under 4s attended accident and emergency in 2011/12 (that s 441 per 1,000 of the population)

Transcription

1 East Midlands Children's Strategic Clinical Network Poverty affects 1 in 5 children 28% of accident and emergency attendances were 0-19 year olds in 2010/11 51 per 100,000 population - rate of emergency admissions for diabetes in under 20s. On average, patients stay in hospital for 2 days 119,393 1 in year olds is obese under 4s attended accident and emergency in 2011/12 (that s 441 per 1,000 of the population) 2 in year olds are obese 24% of the population are under 20 years of age 52,895 live births in in 10 5 year olds have one or more missing, decayed or filled teeth 9.5% of children aged 5-16 have a mental health disorder - 59,960 in cancer cases diagnosed in the under 25s in the East Midlands in 2012 All data refers to East Midlands populations and represents the most recent available at August 2014

2 Clinical Director welcome Welcome to the first newsletter and infographic issued by the East Midlands Children s Strategic Clinical Network. Launched in June 2013, we facilitate quality improvement and support large scale change through clinical leadership, networks and advisory groups by bringing together commissioners and providers of children s health services from across the East Midlands. We work closely with Public Health England to help inform understanding of children s and young people s health in the area, through intelligence and data. The infographic highlights key facts about the region from the Public Health England data and knowledge gateway (datagateway.phe.org.uk). Over the next year, we will be creating themed infographics and would welcome suggestions on the data that would best support you. We hope that relevant information, that is easily accessible, will help identify our priorities and success stories, which we can share. If you have any queries, please get in touch our details are in the contact box below. Dr Jane Williams and Natalie Cantillon General paediatric surgery During the last 18 months, we have developed a general paediatric surgery network across the East Midlands, which is led by Mr Richard Stewart, Consultant Paediatric Surgeon. In December 2013, the network member services undertook selfassessments against the East Midlands Commissioning Framework service standards. Based on these results, network members are contributing Children s palliative care During 2014, we are supporting the reauditing of children s palliative care services against nationally recognised quality standards. We have identified key themes for improvement including standards around staffing levels, training and competence. Using the information gained, we are working with Health Education East Midlands to increase training opportunities. Children with a disability Building on the East Midlands therapies group, we have developed an East Midland s multi-agency children s disability clinical advisory group. The focus of current work includes community respiratory services which aims to reduce unwarranted variation in service provision. Future work includes a review of autistic spectrum disorder services. Events August 2014 to peer support and service review visits to each service provider, between September and November. These focus on the emergency pathway for children s general surgery. We are also working with the Royal College of Surgery to develop two accredited pathways for emergency appendicectomy and orchidopexy, which will be complete in autumn October, 9.30am pm: Transitions workshop, Kegworth Hotel 17 October, pm: General paediatric surgery project group, Kegworth Hotel 6 November, pm: Children s disability clinical advisory group (steering and working group) Kegworth Hotel 18 November, 9.30am pm: Children s palliative care clinical advisory group s steering group meeting, Rainbows Hospice 9 December, 9.30am pm: Children s palliative care clinical advisory group s working group meeting, Rainbows Hospice For more details about these events, contact jayne.chapple@nhs.net Transitions Two local clinicians Simon Hardcastle and Dr Nigel Ruggins have been appointed to the network team as clinical leads for transitions. We are developing East Midlands best practice guidance, to be shared at our next event on 17 October. Contact us Dr Jane Williams, Clinical Director, jane.williams42@nhs.net Simon Hardcastle, Transition Clinical Lead, simon.hardcastle@nhs.net Dr Nigel Ruggins, Transition Clinical Lead, nigel.ruggins@nhs.net Mr Richard Stewart, Surgery Clinical Lead, richard.stewart3@nhs.net Joanne Harrison, Quality Improvement Lead, joanne.harrison@nhs.net Sharon Verne, Senior Quality Improvement Lead, sharon.verne@nhs.net Sue Dryden, Network Manager, sdryden1@nhs.net Jayne Chapple, Network Assistant, jayne.chapple@nhs.net Natalie Cantillon, Principal Public Health Intelligence Analyst, Public Health England, natalie.cantillon@phe.gov.uk Produced by East Midlands Strategic Clinical Networks and Clinical Senate and Mono Design Ltd, August

