Evelina London Child Health
Programme
Integrating services
Claire Lemer
29th April 2014
England is failing it’s children:
Poor mortality
•UK child mortality rates among the highest in Europe
•Equivalent to 5 children per day excess deaths when compared to
Sweden
•>132,000 person years of life lost
•Healthcare deaths with modifiable factors: 21%
Poor morbidity
–Even the best group of T1 DM have poorer control than Germany or
Austria – 16% have HbA1C below 7.5% vs 34%
Inequalities widening
–Potential 59% reduction in psychological and behavioural problems, in
children and young people with conduct disorders if all children had the
same risk as the most socially advantaged
Source: Our Children Deserve Better: Prevention Pays CMO’s Annual Report 2012
Disease is changing
Priorities
Health
Variable and poor
outcomes
Fragmented
inconvenient
services
Failure to maximise
potential
Sustainability
Escalating cost
Integration needs are
different for children
and young people
Increasing demand
Workforce crisis
Health +Education= 100% children
Health + Social =2% children
2%
Aim of ELCHP
To serve children’s best interests by
improving quality and convenience of
everyday care
To serve the health economy’s
interests by increasing workforce and
financial efficiency
Social Adversity and Vulnerability
AIMS: to build resilience and emotional wellbeing
AIMS: to ensure that CYP are kept healthy and minor illnesses are managed in the most appropriate
place
INITIAL OUTCOMES: improved knowledge and use of healthcare
AIMS: to improve healthcare use by providing a better balance between access and expertise in the
community, preventing unnecessary trips to hospital.
INITIAL OUTCOMES: fewer visits to hospital, fewer avoidable hospital admissions
AIMS: to improve care of CYP to ensure that the right professionals with the right skills
work in the right place to detect serious illness promptly and provide safe effective care
INITIAL OUTCOMES: less time to diagnosis, reduced length of stay, improved patient experience
AIMS: to improve the outcomes of children and young people with chronic conditions
INITIAL OUTCOMES: fewer visits to A&E, fewer hospital admissions, more care meeting quality
standards, improved patient experience
AIMS: to improve quality and experience of care and to maximise health and wellbeing
INITIAL OUTCOMES: improved integration between services, better patient experience
supported by documented multi-professional care plans held by families.
AIMS: to improve quality and experience of care and to maximise mental health
INITIAL OUTCOMES: improved access to mental health services, better
coordination between physical and mental health care, better patient experience
Public Health and Health Education
AIMS: to bring prevention and health education into all front line care
How we are creating the case for change to reflect local
context and experience …
Connect
Feedback
from CYP
& families
Provider Data,
Reports &
Services
Feedback from Health
Professionals, Partners
& Stakeholders
Collect
Communicate
International
Evidence
National
Evidence
Local
Evidence
(Lambeth and
Southwark)
Phase 1:Understanding the Local Situation- Where feasible by practice level / locality / category
1.Primary Care Data
Visits adjusted by population by practice /
locality / category
2. Nursing Review
3. GP A+E Referral Audit
4. A+E Attendances
Visit trends national vs local
Visits adjusted by population by practice /
locality/ disease trends
5. A+ E Admissions
Admission trends national vs local
Admissions adjusted by population by locality /
disease trends
Less than 24 hour admissions adjusted by
population by practice /locality / category
6. Admission audit
7. Length of stay data
8. Wellbeing data e.g. immunisations / mortality
9. Cost data
10. Health Visitor Data
11. Survey of families
12. Focus Group of BME families
13. Survey of HCW: Hospital, Community, GP
14. Out patient Visits
Outpatient Audit
Attendances adjusted by population/ locality
15. Long Term Conditions
A+E visits by disease adjusted
Admissions by disease adjusted
Standard compliance (NICE e.g. Asthma)
GP Database
16. Complex Needs
Multiple service use audit
Focus Group
Long stayers
17. Post code of OPA
18. Integration Data
19. Additional Cost Data
Phase 1:Understanding the Local Situation- Where feasible by practice level / locality / category
1.Primary Care Data
Visits adjusted by population by practice /
locality / category
2. Nursing Review
3. GP A+E Referral Audit
4. A+E Attendances
Visit trends national vs local
Visits adjusted by population by practice /
locality/ disease trends
5. A+ E Admissions
Admission trends national vs local
Admissions adjusted by population by locality /
disease trends
Less than 24 hour admissions adjusted by
population by practice /locality / category
6. Admission audit
7. Length of stay data
8. Wellbeing data e.g. immunisations / mortality
9. Cost data
10. Health Visitor Data
11. Survey of families
12. Focus Group of BME families
13. Survey of HCW: Hospital, Community, GP
14. Out patient Visits
Outpatient Audit
Attendances adjusted by population/ locality
15. Long Term Conditions
A+E visits by disease adjusted
Admissions by disease adjusted
Standard compliance (NICE e.g. Asthma)
GP Database
16. Complex Needs
Multiple service use audit
Focus Group
Long stayers
17. Post code of OPA
18. Integration Data
19. Additional Cost Data
3. GP A+E Referral Audit
•
80 GP referrals to A+E audited by team of
professionals:
– GP, GP trainee, Paediatrician, Paediatric Trainee,
A+E Nurse, Paediatric Nurse
•
•
•
Number of unanimously unavoidable (i.e. no health care professional
thought interventions could prevent referral) 5%
Range in unavoidable referrals by health professional 25%(paediatric
nurse) to 99% (GP trainee).
