Child Health 2020 A Strategic Framework for Children and Young People s Health Consultation Paper Please Give Us Your Views Consultation: 10 September 2013 21 October 2013
Our Child Health 2020 Vision By 2020, the children and young people of Grampian will have the healthiest possible start in life.. Our six themes to deliver this vision y Children, young people and families at the heart of what we do. y Acting early and intervening at the right time. y Safe and sustainable services. y Integration and partnership. y Workforce, education and training. y Knowledge and evidence. This publication is also available in large print and on computer disk. Other formats and languages can be supplied on request. Please call Equality and Diversity on 01224 551116 or 552245 or email grampian@nhs.net Ask for publication CGD130477
3 How to give your views on Child Health 2020 y Complete the online survey at www.nhsgrampian.org/childrenandyoungpeople y Complete the paper survey and send to Freepost, NHS Grampian (no stamp required). y Email your comments to nhsg.consult@nhs.net y If you would like someone to come and talk to your group or organisation about Child Health 2020, please telephone 01224 558098 or email nhsg.consult@nhs.net y A fuller document with more background information is available at www.nhsgrampian.org/childrenandyoungpeople or on request on the contact details above. All responses must be received by 21 October 2013.
4 What is Child Health 2020? Child Health 2020 is NHS Grampian s plan for the future for children and young people in Grampian (known as our strategic framework). It outlines what we (NHS Grampian) will focus on to help ensure children and young people are as healthy as possible and, at the same time, make the most of our resources. Child Health 2020 is part of NHS Grampian s overall vision known as Healthfit 2020. What and who does it include? Child Health 2020 covers all children and young people living in Grampian as well as children from other areas who have to come to hospital in Aberdeen. It covers the age range from the time of conception to 18 years. This upper age limit is not strictly set as it can vary depending on an individual s needs. Child health covers everything from prevention and primary care through to specialist services. This includes the small number of children who have to travel to other hospitals in Scotland or England to receive the care they need. How was Child Health 2020 developed? We spoke to NHS staff, local authority and third (voluntary) sector partners, children, young people and families about what we were getting right, what could be better and what was important to them. Their feedback, together with information from national policies (page 15), has been used to develop six Child Health 2020 themes. For each theme, we have then developed goals (pages 5-6) on which we will concentrate our efforts to make the biggest difference to child health. What will happen next? We are consulting on Child Health 2020 until 21 October 2013. We will then make changes based on the feedback we receive. We will present the final framework to the Board of NHS Grampian for approval. This will include an Action Plan setting out the activities which will achieve our goals. The Action Plan will ensure strong leadership and monitoring mechanisms are in place and will include ideas people have already shared with us as well as suggestions that are made during the consultation.
5 Our themes and goals at a glance Theme 1 - Children, young people and families at the heart of what we do Goals We will support children and families to look after and improve their own health, by providing information and help in building resilience. We will involve children and young people in their own care and communicate with them using language they understand. We will regularly gather and learn from the experiences and views of children, young people and families and we will make improvements as a result. Theme 2 - Acting early and intervening at the right time Goals We will give all children the opportunity to realise their potential to be healthy. This includes vulnerable children such as those on child protection registers and looked after children. We will shift our focus towards early prevention, recognising where this can have longer term benefits for health care and other services. We will provide reassurance that services will be responsive and will be available in the right place at the right time. We will improve joint working at a strategic level to ensure that programmes which lead to improvements in health are sustained. Theme 3 - Safe and sustainable services Goals We will provide services which are safe and sustainable and, working with specialist networks, we will keep a broad range of services available locally and in the north of Scotland. We will redesign our workforce to meet the demands of a changing paediatric service. We will work with the national collaborative programmes to deliver improved services. We will review acute paediatric services across Grampian in the context of sustainability across the north of Scotland. We will improve access to all services. We will develop clear pathways for transition between services for children and adults.
6 Theme 4 - Integration and partnership Goals We will improve joint working with other organisations to ensure children and young people are seen as a whole rather than as a set of needs or problems. We will work more closely with colleagues and partners at a strategic level to ensure we have a joint agenda and goals for child health. Theme 5 - Workforce, education and training Goals We will make the best use of our child health workforce to offer the highest quality healthcare and provide proactive support in building positive health for children. We will review the resources and structures that health visitors, school nurses and allied health professionals need to make the best use of their skills and time. We will review the staff skill mix needed to ensure the highest quality service for children. We will review the training required by generalist staff to enable them to better fulfil their role in child health. Theme 6 - Knowledge and evidence Goals We will assess the IT needs of health visitors, school nurses and allied health professionals. We will put systems in place which allow accurate recording of information, sharing of information and data extraction for monitoring. We will develop a mechanism to ensure NHS Grampian can monitor the status of child health in Grampian and assess progress.
