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Caring for Children Closer To Home

Early Help Health Matters Conference19 June 2014

Workshop

Fiona West, Commissioner for Children, Young People and MaternityMaria Wogan, Commissioning Programme Manager

Please contact Maria Wogan if you have any queries about the information in this pack. Tel: 01908 278721 email: maria.wogan@miltonkeynes.nhs.uk

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Agenda

• Background to the project

• Feedback from MK parents and carers

• What the data is telling us about MK

• Examples of good practice

• Workshop activity

• Summary and project next steps

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Caring for Children Closer to Home Project - BackgroundOutcome: More children are cared for closer to home when they are unwell.

Supporting objectives:• Develop health information and education provision for parents and carers to support self-care and the appropriate use

of services.

• Reduce avoidable A&E presentations and avoidable emergency admissions at MKHFT.

• Build up paediatric expertise in MK to enable care to be provided closer to home

• Implement high impact paediatric care pathways to enable safe and effective care for children to be provided closer to home.

• Agree a specification for MKHFT’s community paediatric nursing team

• Evaluate the impact of the project and continuously improve on the basis of evidence

• Establish an on-going effective mechanism for joint-working between commissioners and providers to provide the best possible care for children and young people in MK.

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The approach to engagement with parents/carers

• Qualitative research approach with some quantitative data from two questionnaires

• Visited seven children’s centres across MK

• Focus groups and one to ones using a scenario to test parent decision-making and experience and share ideas for improvement

• Majority of participants were women

• Ethnic origin of the participants: White British, Chinese, Eastern European, Western European, Asian, North African and South American.

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Geographical spread of the engagement

= Children’s centre

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Summary of feedback from parents• Good awareness of the need to avoid inappropriate use of A&E – but not always

reflected by parents’ decisions about where to take their child

• Awareness and understanding of the role of NHS Choices, 111, health visitors and pharmacies could be improved

• Lack of access to GP appointments and lack of confidence in some GPs is driving activity to MKUCS and (less so) to A&E. In some areas serious difficulties getting calls through to GP reception.

• Some parents are going to A&E if they think there is a long wait at MKUCS

• Parents want their concerns about their child to be listened to and if they take their child to a clinician they want the clinician to look at/examine their child

• Parents want to increase their knowledge of and confidence in caring for their children when they are ill

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Feedback from Parents – Variation between areasChildren’s centre More likely to … Less likely to …

Netherfield Trust hospital doctors more than GP

Call 111Feel listened to & satisfied by GPAccess health information on the internet

Newport Pagnell Be positive about their GP Seek advice from health visitor

Fishermead Go to A&E for minor complaint Feel listened to & satisfied by GP

Furzton Use MKUCS Use 111 & NHS Choices

Feel satisfied with GP

Oxley Park Self care Be able to get through to GP reception to make an appointment

Simpson Use 111 before going elsewhere for care

Seek advice from health visitor

Bradville Use MKUCS and A&EUse Pharmacist for advice

Be able to get through to GP reception to make an appointmentFeel listened to by GP

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Feedback from Parents – ideas for improvement• Focus on first time parents

• Listen to parents’ concerns

• Dedicated children’s telephone line at GP surgeries, increase GP appointments

• Walk-in-Centre for children

• Extend health visitor access and promote health visiting

• Improve access to mental health support for parents and children

• Use children’s centres as a base for training and support

• Minor illness and service information in red book &useful number card

• Improve facilities for children in MKUCS and GP surgeries

• Promote 111

• Give clear advice on going to MKUCS & A&E & reduce waiting times

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A&E questionnaire conclusions

• The majority of children whose parents completed the survey had attended A&E because of trauma (physical injury) (76%)

• The largest reason given by parents (29%) for attending A&E was because they believed their child needed an x-ray. 50% of children presenting to A&E in 2013/14 as ‘minors’ received x-rays.

• The majority of parents (44%) had not sought any advice before attending A&E. This appeared to be because they believed their child needed an x-ray / specialist advice, only available at A&E.

• The majority of children had been unwell for less than 4 hours

• 6 out of 154 reasons given for attending A&E was because parents could not get a GP appointment

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Data analysis Paediatric Assessment Unit (PAU) at MK Hospital

2011/12 2012/13 2013/143400

3600

3800

4000

4200

4400

4600

4800

MKHFT PAU activity – MKCCG patients only under 18 years

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Data analysis PAU

bronchioliti

s

asthma

epile

psyfev

er

gastr

oenter

itis

diabete

s

nausea

& vomiting

abdo pain

head/fa

ce/ey

e in...

0

100

200

300

400

500

600

700

800

Diagnosis of PAU admissions 2011/12-2013/14 MKCCG patients under 18 years

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Examples of Good Practice

• Sunshine Children’s Centre – first aid training for parents of 0-1 year olds & 1-5 year olds

• Bedfordshire – training and education for parents via health visitor training pilot

• Luton – rapid response children’s community nursing team & high impact pathways

• St Mary’s, London – Child Health GP hub – closer working between acute & primary care

• Nottinghamshire – health visiting helpline promoted by children’s centres

• Liverpool – Children’s Walk-in-Centre

• Doncaster – quicker access to GP advice and appointments for children

• Sunderland – health information sessions to deliver in schools as part of PHSE

• Newcastle – school assemblies about local GP services

• North Hertfordshire – 4US clinics delivered in schools

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Workshop

1. Group discussion – do you have anything to add to the feedback based on your experience?

2. In pairs – what could you/ your service do to contribute to this project?

• Put name/type of service and each idea on a post-it note• Stick it on the target – most powerful ideas nearest the bulls eye!

3. In two groups – draw a picture to represent the project’s desired outcome of more children being cared for closer to home?

• What does success look like? • What should we be aiming for?• How can we get there?• Be creative!

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Caring for Children Closer to Home Project - Next Steps

More children are cared for

closer to home when

they are unwell

Information, education

and support for parents

Focussed support for

GPs

High impact pathways

with enabling support

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Thank you

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