Of avoidable referrals, top 3 preventative interventions by health
professional in order were:
–
–
–
•
Phone/ email hotline,
GP education
Community nursing.
7/8 health professionals thought a phone hotline could avoid the
highest percentage of unnecessary referrals
GP Practice Rate
CCG Average
GP Practice Rate
CCG Average
G85642
Visits by locality (unadjusted show considerable variation- adjusted awaited)
Visits by practice – adjusted:
G85051
•
•
G85623
National vs Local Trends – 7% increase over 3 years
G85095
•
G85050
G85034
G85707
G85082
G85721
G85007
G85723
G85042
G85019
G85001
G85685
G85012
G85094
G85030
G85134
G85013
G85052
G85726
G85692
G85644
G85097
G85712
G85138
G85006
G85125
G85119
G85029
G85031
G85132
G85084
0.0
G85632
1000.0
G85091
1500.0
G85009
2000.0
G85087
Lambeth CCG All Inpatient Attendances (Crude Rate per 10,000 GP Registered Population)
Ages 0 to 24 by GP Practice, 2012-13
G85715
2500.0
G85651
3000.0
Crude Rate per 10,000 GP Registered Population
4000.0
G85112
G85102
G85002
G85028
Y01962
G85647
G85073
G85618
G85054
G85724
G85041
G85127
G85047
G85137
G85136
Y00020
G85674
Y03063
G85690
G85045
G85078
G85088
G85109
G85011
G85133
G85044
G85123
G85100
G85673
G85682
G85025
G85086
G85129
G85039
G85118
G85130
G85022
G85053
G85021
G85096
G85662
G85083
G85014
G85113
G85135
G85695
G85016
G85708
G85706
G85010
Crude Rate per 10,000 GP Registered Population
4. A+E Attendances
Southwark CCG Respiratory Attendances (Crude Rate per 10,000 GP Registered Population)
Ages 0 to 24 by GP Practice, 2012-13
300.0
3500.0
250.0
200.0
150.0
100.0
500.0
50.0
0.0
5. A+ E Admissions
Admissions by disease by locality adjusted.
•
Emergency Inpatient Admissions (Ages 0-19), Crude Rate per 10,000 GP
Registered Population, for Gastroenteritis by Lambeth CCG GP Locality
Crude Rate per 10,000 Registered Population
30.0
25.0
20.0
15.0
10.0
5.0
0.0
North Locality
Southeast
Locality
Southwest
Locality
North Locality
Southeast
Locality
2010-11
Gastroenteritis (A09, K52)
Southwest
Locality
2011-12
2010-11 CCG Average
North Locality
Southeast
Locality
2012-13
2011-12 CCG Average
2012-13 CCG Average
Southwest
Locality
13. Survey of Health Care Workers:
Hospital Trainees -1
51 Trainees across 3 hospitals
13. Survey of Health Care Workers:
Hospital Trainees -2
How often do trainees discuss health promotion?
13. Survey of Health Care Workers:
Hospital Trainees -3
What do trainees discuss?
13. Survey of Health Care Workers:
Hospital Trainees - 4
When discharging a child or young person form A&E, are
they advised where to go if they have on-going concerns?
18. Integration Data -1
How i nt egr at ed do you t hi nk E vel i na i s cur r ent l y
V er y
Somewhat
A Li t t l e
Not at al l
18. Integration Data -1
Do you f eel you know t he services of f ered by c/ h?
Yes
Somewhat
No
18. Integration Data -1
Do you have a met hod f or ident if ying t he right person t o cont act in c/ h?
Yes - direct ory
Yes - Personal Cont act
No
18. Integration Data -1
Can you think of example pathw ays w hich are w ell
integrated
Yes more than 10
Yes more than 5
Yes 0-5
No
Acute Hub
Acute Assessment Centre
Short Stay Unit
Community Children’s Nursing
Acute
Hub
Non Acute
Hub
Non acute hub
Hub & Spoke Model (L&S)
Single Point of Entry
Evelina
Academy
Primary care plus
Family Education Sessions (pm)
Lead by Primary Care (L&S)
Reducing Admissions to hospital
Direct Access to Diagnostics
The Evelina Academy
Purpose: Education &
Training for
Professionals:
Families:
Primary
Care
plus
Supporting
Primary
Care
Supporting primary care
Guidelines
Protocols
Standards