7 Facts and figures about child health in Grampian There are 117,835 children and young people aged under 18 in Grampian that is one in five of the total Grampian population. Nearly half live in Aberdeenshire. There are around 6,500 babies born in Grampian per year, with 800-900 babies admitted to Aberdeen Maternity Hospital Neonatal Unit. More babies are born at less than 26 weeks gestation each year, often requiring long hospital stays (e.g. 4-5 months) and some requiring ongoing care. Just under a third of Grampian women breastfeed. This figure compares well with the Scottish average, but some areas in Grampian have low or very low rates. Uptake of all primary childhood immunisations meets the national target of 95%. This is consistent across all socio-economic groups. On average, every month in Grampian, children and young people account for nearly 4,000 outpatient appointments, 1500-2200 A& E attendances, and 900 inpatient stays. Aberdeen has a significantly higher hospitlisation rate for unintentional injuries in the home for children under 15 years old when compared to the Scottish average. Aberdeenshire has a particularly high number of road traffic hospitalisations for people under the age of 24. Moray has a particularly high rate of asthma hospital admissions for children aged 0-15. Fewer young people are now smoking, drinking alcohol or taking illegal drugs than they were a decade ago. Nearly 1200 children have completed a Grow Well Choices programme to achieve a healthy weight. More than 16,500 nursery children are brushing their teeth daily as a result of our Childsmile programme. The number of children under 15 years old on the Child Protection Register in Grampian has fallen in recent years to approximately 200 children in 2012. Many of the migrant population living in Grampian include children and young people who may have specific support needs when using our services. Sources include 2010 ScotPHO Children and Young People Health and Wellbeing Profiles and NHS Grampian health intelligence data.
8 Some important factors that affect child health The health of children and young people in Grampian Children and young people in Grampian are healthier today than ever before (page 7). However, these figures also show there are areas where outcomes could be improved. Mental health and wellbeing The emotional wellbeing of children and young people is as important as their physical health. Good mental health allows children and young people to develop the resilience to cope with whatever life throws at them and grow into healthy adults. The need to improve mental health and wellbeing was highlighted by young people, staff and partners when developing our Child Health 2020. Maternal health What happens during pregnancy can have lifelong effects on many aspects of health and wellbeing. Factors in a mother s health such as obesity, diabetes, undiagnosed infections and mental health problems can all be risk factors for babies. Smoking, drug and alcohol consumption can also adversely affect a baby s health. The role of parents and carers Children who experience a secure, loving and nurturing home environment are better able to withstand life s challenge and achieve their full potential. Parents (including carers who are fulfilling the role of parents) are key to achieving the best physical and mental health and wellbeing outcomes for children. Families who need more support Children s early life experiences are central to shaping their long-term health and wellbeing. The most important factor determining a child s access to positive early experiences is poverty. Addressing this is key to improving the health of the whole population and reducing inequalities in health. NHS Grampian has a responsibility to provide healthcare services and to improve the health of the Grampian population. Our aim is to keep children healthy but, when they do require healthcare, we will provide the best quality possible.