3 East Midlands Maternity Strategic Clinical Network 52,895 births in % of mothers initiate breast feeding falling by 30% at 6-8 weeks 795 to teenage mothers ( ): 1.5% of live births 2,298 under 18s conceptions in % of births to over 35 year old mothers 29,008 1,559 multiple births spontaneous deliveries (2012) births a day in % of mothers smoke at the time of delivery 2 in 30 babies have low birth weight: 4,037 in % of women accessed antenatal care by 12 weeks and 6 days ( ) 12,292 caesarean sections ( ) Infant mortality 4.3 per 1,000 live births ( ) 713 deaths in 3 years 277 still births (2012): 5 per 1,000 births 2,366 emergency admissions babies under 14 days old per year ( ) 6 babies under 14 days old are admitted as emergencies each day All data refers to East Midlands populations and represents the most recent available at September 2014

4 Clinical Director welcome Welcome to the first newsletter and infographic from the Maternity Strategic Clinical Network. Public Health England and East Midlands Maternity and Children s Strategic Clinical Network are committed to working together to develop a knowledge and information work programme that takes account of the wider factors that impact health and pregnancy outcomes, and which h aims to support decision making for services in the region. This first infographic highlights some key facts about the East Midlands with information taken from a range of products available via the PHE Data and Knowledge Gateway (datagateway.phe.org.uk). We will expand this series over the next year with topic specific data. We would welcome suggestions about the data sets that best support your development. In the East Midlands as a whole, many performance indices mirror the national average, but this is not uniform amongst providers. We believe that accessible relevant information will help us focus on priority areas and enable us to share many success stories. Marwan Habiba, Natalie Cantillon and Alison Whitham High risk pregnancy Following an East and West Midlands wide workshop on high risk pregnancy in February 2014, the network agreed to support work to implement an East Midlands approach to managing high risk pregnancy. We have collected initial baseline data, and stakeholders are focusing on obesity and fetal maternal medicine. A workshop is being planned for November 2014 to take this work forward. East Midlands maternity services specification The development of a mandate for SCN maternity services work resulted from a desktop review of maternity services across the East Midlands during This revealed variable quality and availability of service specifications and the requirment for an up to date comprehensive service specification.the need for such commissioning support was also identified in the 2013 National Audit Office report. Building on some work already undertaken across the East Midlands, a generic service specification has been Maternity user September 2014 developed. It draws on national documents, published evidence and locally available data and information. This collaborative document has been produced with input from local clinical commissioning groups of maternity and children s services from across the East Midlands, as well as service providers and clinicians. It provides an approach to local commissioning based on best practice that aims to support maternity services to reduce unwarranted variation and to improve quality outcomes across the East Midlands. This has been widely circulated to provide a basis for the commissioning round. A copy of the service specification can be obtained from ailsa.morrison1@nhs.net Forthcoming events engagement event: January 2014 In January 2014 a successful maternity services user engagement event was held, which included commissioners, providers and users. The outcomes were shared with CCGs and changes in local arrangements have been reported including greater voices for women. A follow up event is planned for January This will provide and opportunity for participants to showcase their work around maternity services user engagement, as well as learn from colleagues. Escalation guidance Maternity unit closures were highlighted regionally as an issue as part of background preparation of the mandate. The Strategic Clinical Network has worked with the Heads of Midwifery and the Local Supervisory Authority Midwifery Officer to strengthen current protocols. 2 December 2014, 2-5pm: Maternity Clinical Steering Group, IGEM House, Kegworth. Focus on high risk pregnancy. Invited guest Catherine Calderwood, National Clinical Director for Maternity 22 January 2015, 10am-3pm: Maternity PPI event, Kegworth Hotel, Kegworth. Early March 2015, 2-5pm: Maternity Clinical Steering Group, venue TBC For more details about these events, contact ailsa.morrison1@nhs.net The next stage of this work is to suggest standards for escalation policies to reduce variation. Contact us Marwan Habiba, Clinical Director, marwan.habiba@nhs.net Alison Whitham, Network Maternity Associate, alison.whitham@nhs.net Sue Dryden, Network Manager, sdryden1@nhs.net Sharon Verne, Senior Quality Improvement Lead, sharon.verne@nhs.net Joanne Harrison, Quality Improvement Lead, joanne.harrison@nhs.net Ailsa Morrison, Network Admin and Support Officer, ailsa.morrison1@nhs.net Natalie Cantillon, Principal Public Health Intelligence Analyst, Public Health England, natalie.cantillon@phe.gov.uk Produced by East Midlands Strategic Clinical Networks and Clinical Senate and Mono Design Ltd, September

