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.