9 Theme 1 - Children, young people and families at the heart of what we do Why it is important Children and young people have the right to an opinion and for it to be listened to and taken seriously. 1 We know that when people are involved in their care and treatment it leads to better health outcomes and we also know that bad experiences of care and treatment can have a profound and long lasting negative effect. We need to work with children, young people and families to ensure we meet their needs, involve them in decisions that affect them, and treat them as individuals. We also need to empower and support parents to care for and nurture their children. What is working well and what we need to improve When we spoke to children, young people and families, they told us what mattered most to them was: y Services are there when they need them. y Services are available locally where possible. y We involve them in discussions and decisions about care and treatment. y We talk to them in a way that is understandable. y We think about the whole child and not a set of needs or problems. y We provide good quality information to help them be healthy. y We help them to support themselves but we recognise when they need support. y We speak to each other and to other agencies involved with their care. Most children, young people and families told us about their positive experiences of the NHS. However, a few also shared examples where we did not always do the things above. Long Term Goal - We will support children and families to look after and improve their own health, by providing information and help in building resilience (for example, through parenting and community support). Long Term Goal - We will involve children and young people in their own care and communicate with them using language they understand. Short Term Goal - We will regularly gather and learn from the experiences and views of children, young people and families and we will make improvements as a result. 1 Article 12, United Nations Convention on the Rights of the Child (UNCRC)
10 Theme 2 - Acting early and intervening at the right time Why it is important We need to move away from reacting to problems as they arise to proactively supporting every child to be healthy. This means that services that keep children and young people free from harm and support them to live healthy, satisfying and self sufficient lives need to be given a higher priority. This approach will lead to lifelong benefits for children and young people and will reduce pressures on services. What is working well and what we need to improve Many of our public health programmes extend beyond lifestyle choices and have already achieved considerable success (page 7). For example, Give Kids a Chance supports young people from disadvantaged areas or those excluded from their peer group to develop life and social skills through involvement in leisure activities. But we need to do more. Young people told us that health information in schools could be better and more support around mental health and wellbeing would be helpful. Preventing infant mortality, improving the health of pregnant women and ensuring best possible child development in early years are also key priorities. To do this properly, public health programmes need to be part of our routine practice and not reliant on short term funding. How we deliver services must also change. We need to recognise people who use our services have skills and attributes and not just view them as having a problem to be solved. We need to consider how people, and the communities in which they live, can contribute to improving health. Long Term Goal We will give all children the opportunity to realise their potential to be healthy and happy individuals. This includes vulnerable children such as those on child protection registers and looked after children (LAC), but also takes into account inequalities in the early years experiences of children who are not known to services. Long Term Goal - We will shift our focus towards early prevention, recognising where this can have longer term benefits for health care and other services. This will include reviewing how we support parenting and addressing inequalities at an early stage of life. Long Term Goal - We will provide reassurance that services will be responsive and will be available in the right place at the right time. Short Term Goal - We will improve joint working at a strategic level to ensure that programmes which lead to improvements in health are sustained.
11 Theme 3 - Safe and sustainable services Why it is important Children are seen locally by primary care professionals (GPs, health visitors, school nurses) for screening, immunisation and their other primary health care needs. When children need more complex health care, services are available from general medical, surgical and community paediatric services. 2 Many services are very specialised and are delivered through networks of professional staff working over regional or national boundaries, to ensure that the most expert staff are involved in care delivered locally. Occasionally children are supported to receive their care in other hospitals across Scotland and the UK. What is working well and what we need to improve Support nationally has allowed us to increase the surgical paediatric team for the North as well as extend the number of specialist nurses available to support families in communities and in hospital. There has been a move away from doctors holding single-handed posts in specialties such as paediatric gastroenterology and cancer services and instead a move towards them working as part of regional and national networks. But issues remain. The North of Scotland Paediatric Sustainability Review 2011 outlined the challenges currently facing acute paediatric care in the North and recommended where regional collaboration might strengthen the sustainability of services. We need to continue to work with the Scottish Government to plan very specialist services on a national basis. We must also support our Child and Adolescent Mental Health Service to continue developing to better meet the needs of the children and young people they care for. The challenges we face mean that we must examine how we deliver services to help ensure they are as safe and sustainable as possible. This may mean that how we deliver care may need to change. Long Term Goal - We will provide services which are safe and sustainable and, working with all relevant specialist networks, we will keep a broad range of services available locally and in the north of Scotland. Long Term Goal - We will redesign our workforce to meet the demands of a changing paediatric service. Long Term Goal - We will work with the national collaborative programmes to deliver improved services. 2 Information about how services are managed and delivered in NHS Grampian available at www.nhsgrampian.org/childrenandyoungpeople
12 Short Term Goal - We will review acute paediatric services across Grampian in the context of sustainability across the north of Scotland. Short Term Goal - We will improve access to all services. Short Term Goal - We will develop clear pathways for transition between services for children and adults. Theme 4 Integration and partnership Why it is important We know that we cannot support children to have the healthiest possible start in life on our own. Whilst the most important partnership is with children and families themselves, we must work across organisations to make the biggest difference to child health. What is working well and what we need to improve NHS Grampian works within three Community Planning Partnerships (Aberdeen, Aberdeenshire and Moray) which bring together services such as education, social work, police and third sector organisations. Community Planning Partnerships are particularly important in planning and delivering services for vulnerable children and publish Integrated Children s Services Plans to demonstrate where we will work together. The national Early Years Collaborative is a coalition of Community Planning Partners working together in local areas to improve the health and wellbeing of children and their families, from conception to starting primary school. The collaborative must improve outcomes and reduce inequalities for vulnerable children and see a shift towards early intervention and prevention. Whilst these Partnerships and Collaborative illustrate what is working well, families and professionals from different organisations also shared experiences and examples of when joint working could be better. This included within the different parts of the NHS, with local authorities and with the third sector. Suggestions for improvement included having clear lines of communication; a clearer understanding of each other s roles and remit; and consideration of the needs of the whole child. Long Term Goal - We will improve joint working with other organisations to ensure children and young people are seen as a whole rather than as a set of needs or problems. This will include being clear about boundaries within which to work and avoiding barriers to a whole person approach. Short Term Goal - We will work more closely with colleagues and partners at a strategic level to ensure we have a joint agenda and goals for child health. Current mechanisms for this include the Early Years Collaborative and Integrated Children s Services Plans.