5 East Midlands Maternity and Children's Strategic Clinical Network: focus on obesity and diabetes 1 in 10 children are obese at the start of reception (2) 84% of diabetic children have an HbA1c above 58mmol/mol (3) Only 40% of women with diabetes take folic acid supplements prior to pregnancy (1) 1 in 5 children are obese at the end of primary school (2) Estimated 1800 children in the East Midlands have diabetes (3) 7% increase in obesity in women aged between 1993 and 2010 (1) Sources: (1) National Pregnancy in Diabetes NPID 2013 (includes data from 128 centres) (2) PHE (Refers to East Midlands populations and represents the most recent available at November 2014) (3) National Paediatric Diabetes Audit NPDA 2013

6 Introduction Welcome to the winter Maternity and Children's Strategic Clinical Network s infographic and newsletter, which focuses on obesity and diabetes. To help tackle these important issues in the last few months, we have facilitated an event highlighting how to improve care for women with a raised body mass index and worked closely with the East Midlands Children s Diabetes Network. You can also read about our forthcoming events and new members of our team. Seasonal Good Wishes, Marwan, Jane and Sue National Clinical Director visit On 17 September, the Children s Strategic Clinical Network held its first Children s Clinical Reference Group. Leaders in children s and young people s care from across the region were joined by Dr Jackie Cornish, National Clinical Director for Children, Young People and Transition. Jackie gave an update on current NHS England priorities for children s health care. Even though much has been achieved, we need to continue to raise the profile and importance of child health. Children s diabetes There are around 1800 children and young people under the age of 18 in the East Midlands with diabetes. Over 97% of these children have type 1 diabetes our incidence rates are broadly similar to England and Wales. Outcomes in the East Midlands are also not significantly different from England and Wales, Managing the obese pregnant woman workshops Maternal obesity is recognised as an important risk factor for complications in maternity care. As part of our work across the region to improve the outcomes for high risk pregnancy, the Maternity Strategic Clinical Network is holding workshops on antenatal, intrapartum, and postnatal care of the obese woman. Successful work in Lincolnshire that supported pregnant women with a high body mass index with one to one intervention and advice has been highlighted. Several key standards are being developed, including an agreement to use a standardised information leaflet across the East Midlands. If you are interested in contributing to this work, please contact ailsa.morrison1@nhs.net. Edition 2, December 2014 although our mean HbA1c is the lowest in the country (along with South Central region). Good control is considered to be an HbA1c of 58 mmol/mol or lower and across the East Midlands, the overall percentage achieving this in the NPDA was 16.7% (compared to 15.8% across all England and Wales), but varying from 28.8% to 10.4% in different centres. There is still much to be done to improve control. Type 2 diabetes is still rare in children, with less than 2% of children with diabetes having this form. It is more common in girls than in boys and is directly related to obesity, so entirely preventable. Dr Tabitha Randell Chair, East Midlands Children's Diabetes Network Forthcoming events 13 January: Senior children s nurse leaders meeting 19 January: Special education need and disability act (SEND) event 22 January: Maternity patient and public involvement event 30 January: General paediatric surgery project group 11 March: Transition (children moving to adult services) event 27 March: General paediatric surgery annual training event For further information contact ailsa.morrison1@nhs.net New team members Two new clinical leads have joined the team. Dr Toni Wolff, a Consultant Paediatrician at Nottingham Children s Hospital, is undertaking a review on children s palliative care across the East Midlands. Dr Rajat Srivastava, a GP in Wellingborough, will help improve understanding of maternity, children's and young people's health services between primary and secondary care. To contact them, toni.wolff@nuh.nhs.uk or rajatsrivastava@nhs.net Produced by East Midlands Strategic Clinical Networks and Clinical Senate and Mono Design Ltd, December

7 East Midlands Children's Strategic Clinical Network 437 admission episodes for cystic fibrosis in 2012/13 (4) 4,481 admission episodes of children with a diagnosis of neoplasm in the East Midlands (1) 269 live births with a congenital heart disease recorded on the East Midlands and South Yorkshire register in 2010 (3) ,524 children admitted to hospital and admission episodes of children who live in the East Midlands in 2012/13 (1) 106, years diabetes admissions in 2012/13 (4) admission episodes for renal failure in 2012/13 (4) 1,718 tonsillectomies in the East Midlands in 2012/13 (1) year olds diagnosed with cancer in the East Midlands (2) Sources: (1) HES 2012/13 (2) PHE extracted from CASCADEv1 (February 2015) (3) British Heart Foundation (4) Chimat

