Our Vision for Local Paediatric Services Paediatric care is changing. As time progresses, the problems children and young people face both acutely and with long term health are changing. Public health measures such as immunisations have prevented many of the severe life-threatening illnesses that affected children in the past. With advancing paediatric care, children with complex medical problems are surviving longer and needing more support in the community. Increasing evidence of best practice for managing illnesses in newborns, children, and teenagers continues to shape medical and nursing care and are being applied to achieve standards that we would expect for our own children. With this in mind, services for children and young people should be delivered in accordance with modern standards, based on clinical evidence, and meet the needs of the whole population as close to home as safely and sustainably as possible. Throughout the UK, training standards and expectations have changed. Recruitment challenges currently exist for paediatric-trained staff of all types nurses, consultants, trainees, and speciality doctors. The skills that were needed historically are not mirrored by those needed in our evolving system of care. Roles within the health professional workforce are developing. The traditional values of care must be integrated into meeting the current care requirements of children and young people. Future developments in the provision of acute and community based care for children and young people will inevitably lead to increased integration between community, primary and secondary care. This will ensure that the best specialised care can be provided as locally as possible, whilst acknowledging that, for some clinical conditions, evidence clearly demonstrates that achieving a critical mass of care produces better clinical outcomes. The key principles underpinning the provision of integrated acute and community based paediatric services for our local population include: Prevention of Acute Illness Supporting our public health and primary care colleagues in promoting healthy pregnancies, breast-feeding and early intervention work from midwives and health visitors. We will continue to advocate proven public health interventions including immunisations. Developing our community and specialist nursing workforce to help prevent unnecessary admissions through direct support for families and ongoing education in disease management. With a third of all our children being overweight or obese, investment in staff and development of pathways of care. Prompt Intervention Development of our community nursing team to allow more local access to expert advice and immediate care for illness, therefore preventing unnecessary travel and admissions. Partnership working with our emergency departments, site teams, therapy services, primary care and others to ensure an integrated approach to the timely delivery of care. High quality inpatient care, provided by consistent and skilled medical, nursing and supporting staff. 2
Proactive Discharge Planning Development of our community nursing resources (building on the foundations of the current community nursing teams, including the neonatal outreach team) to support timely discharge. Acute Paediatric Services The University Health Board s primary aim in the provision of acute paediatric services is to ensure children and young people up to the age of 16 can be seen, assessed and treated as locally as people where this is deemed safe and sustainable. Emergency and urgent care needs will be met in all sites where it is safe to do so and the University Health Board will use the best evidence to provide modern care for all the diverse clinical conditions affecting children and young people. As paediatric care has evolved and new standards have developed, the University Health Board and its clinicians have continuously reviewed the way services are provided in serving the local population. Most significantly for acute care, this led to the major reorganisation of paediatric and neonatal services across Carmarthenshire and Pembrokeshire in 2014 in order to meet neonatal standards, supported by the current evidence, and to meet the Deanery's requirements for junior doctor training. This reorganisation of services has facilitated the development of the neonatal service, neonatal outreach team, increased cot capacity, and a larger team including allied health professionals. It also enabled the development of a combined model of paediatric ambulatory care units (PACU) alongside inpatient and high dependency care as follows: Bronglais Hospital - PACU and inpatient service 24 hours Glangwili Hospital - PACU, inpatient and high dependency unit service 24 hours Withybush Hospital = PACU service 12 hours (temporarily reduced to 8 hours) The Royal College of Paediatrics & Child Health carried out an independent evaluation of these service changes in 2015. The evaluation confirmed the clinical case that led to reorganisation of acute paediatric and neonatal care and concluded that there was no clinical sense in reversing these changes. Community Children s Services Integral to the vision described above is the further development of community children s services across the Hywel Dda University Health Board area. These community teams are made up of community paediatricians, community children s nurses, specialist nurses and GP practices, as well as specialist child and adolescent mental health services (S-CAMHS), health visitors, specialist health visitors and school nurses. These professionals work in close partnership with social services, education and third sector providers. The current configuration of service provision has evolved over many years and reflects differing priorities within the former health board areas and geographical demography. Some aspects of service provision are markedly different; for example key worker services for disabled children and young people in Carmarthenshire and Ceredigion are provided by multi-agency children s disability teams, whereas in Pembrokeshire, the University Health Board commissions a third sector provider to deliver the key working service. Community nursing care for children living in the Hywel Dda University Health Board area is delivered by staff who have the knowledge and skills to cater for the needs of children and young people in the following four groups: 3
