Integrated Care Systems' (ICSs) and Sustainability and Transformation Partnerships' (STPs) strategic plans should be developed by November 2019 and will guide their work for the next five years. These plans will feed into national NHSE strategy and are of paramount importance to improving the health of children and young people in England.
The RCPCH encourages STPs and ICSs to accord with three recommendations in the development of their plans: 1) draft their plans in line with the NHS Implementation Framework; 2) engage with children and young people; and 3) draw inspiration from best practice examples.
1. Fulfill the NHS Implementation Framework
The NHS Implementation Framework was published June 2019 to guide the creation of five year strategic plans by Sustainability and Transformation Partnerships (STPs) and Integrated Care Systems (ICSs).
According to the Implementation Framework, the following stakeholders must be involved in the development of the plans:
- Plans must be co-produced with the input of children, young people and parents/carers
- Named clinical and management leaders must work alongside others in the field of child health to produce the plans.
The plans must address a number of priority areas:
- Integrated care, specifically between: physical and mental health; primary, community and acute services; paediatric and adult services
- Mental health and social services must be aligned
- Care for children and young people with long term conditions
- Improved access to high quality children's services via cancer networks
- The expansion of children and young people's mental health services (CAMHS)
- The expansion of services and initiatives to treat and manage childhood obesity.
All plans should meet these conditions in ways that are suitable for their local context.
2. Engage children, young people, families and carers
The Implementation Framework states that the plans produced by STPs and ICSs must be co-produced with the input of children, young people and parents/carers. The input of children and young people should not end there, however; the plans themselves should outline how children and young people will be consulted and engaged with on decisions that affect their health.
This is vital if services for children and young people in the area are to be successful and sustainable. Patient consultation is also mandated by the NHS Constitution for England and the UN Convention on the Rights of the Child, which applies to the NHS and associated bodies.
There are many different ways to engage children and young people; some STPs and ICSs may benefit from established youth groups that they can involve in decision-making. Others may not have this and therefore focus initially on ad-hoc engagement via school visits or fast patient feedback. All STPs and ICSs should include ongoing engagement with children and young people in their plans, and the RCPCH&Us webpages have a wealth of resources and case studies to use in this.
3. Draw inspiration from case studies
The NHS has identified a number of examples from across England where integrated models of care have been deployed for the benefit of children and young people. Many of these examples involve a variety of stakeholders to create change across the system.
The plans developed by ICSs and STPs should meet the objectives set out in the Implementation Framework, and the needs of their local population, in creative ways. The best plans will aim to utilise the expertise of a variety of different child health professionals or amend the patient pathway to avoid unnecessary steps.
The RCPCH also considers the examples set out below to be best practice case studies in re-designing services and establishing new initiatives for the benefit of children and young people.
The Healthier Together programme in Wessex
The Healthier Together website and its resources were developed in partnership with parents and healthcare professionals from across Dorset, Hampshire and the Isle of Wight, with the aim of improving the quality of care for children and young people across Wessex. The resources provide public facing information, clinical pathways and safety netting information on common presentations.
The Healthier Together website has been developed to provide parents and carers with accurate, reliable healthcare information for their child in one easily accessible place. This helps parents and carers to decide if they can provide care for their child at home or if they should seek professional advice.
The website is also intended to be used by healthcare professionals, providing clear guidance on what is likely to be within their competencies and when they should consider escalating the patient. This helps to standardise the patient pathway and reduce variations in care across the region.
In addition to the online resources, the Healthier Together programme oversees the delivery of paediatric education in the format of interactive workshops based on the Healthier Together clinical pathways. These workshops are delivered to professionals working across the urgent care pathway, ensuring their buy-in to the programme.
Urgent care metrics show reduced presentations to primary care, emergency departments and reduced admissions. These are linked to the introduction of Healthier Together and its use in the Wessex.
The programme has also led to a variety of collaborative initiatives within the Hampshire and the Isle of Wight STP children's programme, including the introduction of Connecting Care Children's Hubs (CCCHs) across Hampshire and an NHS 111 paediatric desk pilot funded by NHS England. More information on these initiatives is available on the Healthier Together Service Improvement Projects page.
The acutely unwell child Managed Clinical Network in South Yorkshire and Bassetlaw
The acutely unwell child Managed Clinical Network (MCN) in the South Yorkshire and Bassetlaw ICS is a workstream that aims to improve equity of access and the quality of care, resulting in a reduction of health inequalities. The MCN bridges three STP/ICS footprints as it includes hospitals from South Yorkshire, East Midlands and West Yorkshire.
The MCN has an agreed set of early priorities to deliver consistent pathways for six common conditions: asthma, bronchiolitis, diarrhoea and vomiting, abdominal pain, epilepsy and the febrile child (children aged under five with fever). The network focuses on reducing attendance to GPs and A&E and reducing hospital stays. The network will also focus on exploring diverse workforce solutions, including physician associates and advanced nurse practitioners.
In addition to the MCN, the ICS has established two new forums to work across South Yorkshire and Bassetlaw: a ‘Health and Care Institute’ linked with universities, colleges and schools to develop and support the workforce; and an ‘Innovation Hub’ for researching new developments and technologies.
More information is available on the ICS website.
Children and Young People Health and Wellbeing Framework in Greater Manchester
The Greater Manchester (GM) Children’s Board oversees work on a wide portfolio covering education, early years, life readiness and employability. The GM Children’s Health and Wellbeing Executive Board are accountable for the deployment of the Children’s Health and Wellbeing Framework on behalf of the GM Health and Social Care Partnership Board and the GM Children’s Board.
At the centre of the Framework is the ‘Children’s Charter’ that puts young people’s voice at the centre of the framework and includes young people as key stakeholders in which to monitor progress. The framework is built around the principle of an integrated model that covers health, education, social care, youth justice and the voluntary sector.
Cheshire and Merseyside Women and Children's Partnership
The Cheshire and Merseyside Women's and Children's Partnership is the only women and children focused acute care collaboration vanguard. The Partnership included 27 providers and commissioners across the region and is one element of the area's STP.
The STP are supported by eight clinical programmes, with one focusing on women's and children's services. Agreed early priorities for the STP were for the better integration of community services, the seamless working between local authority and NHS providers and a focus on mental health support, including collaboration with schools and education.
The RCPCH was commissioned to carry out an evaluation of the Partnership and found that it initiated change and innovation across Cheshire and Merseyside through fostering collaborative working between providers.
More information on the Cheshire and Merseyside STP is available on the NHS website.