8 Clinical Director welcome Welcome to our third newsletter which reflects the agenda of our workshop on specialist services for children and young people on 18 March. The strength of the care depends on the quality of the communication links between teams and providers of care at all levels: primary care, community teams and district units. We are committed to developing effective referral pathways to diminish inequalities. Thank you for your ongoing hard work. Jane Williams Events 18 March, 9.30am pm: Children s clinical reference group 27 March, 9am - 5pm: General paediatric surgery training day 24 April, 2pm pm: General paediatric surgery meeting For further information, contact ailsa.morrison1@nhs.net Working with other networks The Children s Strategic Clinical Network continues to work with a number of partner children s networks, supporting children s services across the East Midlands. During 2014, the East Midlands Children and Young People s Palliative Care Network undertook an audit against the Together for Short Lives/West Midlands quality standards for children s palliative care services. Phase two of this work is being supported by Dr Toni Wolff, who is examining the qualitative aspect of this audit to understand the range of children s palliative care services. As part of the commitment to engage with children and young people, the Children s Strategic Clinical Network funded a parent survey for the East Midlands Paediatric Diabetes Network. This partnership approach disseminated the survey to a much wider audience, resulting in a good response, which has enabled the diabetes network to plan further work. To support clinical colleagues in understanding the new Special Education Needs and Disability Act, the Children s Strategic Clinical Network worked with the Disabled Children s Network to facilitate a learning workshop. Learning points included further clarity around designated medical/clinical officer roles, and the need to develop person specific outcomes. Thoughts from the tertiary centres Following the establishment of national service specifications, Nottingham's and Leicester's children s hospitals are reviewing the way services are provided in the East Midlands and have agreed to work proactively together. Working with specialised commissioning colleagues and the East Midlands Maternity and Children s Strategic Clinical Network, we are looking to build partnerships between the two hospitals and ensure more effective pathways for children, young people and their families. Transporting sick children in the East Midlands One of the first joint pieces of work is the development of an East Midlands paediatric critical care retrieval service. Currently, neither Nottingham s nor Leicester s paediatric intensive care units have standalone capacity to transfer patients to or from intensive care, and so fail to meet NHS England draft March 2015 service specifications for paediatric intensive care transport. A project group will present a number of options to improve this service in the spring. For further information, contact: patrick.davies@nuh.nhs.uk or pwb1@leicester.ac.uk Joint website development A project group has convened to take forward the development of a joint website for East Midlands specialised children s health services. This work is initially supported and facilitated by the East Midlands Maternity and Children's Strategic Clinical Network, and being taken over by the trusts in the 2015/16 financial year. Dr Jonathan Evans, Clinical Director for Family Health, Nottingham University Hospitals NHS Trust, and Dr Ian Scudamore, Clinical Director for Children and Family, University Hospitals of Leicester NHS Trust Commissioning guide national publication The East Midlands Maternity and Children s Strategic Clinical Network published a National Institute for Health and Care Excellence accredited commissioning guide for paediatric emergency appendicectomy in January It can be accessed at Produced by East Midlands Strategic Clinical Networks and Clinical Senate and Mono Design Ltd, March

9 East Midlands Maternity Strategic Clinical Network 8.6 still births per 1000 women with a body mass index greater than 35 (2) 39.8% of pregnant women received flu immunisations in England (2013/14) (6) 1 in 200 babies stillborn in England in 2013: higher than expected in a high income country (7) 1,454 babies born in the East Midlands with a low birth weight (3) 15% Smoking in pregnancy doubles the risk of still birth (5) of pregnant women in the East Midlands smoke - 7,616 people (2013/14) (4) 4.99% of pregnant women in the UK have a body mass index greater than 35 (2) 40.1% of women in the diabetes audit known to be taking folic acid in England; 33.8% in East Midlands (1) Sources: (1) National Pregnancy in Diabetes Audit HSCIC (2013) (2) Maternal Obesity in the UK CMACE (2010) (3) Public Health Outcomes Framework PHE (2012) (4) HSCIC (2013/14) (5) Wisborg K, Kesmodel U, Henriksen TB, Olsen SF, Secher NJ. (2001) Exposure to tobacco smoke in utero and the risk of stillbirth and death in the first year of life. (6) National flu programme training PHE (2014) (7) Office of National Statistics (2013)

