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High quality care for every child at all times

A consultant paediatrician leading a clinical network in South Yorkshire and Bassetlaw talks about the work being done to integrate care across seven hospitals and health services in the community:

We have a vision. It’s quite simple: every child should have high quality care and equal access at all times, whether that’s in hospital or in the community.

The reality is that we operate in complex systems. They have evolved over time to serve local communities as best they can but face increasing challenges as the needs of children change with more chronic health problems.

In South Yorkshire and Bassetlaw, we have half a million children, many living in deprived communities. Three of our five councils report higher levels of obesity for 11-year-olds than in other parts of the country. We are admitting more children with common childhood diseases into hospital, seeing year-on-year growth of 6%. 11,000 operations are carried out every year and more than 200,000 children visit A&E. Outpatients services struggle to cope.

We have five district hospitals providing paediatric services with a specialist neo-natal department at Sheffield Teaching Hospitals and a specialist tertiary centre, Sheffield Children’s Hospital.

Children and their families also see GPs and community nurses. They may go to minor injury units, pharmacists, walk-in centres or children’s assessment units. They may call 111 or 999.  They may need mental health or social care support.

You get the picture of the numerous points of access for care and treatment a child may experience; and how many relationships there are to manage – not to mention the connections we have with services for new-born babies and maternity.

Against this landscape, we have significant workforce issues. Our professionals in child health are very dedicated but stretched. We plug gaps with locums and agency staff – at high cost.

To achieve our vision, we need to do something that simplifies the system for children and their families, supports professionals on the front line, and delivers high and consistent standards of care that we can sustain for generations to come.

In South Yorkshire and Bassetlaw, we took steps last year to create a single clinical network for hospital paediatrics.

The core network includes paediatricians from each hospital alongside colleagues from GP practices, emergency care, children and adolescent mental health and the ambulance services. We have close links to public health, commissioners, hospital management, and public and patient engagement teams.

We agreed a set of early priorities:

The first is to deliver consistent pathways for six common conditions: asthma, bronchiolitis, diarrhoea and vomiting, abdominal pain, epilepsy and the febrile child (children aged under 5 with fever).

These set out guidelines that informs a family or a healthcare professional what they need to and when to respond to these conditions.

There’s a strong focus on helping children and families to better manage their conditions through self care. Trips to see their GP or to A&E will be far less frequent. We will prevent many children from hospital admission. When they do need hospital treatment, we will keep their stays as short as possible, providing support closer to home.

Our guidelines are almost ready and we will be working with patients and families to design information to help them manage these conditions, and get the right care in the right place.

A second priority is around workforce solutions. We know that traditional routes into paediatrics are unlikely to bridge the gaps. We are looking, for instance, at physician associates – widely used in the US to support consultants – and advanced nurse practitioners. We need the right training and education programmes to develop new roles as well as the capabilities of healthcare professionals in our communities.

We have other objectives – measuring quality, aligning paediatrics to maternity and neonatal services, supporting the independent review of hospital services across the region.

The review recently set out a series of recommendations for change. This is reinforcing the work we have started, recommending that we create a single service model for acute paediatrics, led by Sheffield Children’s Hospital.

For young people change is overdue. During the review, one member of our youth forum said: “In many cases you have to make sure that each service has talked to each other, then it doesn’t cause long delays and an appointment isn’t wasted.”

Outcomes are clear. No child will get treatment in an environment that falls short of required standards but there will be no unnecessary transfers of patients. Care close to home, where it can be delivered to those standards, is preferred.

Our hospitals will work together to achieve those outcomes. We are turning a corner – a partnership for integrated child health is growing in strength.

If we get it right it will make a difference to tens of thousands of young lives every year.

Nicola Jay is a consultant paediatrician leading a clinical network in South Yorkshire and Bassetlaw.

After qualifying as a doctor in London (Royal Free Hospital MBBS, St Mary’s Hospital/Imperial BSc physiology) she trained in paediatrics across three regions (Nottingham, Sheffield and Birmingham) with post graduate qualifications in Health Care Leadership (MSc) as well as Ethics & Law (PgDip).

Nicola has worked at Sheffield Children’s Hospital as a consultant in paediatric allergy for a decade with research interests being prevention of food allergy as part of the BEEP study, looking at minority population to improve health, moving allergy services into the community to improve access and de-labelling of antibiotic allergy.

She sits on the paediatricians in medical management committee at the RCPCH which advices on national health policies and standards for young people and is a council member for the clinical senate of Yorkshire & Humber which gives impartial advice to clinicians.

Her main additional role is as the clinical lead for the acutely unwell child managed clinical network (MCN) of South Yorkshire and Bassetlaw (Barnsley, Bassetlaw, Doncaster, Rotherham, Sheffield and Chesterfield/Mid Yorks NHS Trust). The MCN is a workstream of the Integrated Care System (ICS) aiming to improve equity of access, quality of care and subsequent reduction in inequalities of health for the children in our region by working closely together.

Central to her vision is an NHS that unites across currently recognised boundaries to provide seamless care for all children that need health care.

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14 comments

  1. Nora Everitt says:

    I would like to thank Nicola Jay for taking the time to answer the comments. Perhaps she could suggest that the SYBICS actually allow such conversations to happen in SY & Bassetlaw.
    I would also like to thank Ms Jay for giving so much information in her blog, such as which conditions that will be affected by the changes. This detail has not been shared so far by the SYBICS. They do not seem to think people want to know. One of my children had febrile convulsions when very small that needed emergency care when she fitted for many minutes. It was awful watching her being carried away, as I had other little ones who couldn’t travel in the ambulance too, and arranging emergency childcare was not easy to let me follow on the 10 miles to A&E. I had to leave her dangerously unwell, distressed, and alone with strangers.

