
document by June 2014

13. Report card 2014
 184 page visitation document now HSE
policy
 National Charter for children (in
collaboration with patient reference
group)
 24/7 neonatal transport with additional
appointments

14. Report card
 25 algorithms developed for use by first
responders and GP’s and launched at
ICGP AGM
 Visitation of 34 tertiary subspecialities in
Paediatrics -> Model of care document
 National diabetes audit and model of
care for type 1 DM

15. A national model of care for
children and young people
 Avoid ‘postcode disadvantage’
 Improve primary-secondary interface
 NETS + PETS
 Adolescence and transition
 Strengthen regional care / networks and outreach
clinics
 New models for urgent care delivery
 National manpower plan for Paediatrics