10 Clinical Director welcome Welcome to our latest Maternity and Children's Strategic Clinical Network's newsletter, which focuses on demographics and key public health indicators. Improvements in areas of challenge require complex interventions that are difficult to implement and maintain. But success stories are a reminder that much is achievable. The reduction in under 18 teenage conception rates (41% in England and 43% in Leicestershire) is an example of what can be achieved through sustained focus. This year, the Royal College of Obstetricians and Gynaecologists and others have committed to seeing a 50% reduction in the number of babies who die or are left with severe brain injury National Clinical Director visit On 2 December 2014, National Clinical Director for Maternity Catherine Calderwood, visited the East Midlands Maternity Strategic Clinical Network and joined the network steering group. Catherine gave an update on the national picture for maternity; in particular, she commended the specific inclusion of maternity services in the NHS Five Year Forward View. Catherine highlighted postpartum haemorrhage as an area for future focus. by Tackling obesity, smoking, infections, and flu, and attention to preconception health and well-being are key to better outcomes. We have been focusing on care for women with a raised body mass index and support of national initiatives. Mr Marwan Habiba Maternity patient and public engagement event Building on the success of maternity users' engagement workshop in 2014, a further workshop was held in January Representatives from maternity provider units from across the East Midlands attended the workshop, together with commissioning colleagues and a number of Maternity Services Liaison Committee lay representatives. Key note speaker, Kath Evans - NHS England Head of Patient Experience - updated on national work. Other areas of focus included the experience of puerperal psychosis and feedback on families experience of neonatal services. March 2015 Messages to GP colleagues Dr Rajat Srivastava, GP Lead for the network, promotes good practice in primary care for pregnant women. His key messages include: mcg folic acid should be taken three months pre-conception to the end of first trimester. 2. 5mg of folic acid should be given to women who: are being treated for epilepsy are diabetic have a personal or family history of neural tube defects have sickle cell disease mcg (400IU) vitamin D daily should be taken through pregnancy and breastfeeding. 4. Close networking should occur with the practice link midwives, so high risk cases can be identified, and care shared. 5. Advice should be given about smoking, with signposting to smoking cessation clinics where needed. 6. The flu vaccine should be given after the first trimester, whooping cough vaccination after 28 weeks, and postnatal immunisation of women who are not rubella immune. 7. Women with gestational diabetes should have a followup test at six weeks postnatal and yearly thereafter. Team news Lucy Kean has joined the maternity network to support the work on developing a framework of standards for caring for pregnant women with a high body mass index and working with fetal medicine colleagues across the East Midlands to develop a network of practice. Lucy is a Consultant Obstetrician from Nottingham University Hospitals. Contact us Marwan Habiba, Clinical Director, marwan.habiba@nhs.net Alison Whitham, Network Maternity Associate, alison.whitham@nhs.net Sue Dryden, Network Manager, sdryden1@nhs.net Sharon Verne, Senior Quality Improvement Lead, sharon.verne@nhs.net Joanne Harrison, Quality Improvement Lead, joanne.harrison@nhs.net Ailsa Morrison, Network Admin and Support Officer, ailsa.morrison1@nhs.net Natalie Cantillon, Principal Public Health Intelligence Analyst, Public Health England, natalie.cantillon@phe.gov.uk Lucy Kean, Obstetric Project Clinical Lead, lucy.kean@nuh.nhs.uk Produced by East Midlands Strategic Clinical Networks and Clinical Senate and Mono Design Ltd, March