  2. Murrays Pharmacy says:

    This blog shared by you is really informative.I have been searching for a blog on child health care and i have found one on your website.Thank you very much for sharing.

  3. Anonymous says:

    leave our services where they are and also don’t move them away it’s for our residents here in Barnsley , you will be putting people’s lives at risk.

  4. Mike Higgins says:

    “self care” – this says it all, families left to cope on their own. Children are being ferried from Bassetlaw Hospital to DRI every night and back again next morning. Children needing operations in Barnsley and Rotherham now have to go to DRI or Northern General. The whole system is failing children and it can only get worse as the full effect of the £571 million funding cut kicks in. All that you are doing is trying desperately to paper over the cracks. What pressure are you and the CCGs bringing on the government to reverse the (deliberate) underfunding of the NHS?

    • Nicola Jay says:

      I am, along with many others, committed to improving child health and that means more funding needed for children. We currently don’t have enough health visitors, school nurses, GP’s trained with experience in child health etc. Social inequality has a major impact on child health and we need more public health not less. You cannot paper over cracks, you either start from scratch or fill with a substance that is tough enough to last. We are aiming for a 20-30 year plan for children in our region, one that will improve child health and have longevity.

  5. Susan Shaw says:

    What will a physician associate do?

    • Nicola Jay says:

      We need to understand whether physician associates are a viable model to use in child health. They need to be safe, effective and deliver quality care within a multidisciplinary team of nurses, doctors and other allied health professionals. Many years ago we never allowed nurses to deliver the enhanced care that they now do and we need to broaden our thinking and empower individuals who are committed to looking after children.

  6. Gillian Higgins says:

    You talk about care close to home and no unnecessary transfers of children, but children from Barnsley Hospital are being transferred to Doncaster Royal Infirmary for overnight care. Surely this cannot aid children’s care?

    • Nicola Jay says:

      It has been agreed that out of hours, if a child needs to be operated on, in either Barnsley, Rotherham or Chesterfield then the child will be transferred to a different hospital for that operation.

      Care close to home is important as if a child is unnecessarily looked after in a hospital further away then this is very difficult and expensive for the family. Time off work, school, cost travel/meals and inability of some family members to visit when we know how important this is all needs to be thought of.

      Care closer to home may mean a child being looked after at home ie a nurse going to visit the child and assess based on a GP’s referral and then discussion with a hospital team whether its safe to keep that child at home ie “virtual hospital ward’. Lets think differently.

  7. Mike Smith says:

    Do you agree that the ” significant workforce issues ” have been created deliberately in order to force the NHS into this position? If ” no ” then why have you remained silent as not enough staff have been trained? If ” yes ” then why have you remained silent as not enough staff have been trained?

    Do you agree with ex health secretary Jeremy Hunt that the future is an American health system based on Kaiser Permanente including the de-skilling of staff as outlined in your view that physicians assistants ( described as requiring enthusiasm rather than qualifications in the SYBICS ) being widely used in universally criticised American insurance based health system is appropriate or desirable here?

    If ” yes ” then why can’t you be honest about what the future is? If ” no ” then why are you going along with this?

    • Nicola Jay says:

      The future is not an American health care system or it will be one that I am not working in.

      Physician Associates have allowed staff to upskill by allowing surgeons to attend to theatre to learn how to operate and medical doctors to attend clinics to understand how to look after chronic health problems in children. However, they also have skills in their own right being trained as an undergraduate in usually a science based subject, two years postgraduate training and our plan ( if felt appropriate) would be a training programme in paediatrics to ensure they have the skills to look after children.

      There has been underfunding of the NHS and I am sure that everyone who works in the NHS has shouted loud about it.

      Current workforce issues have been compounded by BREXIT We can sit and wallow or we can be proactive and broaden our thinking about how to improve child health in this country as currently ‘The State of Child Health 2017’ tells a story that I don’t like reading.

  8. Shivaun Aveston says:

    Excellent vision and would be keen to hear how the network is progressing specifically with engagement and whole systems approach to delivery.

    • Nora Everitt says:

      I think you need to look at the SYBICS website at -https://www.healthandcaretogethersyb.co.uk/index.php/about-us/whychange/latest-news/high-quality-care-every-child-all-times .
      This may give you an answer to your question about engagement. The post published on NHS England’s blog page was reproduced on the News page of the SYBICS site – but there is NO invitation to comment. It appears they do not wish people in SY&B to comment on their plans.

      • Nicola Jay says:

        If you go to
        https://www.healthandcaretogethersyb.co.uk/index.php/get-involved/get-involved you are able to contribute to work streams. For paediatrics we need families with children under the age of 16 years. All views are welcome however we need to acknowledge that the problems children have in relation to health have changed since district general hospitals were built.

        Forty years ago children stayed in hospitals for weeks at a time due to lots of serious infections but with our vaccination schedule that is much less likely to happen. Instead we have children that attend the hospital and stay only for a few hours and we also have lots of children with chronic health conditions (diabetes, asthma etc) that don’t need to be looked after in hospitals if they are kept well. We also need more mental health services and health promotion to reduce the number of children who are overweight. We are putting children at risk if we don’t look at how we deliver care