Children's health strategy implementation

During the past two years, the Government has paid special attention to improving health services for disabled children and their carers. Children are one of the key priorities on the NHS Operating Frameworks for 2008-09 and 2009-10. This priority is reflected in the publication earlier this year of Healthy Lives, Brighter Futures, the first Child Health Strategy.

The needs of disabled children, and of those with life-limiting or life-threatening conditions, have been specifically addressed in Aiming High for Disabled Children (the transformation programme for disabled children’s services) and in Better Care: Better Lives (the vision for improving paediatric palliative care services).

As the local leader of the NHS, NHS Birmingham East and North is working to commission services which can deliver the outcomes envisaged by these documents. In order to do this in the most efficient and effective way, the PCT collaborates extensively with the Heart of Birmingham Teaching Primary Care Trust and NHS South Birmingham, with Birmingham City Council, with regional networks and with local providers (from the statutory, independent and voluntary sectors).

This collaboration already includes an Integrated Strategy for Disabled Children, a Short Breaks Strategy, a Paediatric Palliative Care Strategy and a Transition to Adulthood action plan. In 2009, the Children’s Trust also adopted a Charter for Disabled Children, Young People and their Families, outlining specific commitments to be achieved by the end of the year. These collaborative commissioning arrangements embrace short breaks, community equipment, wheelchairs and palliative care for the City’s children and young people.

World Class Commissioning

Fundamental to the commissioner’s role is a thorough understanding of the needs and experiences of the local population. Alongside the Joint Strategic Needs Assessment (JSNA), the PCT has been working hard with partners to significantly improve its understanding of the range and extent of the needs of disabled, life-limited and life-threatened children and young people. Historical data was inadequate in many respects. Any additional resource allocation can only be made on the basis of evidenced need.

In addition to this, the PCT has demonstrated a strong commitment to identifying and responding to the views and experiences of service users and their carers. Patients surveys (both new and existing) have been reviewed, stakeholder consultations have been held and specialist user involvement activities have been commissioned. The PCT is also working towards implementation of the Hear by Right standards for involving children and young people, and the You’re Welcome quality criteria for making services more young person friendly. Its Patient Advice and Liaison Service (PALS) is participating in the national ‘getting it right for children and young people’ project. All of this work is providing the PCT with a significantly enhanced understanding of the experiences of services users and their carers, and these experiences are proving invaluable to its review of current services and its commissioning of future services.

Future commissioning is being informed by evidence-based best practice from around the UK, and will focus on the benefits that need to be achieved for our children and young people, and for their families. Although additional resources have been provided in recent years, the current economic climate demands that commissioning intentions take full account of the new financial realities and that they lead to the provision of services which are sustainable. Commissioners’ responses to these realities must meet the challenge of Quality, Innovation, Productivity and Prevention (QIPP). This will include developing the range of providers that are able to offer services, in order to secure an efficient and healthy market which is able to meet identified needs and to respond to patient choice.

Service improvement and development

Our strategic direction-setting documents and our specialist services reviews are both enabling us to identify and deliver continued service improvement and development in line with the Government’s identified priority areas.

Short breaks

• A variety of short breaks (including complex care packages) are being commissioned by the PCT during 2009-2010, amounting to a total investment of £2,128,217, an increase of over £1.275m on 2007-2008.
• The PCT has also significantly increased the support it provides to Acorns Hospices, more than doubling its historic contribution level.
• To secure continued developments in this area, the PCT has recently appointed a Joint Commissioning Manager for short breaks in partnership with the City Council and other Birmingham PCTs.
• The information emerging from current services and from service reviews will – along with the Short Breaks and PPC strategies – inform forthcoming investment decisions for 2010-2011.

Community equipment

• During 2009, the PCT and its partners supported the development of a national procurement strategy for children’s community equipment. The results of this are currently awaited from the DCSF.
• Although the equipment service reports no unmet need, there is an identified lack of duplicate and/or loan equipment for additional settings, and an acknowledgement that equipment supply is adversely affected by a lack of procurement planning, and storage/recycling capacity. A more efficient and timely means of procuring and supplying equipment is being explored.

Wheelchairs

• These are jointly commissioned from Birmingham Wheelchair Services which caters for both adults and children. A service review in 2008 identified inappropriately long waiting lists and a way of reducing lists to acceptable levels.
• Service specifications are to be re-written on an outcomes -based model to create an assessment and enhancement of mobility service, and to meet all needs within the 18 week target period.

Palliative care

• The Birmingham PCTs jointly commission community children’s nursing and specialist palliative care nursing, and this includes some out-of-hours provision. The provision of out-of-hours cover is limited currently, however, and services are not sufficiently integrated.
• Following the appointment of an improvement and development manager, a wide range of issues has been identified in the Paediatric Palliative Care Action Plan, reflecting the strategic development goals of Better Care: Better Lives and the 2008 Regional Gap Analysis. These include;
  • an extension of multi-agency partnership working (including around integrated assessment, seamless services and equity of access);
  • an expansion of service capacity in the community;
  • an improvement in the accessibility of appropriate data, best practice and other information , and;
  • the enabling of a culture of continuous service improvement through increased user/carer involvement, analysis of new data and ongoing service review.

Three other areas are also worthy of comment.

Although services currently have their own key worker arrangements, we recognise that:

• a key worker is not always identified for each child (at least as far as the family are aware)
• stress is caused to the family as they try to plug the gap and fulfil this role themselves
• the nature of the role needs to be clarified between services
• sufficient capacity needs to be provided so that the role can realistically be fulfilled.

The Short Breaks & Paediatric Palliative Care Strategies identify a number of workforce issues in relation to short breaks carers/support workers – recruitment, training, remuneration and retention. A joint PCT and City Council workforce development plan for 2009-2011 is currently being prepared.

The Paediatric Palliative Care Strategy identifies a need to further develop multi-agency partnership working in assessment, care planning and reviewing, key working and ease of access. It envisages that improved multi-agency partnership working will

• enable patients/families to receive a timely, coordinated and holistic assessments
• ensure that there is capacity for fast-track assessments and care planning for patients with a rapidly deteriorating condition
• simplify and coordinate multi-agency assessment (to include use of the Common Assessment Framework and the national minimum dataset), ensuring that there is an early and holistic assessment of patient and family needs after diagnosis (and prior to discharge)
• avoid the duplication of appointments
• provide greater involvement and choice for families
• review transition arrangements
• secure better advanced and emergency planning, and
• ensure that the holistic needs of families are met.