11 Clinical Director welcome This edition provides you with progress updates for the main work-streams for the East Midlands Strategic Clinical Networks. Local models for service delivery continue to be contested in many units in the East Midlands. Ongoing debates will necessarily be informed by the national review of maternity services led by Baroness Julia Cumberlege. The review is currently underway and is planned to report by the end of the year. We would encourage your contributions especially where issues have particular relevance to the East Midlands. You can access the consultation directly via Fetal medicine update Fetal medicine in the East Midlands has been through a difficult time since the change in maternity payments to a tariff based system, and subsequent lack of specific identified funding. Recognising the importance of provision of these services, to pregnant women, trusts within the East Midlands have universally agreed to the ongoing provision of these services whilst continuing to make the case for dedicated funding. Within the East Midlands we are approaching the provision of fetal medicine via the development of a virtual operational delivery network, including all trusts, to provide a complete service, with the exception of fetal laser treatment. Pathway development is currently underway for the management of the morbidly adherent placenta and fetal allo-immunisation. We are also aiming to establish a regional multidisciplinary team by the end of the year for case discussion, education and pathway development. We are looking at the feasibility of a regional training programme for subspecialty training, utilising the best of services from across the region. Contact us We are pleased that all providers in the East Midlands have registered their interest in contributing to Each Baby Counts and would encourage your continued support. Recently, NHS England announced that Dr Matthew Jolly MD MRCOG, Consultant in Fetomaternal Medicine at Western Sussex and Portsmouth, will be the new National Clinical Director for Maternity and we look forward to hearing his views and working with him. Marwan Habiba - Clinical Director New network manager We give a warm welcome to our new manager for the Maternity and Children s Strategic Clinical Network, Angela Horsley, who joins us on 5 October. Angela brings a wealth of experience including her current role as a Senior Nurse for Children and Young People advising the Chief Nursing Officer and her local knowledge of the East Midlands. Maternity newsletter // September 2015 Connect Enable Transform event Join us on 13 October, at East Midlands Conference Centre, Nottingham, for a conference to highlight how we can support clinical commissioning groups to deliver improved outcomes. The morning session includes presentations from our GP clinical leads: Dr Pawan Randev (cancer), Dr Yassir Javaid (cardiovascular disease), Dr Rajat Srivastava (maternity and children), and Dr Sohrab Panday (mental health, dementia and neurological conditions). The afternoon workshops will include sessions on: assessment of the child in acute respiratory difficulty and when to refer Primary care management of fever in children new guidance on perinatal prescribing new guidance on managing paediatric orchidopexy updates on high risk pregnancy The event is suitable for GPs, practice nurses, GP clinical leads, commissioning managers, clinical commissioning group service improvement managers, public health representatives, and patients. CPD approval has been applied for. To book your place, and for further information, visit Setting standards for the care of pregnant women with a raised body mass index The East Midlands Maternity Network has developed a document bringing together best practice in caring for pregnant women with a raised body mass index. The standards have been developed with input from a multidisciplinary group, consisting of obstetricians, midwives, anaesthetists, general practitioners, diagnostics, and local commissioners. The final eight standards cover equipment and manual handling to joint birth planning, fetal wellbeing to caesarean section, and were launched on 24 June. The standards can be accessed via A series of audits related to the standards and development of a self-assessment tool, to allow services to review their services, is suggested as further work. Ailsa Produced Morrison, by East Midlands Maternity Strategic and Children s Clinical Networks Project and Officer, Clinical ailsa.morrison1@nhs.net Senate and Mono Design Ltd, March

12 Clinical Director welcome Welcome to the Maternity and Children Strategic Clinical Network's joint newsletter. I would also like to thank those who participated in the East Midlands study relating to referral pathways for 0/4 year olds into secondary care. The outcome of this study will be circulated soon. Another success has been thanks to our children's epilepsy work stream. Together with three other regions (north east, eastern and Cheshire) we presented nationally that children's epilepsy networks are improving outcomes for children and young people. This further supports the need for prospective data collection and is being funded as a national audit project. Lastly, I must thank Dr Toni Wolff for her review of East Midlands paediatric palliative care services, which will be presented in October. Jane Williams - Clinical Director Future in Mind review At the Future in Mind event in June, young people s experiences highlighted the absolute necessity to consider and meet their mental health requirements in a timely, accessible and coordinated manner. The results of an East Midlands CAMHS service mapping project was presented by Dr Fiona Warner Gale and data was presented from across the East Midlands. Kathryn Pugh (picture above) CAMHS programme lead, NHS England provided the national vision and expectations for ongoing transformation planning. Regional best practice was shared in afternoon workshops and some key themes for further work were identified. Paediatric orchidopexy guidance published With the support of the Royal College of Surgeons we have developed a second NICE accredited paediatric commissioning guidance document. The document is for primary and secondary care colleagues as well as commissioners. It recommends that if the testis is undescended the patient should be referred by their GP to a consultant general paediatric surgeon or urologist with appropriate experience and skill to ensure effective and timely local management and a reduction of unnecessary referral and investigations. It emphasises that care should be given through a network of secondary and tertiary providers, and recommends that surgery should take place around 12 months of age and suggests defined measures to enable a positive patient experience. Contact us Ailsa Morrison, Maternity and Children s Project Officer, ailsa.morrison1@nhs.net Children's newsletter // September 2015 Survey of referrals/ admissions for 0-4 year olds CHIMAT data suggested that Derby, Nottingham, Leicester and Lincolnshire had higher than England average of 0-4 year old admissions. We completed a survey of hospitals, GPs and out of hour GPs to establish potential reasons for this statistic. The key findings included the need for better communication between primary and secondary care about hot week numbers and referral feedback. There is scope for GP education in managing fever and respiratory conditions in 0-4 year olds. For more information please contact Dr Rajat Srivastava, rajatsrivastava@nhs.net. Forthcoming events 14 September: Transitions benchmark workshop 23 September: Maternity clinical reference group 7 October: Children s clinical reference group 7 October: Children s palliative care event 13 October: Connect Enable Transform (GP event) 15 October: Children s nurse leaders group 16 December: Maternity clinical reference group Transitions update The transition agenda is developing fast throughout the East Midlands We have encouraged the identification of transition leads in eight of the nine trusts within the region. We are using these contacts to share examples of good practice as well as identifying areas needing support. Earlier this year we developed transition prompt cards These provide a useful guidance at a glance for anyone caring for young people experiencing transition. The team continue to engage with national projects, including the transition benchmarking work which we are taking forward regionally in collaboration with London South Bank University and Great Ormond Street Hospital. An audit of GP involvement in transition has been completed and results were presented at the last East Midlands transition event (March 2015). This study has now been accepted as a poster presentation at a national transition meeting hosted by Royal College of Paediatrics and Child Health in October. Produced by East Midlands Strategic Clinical Networks and Clinical Senate and Mono Design Ltd, Sept