1. Children with acute and short term conditions. 2. Children with long term conditions. 3. Children with disabilities and complex conditions, including those requiring continuing care and neonates. 4. Children with life-limiting and life-threatening illness, including those requiring palliative and end-of-life care. In each of these four groups there are condition specific needs that require specialist nursing knowledge. Hywel Dda University Health Board has paediatric diabetic nurse specialists, paediatric oncology nurse specialists, paediatric palliative care nurse specialists and a newly established neonatal outreach service to provide this specialist nursing care. For other specialist conditions, those needs are met by specialist paediatric nurses based out of the tertiary centres who are accessible for advice and guidance. Our Paediatric Service The Women and Children s Health Directorate provides services for children, young people and women within the Hywel Dda University Health Board area, across the three counties of Carmarthenshire, Ceredigion and Pembrokeshire. Our in-hospital services are currently delivered in three hospitals, namely: Bronglais Hospital, Aberystwyth, Ceredigion Glangwili Hospital, Carmarthen, Carmarthenshire Withybush Hospital, Haverfordwest, Pembrokeshire Our community services are delivered in various locations in each county. As part of a comprehensive reconfiguration of services for general paediatrics in west Wales, the directorate aims to provide fully integrated secondary children s services and provide a spectrum of flexible and responsive services to meet the health needs of local children. Service Provision Children s outpatient services are delivered in a number of settings. The majority of the clinics take place in the Children s Centre at Glangwili Hospital, the Elizabeth Williams Clinic in Llanelli, the Children s Outpatients Department at Bronglais Hospital and general Outpatients Department or Child Health Department in Withybush Hospital. These include general paediatric clinics, community paediatric clinics and special clinics for children with diabetes, endocrine problems, disability, asthma, behavioural difficulties (some jointly with the CAMHS service) and others. There are visiting tertiary specialists from Cardiff (respiratory, cardiology, endocrinology, nephrology, metabolic problems, genetics and oncology) and Swansea (neurology, immunology and gastroenterology). There are also regular children s orthopaedic, surgical and dermatology clinics. 4
Services Bronglais Hospital Angharad Ward 24 hour inpatient paediatric service 24 hour Paediatric Ambulatory Care Unit High Dependency/Stabilisation bed Neonatal stabilisation unit to support the low risk obstetric unit prior to transfer by the retrieval service Children s Outpatients Department Glangwili Hospital Cilgerran Ward 24 hour inpatient paediatric service 24 hour Paediatric Ambulatory Care Unit High Dependency Unit Special Care Baby Unit Special care cots High dependency cots Stabilisation cot Neonatal outreach service Children s Centre General Paediatric Outpatients Withybush Hospital Puffin Paediatric Ambulatory Care Unit 12 hour service providing assessment, investigation and treatment services (temporarily reduced to 8 hours) Child Health Department Staff base with community and general paediatric clinics Community Nursing Services The community nursing team provides an integrated service for children with acute and chronic conditions across the three counties. In addition, palliative and end-of-life care is provided, working closely with other service providers including Ty Hafen Children s Hospice. 5
Service Structure Hywel Dda University Health Board Operations Directorate Women and Children s Services General Manager CLINICAL GROUP CHILDREN S SERVICES CLINICAL GROUP WOMEN S HEALTH CLINICAL GROUP SEXUAL HEALTH Community Paeds Acute Paeds & Neonates Directorate Nurse Head of Midwifery & Women s Health Obs & Gynae Sexual Health Nurse Community Children s Services Manager Acute Paediatrics & Neonates Midwife Community Midwifery & MLU s Midwife Acute Midwifery Manager Gynaecology Nurse Sexual Health Senior Nurse Acute Paeds Senior Nurse Neonates Senior Nurse Gynaecology Updated December 2016 1 Paediatric Consultants within the University Health Board Dr Marcus Andrews, Consultant Paediatrician (Oncology) Dr Devasettihalli Appanna, Locum Consultant Paediatrician (Diabetes) Dr Hari Bodhla, Consultant Paediatrician (Nephrology) Dr Simon Fountain-Polley, Consultant Paediatrician (/Diabetes/Rheumatology) Dr Suparna Jayasinghe, Locum Consultant Community Paediatrician (ADHD/Epilepsy) Dr Kausik Khan, Consultant Paediatrician (Allergy/Gastroenterology) Dr Francis Kumar, Consultant Paediatrician (Neurology) Dr Katherine Lewis, Consultant Paediatrician (Ambulatory Care/Palliative Care) Dr Vishwa Narayan, Consultant Paediatrician (Non-CF Respiratory) Dr Saurabh Patwardhan, Consultant Paediatrician (Ambulatory Care) Dr Premkumar Pitchaikani, Consultant Paediatrician (Cardiology/Cystic Fibrosis/Neonates) Dr Alice Setti, Consultant Community Paediatrician (ASD/ADHD) Dr Martin Simmonds, Consultant Community Paediatrician (ASD/ADHD) Dr John Williams, Consultant Paediatrician (Epilepsy/Neurodisability) Dr Toni Williams, Consultant Paediatrician (Gastroenterology/Metabolic) 6
Annual activity 14,000 outpatient attendances 11,000 paediatric ambulatory care attendances 300 neonatal unit admissions 290 (average) paediatric community nursing caseload 4,000 inpatient admissions 250 paediatric high dependency admissions What We Can Offer Our Staff South west Wales provides a wonderful lifestyle opportunity and is renowned for being one of the most beautiful places in the UK. Our major sites are near coastal areas, with beautiful beaches, spectacular mountains, an abundance of outdoor activities, such as surfing, mountain biking, fishing, sailing, hiking and walking in a natural and clean environment. There are many historic sites to discover whilst enjoying working and living here. Reasonable property prices contribute to low living costs and a high quality of life. There are also good road and rail connections to Swansea, Cardiff and London. The University Health Board is fully committed to supporting employees to achieve an appropriate work-life balance. We are continually developing ways in which to support greater flexibility. Job sharing and part-time working is already widespread throughout the organisation. Training and education are central to the function of the University Health Board, forming a core element of our clinical governance strategy. We have a dedicated medical appraisal and revalidation lead and manager, who manages and coordinates appraisal and revalidation processes across all sites. We also have a team of 52 trained appraisers to undertake appraisal meetings. Appraisal workshops and training sessions are provided regularly across the organisation. We run a successful consultant development and mentoring programme for newly appointed consultants aimed at developing senior leaders who effectively contribute to Hywel Dda University Health Board and its future direction. 7