13 Theme 5 Workforce, education and training Why it is important Children and young people come into contact with a range of NHS staff generalist staff who work with children as part of their role (for example, GPs) and specialist staff whose main focus is children and young people. To ensure children and young people receive the right care at the right time, we need to not only have the correct balance of staff in terms of numbers and skills; we also need to ensure they have access to education, training and support. What is working well and what we need to improve We have training facilitators across Grampian who provide child protection awareness training and specialist child protection nurses who support training to key groups of staff. We have also developed a training directory which signposts health visitors and school nurses to learning resources specific to their role. Challenges remain in recruiting and retaining staff across all areas of children s services and making the best use of the specialist nursing and medical workforce in hospital and the community. For example, we, along with other Health Boards in Scotland, recognise the pressures on health visiting and school nursing staff and are working with the Scottish Government to explore improvements. We will need to explore different models of support to address some of these challenges; this will include exploring extending the roles of physician assistants, nurses and allied health professionals. We will also review our education programme for generalist staff such as GPs. Long Term Goal - We will make the best use of our child health workforce to offer the highest quality healthcare and provide proactive support in building positive health for children. Short Term Goal - We will review the resources and structures that health visitors, school nurses and allied health professionals need to make the best use of their skills and time. Short Term Goal - We will review the staff skill mix needed to ensure the highest quality service for children. This will be done in the context of national policies and initiatives. Short Term Goal - We will review the training required by generalist staff to enable them to better fulfil their role in child health.
14 Theme 6 Knowledge and evidence Why it is important On an individual level, sharing relevant information about children and young people with partner organisations is vital to protect children and it also helps services work together to better support families. At a community and Grampian level, good quality information and evidence helps identify what we need to improve and whether changes we put in place are making a difference within and across our child population. We need to be able to measure progress against national NHS targets, but we also want to consider whether there are other aspects of child health that it would be important to measure and monitor, particularly with a move towards early intervention. What is working well and what we need to improve Links between professionals and information sharing already takes place around issues of child protection but closer partnership working (theme 4) along with better use of information technology would improve this further. Although NHS Grampian reviews some indicators for early years, this is not as comprehensive as it could be. For example, we have limited data on mental health and wellbeing in Grampian. Short Term Goal - We will assess the IT needs of health visitors, school nurses and allied health professionals. We will put systems in place which allow accurate recording of information, sharing of information and data extraction for monitoring. Short Term Goal - We will develop a mechanism to ensure NHS Grampian can monitor the status of child health in Grampian and assess progress.
15 Background Information National Policies There are many national policies focussing on children and young people and nearly all share common ambitions. All children should expect to be supported to be Safe, Healthy, Achieving, Nurtured, Active, Respected and Responsible and Included (SHANARRI). NHS Grampian s Child Health 2020 aims to build on progress made with implementing national policy frameworks such as Getting it Right for Every Child, (GIRFEC). The GIRFEC approach ensures that anyone providing support puts the child or young person and their family at the heart of what they do. GIRFEC is important for everyone who works with children and young people as well as those who work with adults who look after children. The My World Triangle helps people to think about the whole world of the child or young person when assessing their needs, and planning or delivering their care.