13 East Midlands Children's Strategic Clinical Network Over 50% of all mental ill health starts before the age of 14 [1] England young people hospital admissions for self-harm, years: 352.3/100,000 [1] 75% of mental health problems in adulthood start by the age of 18 [1] East Midlands child admissions for mental health, 0-17 years: 71.6/100,000 [2] England child admissions for mental health, 0-17 years: 87.2/100,000 [1] East Midlands young people hospital admissions for self-harm, years: 357.4/100,000 [2] 1 in 10 children need support with mental health problem [1] Sources: [1] = national statistic; [2] = East Midlands statistic

14 Clinical Director welcome This edition of our newsletter focuses on children and young people's emotional health and well-being. As we know this is a concern to us all: general practitioners who meet young people so often in situations of crisis, our emergency department staff who meet children and young people, some of whom may have self-harmed, the community paediatric teams who see children with behavioural problems, hospital and CAMHS colleagues dealing with all of these groups and children presenting with emotional problems who may have chronic illness. But we know that many children and young people with significant mental health problems are not seen by any professional, including school staff. This we know is unacceptable. In supporting this agenda we have appointed Simon Hardcastle as Senior Quality Improvement Lead and Dr Simon Lalonde and Samantha Sykes as joint clinical leads. Thanking you for your continued support and hard work. With best wishes to you all Dr Jane Williams Local transformation plans The Department of Health has committed significant funding to support the implementation of the Future in Mind recommendations. All health communities have developed transformation plans and secured local funding. Building on the findings of Fiona Warner Gale s report, we have helped to establish an East Midlands hub to support local partners and are developing our work programme, which will embed key national deliverables. For more information, contact simon.hardcastle@nhs.net GP event summary Dr Rajat Srivastava presented the network s achievements and priorities at the East Midlands Strategic Clinical Networks Connect-Enable-Transform event, with keynote speaker Dr Martin McShane. These included orchidopexy commissioning guidelines, work on transition care, and the 0-4 year old referral and admission pathway survey findings. A report on the survey, with results and recommendations, will be available in early Palliative care report Dr Toni Wolff has now published her report reviewing current palliative care practice in the East Midlands, which highlighted many excellent examples of care and the need to look for common solutions to areas that need collective improvement. You can view the document at bit.ly/1lsee74. We would like to thank Dr Wolff and the units involved for their contributions. Children's newsletter // December 2015 Transitions update Our transitions poster showcasing how engaged East Midlands general practitioners are with the transitions process was presented at the Royal College of Physicians transitions event by our transitions clinical leads, Dr Nigel Ruggins and Simon Hardcastle, where it received positive feedback. To view the poster, see: Transition and primary care How engaged are general practitioners in the process? East Midlands Strategic Clinical Networks Dr Nigel Ruggins and Simon Hardcastle (Clinical Leads for Transition - East Midlands Strategic Clinical Networks) Dr Rajat Srivastava (GP Clinical Lead - East Midlands Strategic Clinical Networks) Method: Question 1: Question 2: Five question survey disseminated via Is transition important? Does primary care have an important role? clinical commissioning groups to all GPs in the East Midlands 5% Also asked How best to engage with primary care to contribute to the 28% transition process? Followed up by online survey in December 2014 Total of 55 responses (anonymous) 72% Key: 95% Yes To a certain extent No Maybe Question 3: Question 4(a): Question 4(b): Are you as a GP involved appropriately? Do you have a young persons lead who If no practice lead, do you see the benefit could lead on transition in your practice? of having one? 38% 12% 50% In summary: Majority of GPs recognise importance of transition Primary care has an important role in transition GPs do not feel appropriately involved in transition Most GP practices do not have a young persons/transition lead but many see the benefit in having one 78% The way forward: Some comments: Patients can get lost in the system and continuity of care is essential We want the young person to continue to engage with services, not be disillusioned with change Transition is important but badly done It is essentially an administrative function!! Can t see how GP involvement helps GP involvement is [of] paramount importance as [it] may be best placed to coordinate care Need to be more involved in the process How many doctors does it take to change a light bulb?...provided this is not an opportunity for acute care to dump further work in primary [care] and ease their workload More communication between the sectors? Why can t the hospitals come up with a smooth transition 22% 19% 59% 22% The GP is involved in the transition plan The GP is the link to further primary care services e.g. university/college healthcare teams The young person can chose to share their transition plan with their GP The GP has contact details for the transition team or leading professional when identified Young people are encouraged to access primary care to discuss transition and transfer and their role in the young persons ongoing care Primary care should be informed if young people are failing to engage with adult services around the transition period Engaging with you We are keen to increase engagement with you and ensure our work programmes reflect your local priorities. Please complete our six question survey to share your views as to how we could improve: Produced by East Midlands Strategic Clinical Networks and Clinical Senate and Mono Design Ltd, Dec

