The document discusses transitioning young people from pediatric to adult healthcare in the UK National Health Service (NHS). It provides context on children's health outcomes and outlines the role of the Children and Young People's Health Outcome Forum. It then discusses several key themes and issues around transitioning including integrating services, general practice, transition to adult services, and networks. The document proposes objectives for children and young adults in the NHS Outcomes Framework and additional objectives focused on transition, mental health, long-term conditions, and specialised services. It discusses establishing clinical networks and commissioning to support the transition process and improving outcomes for young people in the NHS.
NHS England Guidance on Transition to Adult Services
1. NHS England – Safe
Transition for Young
People to Adulthood
Dr Jacqueline Cornish,
National Clinical Director Children,
Young People and Transition to
Adulthood
July 31st 2013
2. National Context
Children lose out to demands of adults in NHS, says report
Failure to provide more than 'mediocre services' argues Sir
Ian Kennedy - 2010
3. Children & Young People Health Outcome
Forum: Role
The Forum was launched on 26 January 2012 and
reported to the Government with independent advice in
July 2012 on:
•The health outcomes that matter most for children and
young people
•How well these are supported by the NHS and Public
Health Outcomes Framework
•How the different parts of the health system will
contribute and work together in the delivery of these
outcomes
4. Children & Young People’s
Health Outcome Forum:
‘No decision about me without me’
Key Themes
Promoting Health
Acute illness
Long term
conditions
Disability
Mental Health
Palliative Care
Life Course
Premature/ LBW
Early Years
School child
Teenager
Young Adult
Cross cutting Issues 1
Cross cutting Issues 2
Integrating services
General Practice
Safeguarding
Looked after children
Inequality
Transition to adult services
Choice
Information and data
Technology
Education & Workforce development
Clinical leadership
Aligning NHSE and PHE care outcomes
Levers of funding – PbR / CQUINs
Networks – local / hub; specialised; national
5.
6. The NHS Outcomes Framework will be organised
around 5 national outcome goals/domains that cover
all treatment activity for which the NHS is
responsible.
Networks will support local clinicians to deliver the
Framework in local systems
Domain
1
Preventing people from dying prematurely
Domain
2
Enhancing quality of life for people with long-term
conditions
Domain
3
Helping people to recover from episodes of ill health
or following injury
Domain
4
Ensuring people have a positive experience of care
Patient
experience
Domain
5
Treating and caring for people in a safe environment
and protecting them from avoidable harm
Safety
Effectiveness
7. NHS Outcomes Framework
NCD Children, YP and Transition - Objectives
Preventing people from dying
prematurely
Reducing avoidable deaths –
perinatal/neonatal, infant, focus
on injury, childhood cancers
Enhancing quality of life for
people with long-term conditions
Reducing time spent in hospital
Unplanned hospitalisation
asthma, diabetes , epilepsy
Helping people to recover from
episodes of ill health or following
injury
Emergency admissions for
conditions not usually requiring
hospitalisation, improving recovery
from injuries & trauma,
Ensuring people have a positive
experience of care
Improving Children, YP and
Families experience of
healthcare (GP, OOH’s, A&E,
acute IP care, end of life care)
Treating and caring for people in
a safe environment and
protecting them from avoidable
harm
Harm due to ‘failure to monitor’,
delivering safe care to children
in acute settings
Medication errors, infections
8. NCD Additional Objectives
• Generic Framework for consistent approach to Transition to adult
services, & measurable outcome indicators to inform commissioning
• Mental Health on a par with physical health, measurable progress towards
parity of esteem, roll out of CYP IAPT programme.
• Acutely sick child – supporting urgent care through Primary/Secondary Care
Interface and OOH services, with appropriate workforce needs assessment
• LTC’s, Disability and Palliative Care in children – support and develop
integrated care pathways, and enhanced community nurse support
• PbR – Lead commissioning support of tariff for directly and CCG
commissioned services for CYP and Fetal Medicine
• Work with DH and DfE from NHS England to support response to Pledge,
working also through Children’s Health and Wellbeing Partnership and EIF
• Identifying and addressing inequalities in vulnerable children: looked after,
adopted, travellers, those in criminal justice system
9. The New System
Department
of Health
NHS
Public
Health
England
NHS England
(Local health
improvement
in LAs)
Clinical Commissioning
Group
Monitor
(economic
regulator)
CQC
(quality)
HealthWatch
Primary Care
Specialised
Providers
Local authorities (via health &
wellbeing boards)
Local
HealthWatch
10.
11. Medical Genetics
Mental Health
Paediatric Surgery
Paediatric Medicine
Women and Children
Paediatric Cancer Services
Paediatric Cardiac Services
Blood and Cancer
Metabolic disorders
Paediatric Intensive Care
Trauma
Neonatal Critical Care
Paediatric Neurosciences
Internal Medicine
Complex Gynaecology
Specialised Maternity
Fetal Medicine
Multi-system disorder
12. Women’s and Children’s Programme of Care
•Specialised Service status achieved for Paediatric Palliative Care
•35 Service Specifications and 5 Policies delivered across 12 Clinical
Reference Groups – all clinicians committed and enthusiastic to
ensure safe commissioning of whole pathway, from primary and
secondary to tertiary care
•Children’s Services described in 43 of the former SSNDS
•Need identified for a Generic Paediatric Service Specification, to
be appended to all Service Specifications where Children described.
