Office of Head of Planning, Performance & Programme Management – Primary Care
Briefing Note
Subject:
Children with Complex Medical Conditions
Meeting:
INMO
Date:
12.04.2017
The Primary Care Division of the Health Service Executive carried out a review of current policy and
practice in the provision of home care to children with complex medical conditions in 2014. As a result of
this Review the Primary Care Division began the process of implementing recommendations at the start
of 2015.
The Review recommended:
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The development and implementation of national policy and standard service development and
service delivery frameworks for this client group
The provision of clarification regarding general and clinical governance in respect of the
responsibilities and accountabilities of all service providers to this client group
Strengthening the discharge/transition processes between acute and community settings
Provision of a standard needs assessment tool that incorporates risk assessment
Standard approach to care planning and the development of the individualised care plan
Provision of training and continuous development of staff
Inclusion of a performance management process including clinical audit
Ensure that there are arrangements for the expedited transmission of the discharge summary to
the general practitioner and other clinicians accepting responsibility for the patients care after
discharge from the acute paediatric hospital or regional hospital to the patients’ home.
A review to be undertaken with immediate effect of all existing home care packages for this client
group. The review to be completed using a standard assessment tool incorporating the needs of
the child , the needs of the parent(s)/family/guardian(s), and the factors to be assessed.
The review should be undertaken with reference to the HIQA National Standards for Safer Better
Healthcare, 2012, as the benchmark, e.g. :
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Person-centred care and support
Effective care and support
Safe care and support
Better health and wellbeing
Governance
Workforce
Office of Head of Planning, Performance & Programme Management – Primary Care
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ICT & use of information
Every home care package to be risk assessed and a risk management plan to be developed and
implemented
Establish an effective process for engaging with the child and family/carer
The existing Service Agreements and Contracts with not-for-profit and for-profit providers to be
reviewed with the providers and amended where necessary to address services needs and any
clinical governance issues
Clinical and general governance responsibilities to be restated and reissued to all internal and
external service providers and managers in acute and non-acute settings - providers in the
statutory, voluntary, not-for-profit, and for- profit settings
Community case managers/ coordinators and the hospital discharge managers to receive joint
training regarding roles and responsibilities
The provision of a single IT based solution to support the overall management of services for this
client group, e.g. patient details, the discharge details to the receiving clinicians, care plan
including reviews and updates.
To ensure a coordinated and consistence approach to the delivery of services to children with complex
medical conditions across the country the Head of Operations – Primary Care convened three plenary
sessions with the key contacts in each Community Health Organisations (CHO) both at clinical and
managerial level. The outcome of this process saw the establishment of 8 work streams:
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Documentation – Review national/international reports to ensure all areas are
addressed in line with national and international best practice
Governance - General and clinical governance responsibilities and accountabilities
of all service providers clearly identified and documented
National Assessment Tool – A National Assessment Tool has been developed and
will be now proofed during the Quality Assurance process for PHCP to commence in
January 2017 and to be completed in Quarter 3/2017. Once the step is completed
the Assessment Tool will be implemented across the HSE
Discharge Planning Protocol - A National Discharge Protocol has been developed.
During the Quality Assurance process for PHCP, parent will be asked about their
experience of the Discharge Planning process, and final amendments will be made to
the protocol prior to publication in Q3-2017
Training – Training needs of all staff/disciplines in the delivery of home care
packages has been considered by a working group, currently discussion are ongoing
with the National Office for Nursing and Midwifery to finalise a training programme.
Standard Operational Procedures – To review existing SOP and agree a suite of
National SOP (Quarter 4 2017)
Procurement – In order to ensure the quantum and quality of homecare packages
provided by third parties, the HSE will approach the market place on the 25th
November 2016 to identified preferred providers. Process completed – 5 providers
identified.
Home Care Packages – Review of all existing home care packages (Children with
Complex medical Condition) (Q4 2016 – Q2 2017) to ensure that each package is
quality assured and expenditure is best value for money based on the clinical need
identified.
Office of Head of Planning, Performance & Programme Management – Primary Care
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The Quality Assurance Review will incorporate a questionnaire developed and
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ICT System, in Q2/2107, and ICT system will be in place for CHO to submit their
Business Cases for PHCP. The system will allow for approval on line, and for the CHO
to update the business case at anytime regarding additional resources and actual
costs incurred on a monthly basis. This will allow for real-time track of PHCP in
place.
ethically approved to ascertain parental views on Respite. The responses to the
questionnaire will inform the report of the national working group on Future
Respite Model.
A National Oversight Group was established chaired by the Head of Operations – Primary Care with
representation from the Social Care Division, National Hospital Office, National Clinical Programme for
Paediatrics and Neonatology and the Quality Improvement Division. The function of this group was to
oversee the implementation of the recommendations of the Review in line with National and
International best practice.
Each Community Health Organisations (CHO) established a Governance Group to oversee the
implementation of the Review and the quality of the care packages. Each CHO identified a key contact
person both at senior clinical and managerial level to liaise with the Hospitals in respect of discharge
planning process. In additional, the key contact at CHO level liaised with a designated senior manager at
National level (Primary Care) to address issues outside the direct remit of the CHO
The Hospital Groups were advised of the key contacts at CHO level in terms of the discharge planning
process and of the details of the senior manager at national level in the event of issuing arising, which
could impede the timely discharge of a child.
Engagement has taken place between the National Primary Care Division and the Hospital Groups, in
respect of the recommendations of the Review. Further engagement is planned in Quarter 4, 2016 in
respect of finalising a National Assessment Tool, Discharge Planning Protocol, Governance arrangements
between the CHO and Hospitals (National & Regional) and Training.
A streamlined process for approval and accessing funding at CHO level has addressed the delay that
existed prior to the introduction of the single standard application process. The application process
requires certification by senior clinicians and the Chief Officer that the home care package has been
quality assured; the governance arrangement are, and will remain, in place for the duration of the home
care package and the proposed expenditure is best value for money based on the clinical need identified.
The National Office reviews the business case and issues a decision within 1 working day to the Chief
Officer. The additional funding in 2015/16 for these packages is being sourced through the existing
National Primary Care Division Budget, with no additional allocation in the 2015/16 estimates process.
The challenge of identifying appropriately skill staff to meet the needs of children with complex medical
conditions through third party providers has been identified as a key issue in 2016. Therefore, the HSE
has reviewed the options pertaining to direct provisions, in terms of number of nursing and health care
assistance required and the governance models to be put in place.
In addition, the HSE will through the procurement process go to the market place in Q4 2016 to identified
providers who can specifically deliver homecare packages to children with complex medical conditions.
This process with ensure that there is a single governance process in place in terms of the provision of
care to children with complex medical needs, that the provider, has in place nursing staff and health care
assistance to deliver the required packages.
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Office of Head of Planning, Performance & Programme Management – Primary Care
Conclusion:
Children and with complex needs being cared for in their own homes is a small but increasing proportion
of those receiving community services. Expectations have increased regarding the extent of care that can
be provided in the home and services responses in the context of planning, development and delivery
models have not kept pace with demands.
Services for the care, development and treatment in the home of children with complex needs must be
developed in a planned, proactive way, which specifies the range and extent of services to be provided,
the skills sets required to provide the services, the standard of service to be attained and a clear budget
stream to fund services.
The HSE recognised the requirement for a cross-Divisional approach and on-going engagement with the
Community Health Organizations and the Hospitals Groups pending the full implementation of the
recommendations in the Report of the Review.
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