15 East Midlands Maternity Strategic Clinical Network 55,645 births in the East Midlands 112 new mothers in the East Midlands developed postpartum psychosis 5,560 new mothers in the East Midlands developed postnatal depression 3% of all new mothers are referred to mental health services 15% of pregnant women suffer from depression and anxiety 2 in every 5 households with a new baby have at least one parent suffering from depression or anxiety

16 Clinical Director welcome As you may be aware improving maternal mental health provision is coming into focus nationally. We know that about 10 per cent of new mothers are likely to develop a depressive illness. Care issues that have been highlighted run from preconception care and care during pregnancy. But focus must also be given to improving emotional well-being in postnatal care. Provisions in the East Midlands remain a challenge which fits with the national picture and reflects our demographics. We are keen to showcase examples of good practice, and find out about any emerging issues in your area. We have seen that collaboration can improve quality of care as shown in our feto-maternal medicine and complex pregnancy work with providers and commissioners. The value of cross organisational collaboration is perhaps more critical at this time when, as a region, we are facing considerable strain. Thank you for your continued dedication. Marwan Habiba National Maternity Review Baronness Julia Cumberlege has been chairing the national maternity review to assess current provision and how services should be delivered in the future. A major focus is gaining input from families who have lost a baby before, during, or shortly after birth, to improve patient experience. The review is expected to be published by the end of We are attending a national event around the review on 23 February. Forthcoming events 16 December: Maternity Clinical Reference Group meeting 18 December: National strategic clinical networks meeting 14 January: Fetal medicine meeting Fetal medicine Fetal abnormalities are detected late in a pregnancy. We have recommended that affected women should be offered the choice of a surgical or medical termination, and are developing a regional pathway. This also considers the consistency of information given to these women across the region. To improve communication in fetal medicine, we assisted with organising WebEx multi-disciplinary meetings chaired by Nottingham University Hospitals Trust, so colleagues around the region could join the meeting and share cases for discussion from their own bases. For more information, contact ailsa.morrison1@nhs.net Maternity newsletter // December 2015 Alison Whitham It is with great sadness that we say a fond farewell to Alison Whitham, our Maternity Associate, who has been with us since July Her contribution as a senior midwife, particularly the dedication to her profession and her leadership, have been invaluable towards improving the quality of care for women and their babies. We look forward to continuing to work with her in her capacity as Head of Midwifery for Sherwood Forest Hospitals NHS Foundation Trust. Engaging with you We are keen to increase engagement with you and ensure our work programmes reflect your local priorities. Please complete our six question survey to share your views as to how we could improve: Produced by East Midlands Strategic Clinical Networks and Clinical Senate and Mono Design Ltd, Dec