This could also have potential as guidance for CCG commissioning of
Children’s Services, work in progress
•Develop work programme for 2013-14, Transition a priority
•Work alongside SCN’s
13. NHS OUTCOMES FRAMEWORK
CLINICAL REFRENCE GROUPS
PATHFINDER
STRATEGIC
GROUPS
CLINICAL
NETWORKS
CLINICAL COMMISSIONING
GROUPS
PRIMARY CARE
14. Geography
North East, north Cumbria,
and the Hambleton &
Richmondshire districts of
North Yorks
• 12 senate
Greater
geographical areas
Manchester,
Lancashire and
• One core support team south Cumbria
Cheshire &
per senate
Mersey
• Number and size of
West
Midlands
each network is locally
determined, to take
Thames
Valley
account of patient
flows and clinical
South West
relationships
Yorkshire &
The Humber
East
Midlands
East of
England
London
Wessex
NHS | Presentation for SCN Development Day| [21 st May 2013]
South
East
Coast
15. Proposals for CYP SCN Work Programme
•D1 – 40% premature babies hypothermic, temp< 36.5
•D2 – LTC’s – Depression - poorly defined and diagnosed
Diabetes - poor HbA1c levels
Asthma - only 7% of patients have management plan
Disability – on 50% hav
•D3 - Paediatric Surgical Networks, particularly GPS
Transition to Adulthood Policy
•D4 – Palliative Care, end of life plans, choice of place of death
•D5 – DNA Policy, present, adhered to? Safeguarding implications
Medication errors
Paediatric safety thermometer – the deteriorating child
16. Different Types of Network
NHS Outcomes Framework
Senates [12]
Strategic
Clinical Networks
Local
Professional
Networks
Operational Delivery
Networks
Other
Local
Networks
“The conscious
and guiding
intelligence”
“Engines for change
and improvement
across complex care
systems”
“Gathering
frontline knowledge
and expertise”
“Mapping patient
pathways to ensure
access to specialist
support”
“15 AHSNs: Masters of
science and evidence
based practice”
Multiprofessional
i.e. Cancer; CVD;
Maternity and
Children’s; Mental
Health / Dementia /
Neurological
Conditions
i.e. Pharmacy; Eye
health; Dental
e.g. Adult Critical Care;
Neonatal Intensive
Care; Trauma; Burns;
Paediatric NM;
Paediatric IC
e.g. Academic Health
Science Networks,
Research Networks
NHSCB Network Support Teams (AT-based)
Annual national priorities from the NHSCB Medical and Nursing Directorates
All supported by Improvement Body and Leadership Academy
17. Young People’s Transition to Adulthood
• Opportunity - Uniform commissioning – Direct and CCG
National process with national engagement
More equity, resulting in secure systems for delivery
High level input from the NHS
•Challenge - Service re-design moving towards integration
Precise definitions of levels of skills and workforce needed
Whole pathway approach with appropriate and timely Transition to Adult Services
Absolute clarity in Service Specifications, define outcome indicators
•Conundrum - To link all the parts of Transition service pathways from Primary to
Secondary & Tertiary care, working with CCGs to commission a care continuum with SCN
support.
•Solution - SCN Work Programmes and Pathfinder Working Groups – eg developing
guidelines for the CCG commissioned elements of the complex transition paediatric
pathways - neurodisability/rehab pathway, paed diabetes, LTV,
•Working Relationships – Close working vital with: CRG’s and other POC’s,
Children and Young People Health Outcomes Forum
Royal Colleges including RCPCH and RCP, RCN, RCGP,
DH and DfE, PHE, HEE, NICE, CQC, Monitor, Charitable Sector.
18. Objectives for Today
•To share learning from existing good practice – successes,
challenges and barriers to implementing clinically and patient designed
Transition models
•To define the critical elements of an effective Transition model
•Using the above, develop a generic Service Specification as a
commissioning template, onto which all specialised and complex
services can be bolted
•Start to consider measurable outcome indicators against which
successful Transition plans can be commissioned and monitored
Notas do Editor
An overview of how the new system works. (Still a bit simplified – e.g. doesn’t show NICE or Information Centre)
Animated:
DH allocates £ and sets objectives for NHS CB. No longer any NHS HQ in DH
NHS CB allocates to GP consortia
Who commission services from a range of providers
Who are regulated on a consistent basis (no longer some of them managed by SHAs): by CQC as now for quality and by Monitor as economic regulator (3 functions: 1 promote competition, 2 regulate prices, 3 ensure continuity of essential services)
Meanwhile LAs have new role shaping NHS commissioning
LAs also feed into new public health service, with their role taken from PCTs of promoting local population health improvement. And Public Health England itself is now part of DH, with a separate, ring-fenced budget. More details published in Healthy Lives, Healthy People White Paper
Then adult social care: no change to structure (the debate is about financing – Dilnot commission)
Finally, HealthWatch, nationally and locally
So DH does strategic coordination at national level; LAs at local level.
From 1 April 2013, with the formal introduction of the Health Act changes, there will be various and new types of clinical networks in the NHS . You may not need to understand the differences as what unites networks is much greater than what differentiates them. However, if you do feel the terminology is confusing this is an attempt to clarify matters.
Networks are differentiated by their focus and their governance arrangements. It is the role of the host to ensure that the network itself is effective and meeting members’ needs. There is more information about each type of network on subsequent slides.
Some such as strategic clinical networks focus on broader strategic issues, whereas local professional networks and operational delivery networks are more operational. However strategic networks will at times address operational issues and sometimes an ODN will have the right members to address a particular strategic issue.
Some are hosted and funded by commissioners and some by providers, but all sit between commissioners and providers in their way of functioning, as described earlier.
Some are nationally mandated; some only exist in some parts of the country in line with local need. Eg local respiratory networks hosted by CCGs
Some networks, such as academic health science networks and research networks focus on the innovation ‘end’ of the improvement spectrum as opposed to the dissemination and spread of acknowledged best practice.