The Delivery plan for tackling the COVID-19 backlog of elective care highlighted that long waits before accessing planned care can have life-long consequences on the development of children and young people (CYP).
A delivery group has been formed bringing together the national Elective Recovery Programme, the Children and Young People’s Transformation Programme and stakeholders to accelerate progress and ensure the recovery of paediatric services keeps pace with recovery of adult elective care.
This toolkit has been developed by the group and sets out actions that regions, systems and providers should take to accelerate CYP recovery and reduce the elective activity gap between CYP and adults.
Minimum delivery expectations checklist for CYP elective recovery
To ensure parity of service between CYP and adult elective care, there are short and long term actions that should be carried out across regions, integrated care boards (ICBs), provider collaboratives, operational delivery networks, Children’s Hospital Alliance and providers. Local determination will identify which organisation will be responsible for completion and assurance.
Regions, systems and providers should have recovery plans and actions in place to return CYP activity levels to a minimum of 2019/20 rates (dependent on previous delivery and baselines) and ensure a reduction in waiting lists.
Governance and oversight
All regions are asked to set up a dedicated CYP elective recovery oversight group, reporting directly to a regional elective recovery board, or, ensure CYP features as a standing agenda item at existing regional elective recovery boards.
Disaggregated data on CYP elective recovery should be reported at all levels of elective recovery governance, and as part of wider NHS performance reporting arrangements. CYP activity should be correlated back to tiered trusts, as part of the long waits work, where applicable.
Using CYP data
A CYP elective recovery dashboard has been developed to support CYP elective recovery. It provides greater visibility of CYP data, helping identify and address key challenges and monitor progress.
To access the data, please contact: email@example.com with the subject ‘CYP ER & WL dashboard’.
Data and local intelligence should be used to understand key challenges across paediatric specialties and pathways, and to agree actions required to increase paediatric elective activity and reduce CYP waiting times.
Increase paediatric activity through new schemes
Local responses to nationally funded schemes (such as surgical hubs) should be designed to benefit children as well as adults. For all such nationally funded schemes, ICBs should quantify the impact on paediatric activity and maximise benefits for CYP.
Example: Paediatric accelerator
£160 million was made available to tackle waiting lists, trial new ways of working and develop a blueprint for elective recovery. £20 million was dedicated as part of the Children’s Hospital Alliance (CHA) with funding used for joint innovation projects and transformation in core trusts.
Ensure robust management, validation and prioritisation of CYP waiting lists
Validate CYP waiting lists in line with the validation toolkit and guidance, taking into consideration clinical risk, age, impact of waits on development and education, potential harm or long term consequences and how/if digital technology or virtual care would best be suited to the patient.
Address CYP health inequalities
Systems need to continue to embed measures to improve health and reduce CYP health inequalities. and put in place actions to support improvements and deliver against strategic priorities for tackling health inequalities.
Ensure compliance with Evidence Based Interventions (EBI) standards
The EBI programme provides guidance on when it is and is not appropriate to carry out specific interventions.
There are currently two EBIs which apply exclusively to under 18s:
- 1G: Grommets for glue ear in children.
- 2D: Removal of adenoids for treatment of glue ear.
There is one EBI which applies exclusively to under 1s:
- 2Z: Helmet therapy for treatment of positional plagiocephaly/brachycephaly in children.
For more information on EBIs, please contact: firstname.lastname@example.org.
Utilise existing examples of best practice
Utilise learnings from CYP case studies included within this toolkit and review and implement Getting it Right First Time (GIRFT) recommendations in relation to:
Embed paediatric mutual aid principles
The mutual aid framework has been developed to support the recovery of CYP elective services. This will ensure a collective and coordinated effort across providers, systems and regions. It is intended to help ensure the right conversations take place at the right time to support mutual aid and optimise solutions.
For more information, please contact: email@example.com
Review day case vs. surgery rates
The Paediatric General Surgery and Urology report sets out actions that trusts can take to improve day case surgery for low-complexity cases. It was found if all trusts were to achieve a 98% day case rate in elective surgery, 700 overnight admissions per year could be saved (see p68).
Non-complex elective activity should be carried out in non-specialist centres where capacity allows, with day case rates a minimum of 95% with a top level target of 98%.
Providers should adopt right procedure, right place (RPRP) principles to maximise day case rates and manage procedures that can be carried out in an age-appropriate setting outside of theatre.
Royal Manchester Children’s Hospital developed a standard operating procedure for discharging children and young people home from the second stage recovery room after a general anaesthetic.
Greater Manchester was the first area in England to establish a high turnover, low complexity hub model for paediatric dentistry.
Ensure robust theatre lists booking and scheduling practice
- Aim to ensure 85% theatre utilisation for all elective procedures.
- Align to national theatre programme booking and scheduling processes.
- Adopt HVLC principles – cases per list.
- Robust 6-4-2 theatre scheduling processes with schedulers closely linked to pre-op assessment teams ensuring good booking practice.
- Review day of admission processes and journey to theatre to ensure this is both child friendly and efficient to cases per list (admission close to theatre suite).
- Review theatre schedules to ensure CYP have appropriate access to volume of wait list/resource needed.
Develop processes for keeping in touch on a regular basis with parents and carers of children and young people
Check if they still need the surgery and if there have been any changes to the health of the child or young person.
Implement key outpatient deliverables within CYP
- Continue to translate the GIRFT outpatient guidance where possible to CYP.
- Review non-admitted pathways to understand the impact on admitted lists.
- Review outpatient management, using PIFU where appropriate.
Example: Was not brought AI tool at Alder Hey
Alder Hey developed a ‘was not brought’ artificial intelligence predictor model to identify risk factors and predict the probability of attendances. The tool has reduced was not brought rates by 60% across the targeted groups.
CYP elective recovery report template
The report template provides a structure by which progress, risks and issues can be provided monthly against the checklist to the regional CYP elective recovery boards and national NHSE CYP Elective Recovery Delivery Group.
The report template is to be completed/updated by the relevant stakeholder leading on the specific piece of work and fed into the template.
Using the completed template, ongoing assurance of delivery, actions and outputs should be monitored at a system and regional level and any relevant issues flagged at a national level.
- CYP elective recovery case studies
- Further detail on paediatric accelerators
- Example CYP waiting list telephone call script following nonresponse from a parent/ guardian to support validation
- Example CYP regional agenda
- CYP elective recovery resources to assist healthcare professionals
- South Thames Paediatric Network Elective Recovery table – Contact: firstname.lastname@example.org
- Top tips for paediatric high volume low complexity (HVLC) oral surgery lists from the GIRFT national clinical lead for oral and maxillofacial surgery
- Pathway for the removal of impacted teeth in children
- Pathway for extraction of teeth in children
- Variations in provision of dental general anaesthetic for children in England | British Dental Journal
- Position Statements, Briefings and Consultation Responses — Royal College of Surgeons
- Welfare checks (this pdf will automatically download)
- RCS – Surgical prioritisation of paediatric dental treatment (this pdf will automatically download)
Evidenced based intervention programme
- NHS England » Core20PLUS5 – An approach to reducing health inequalities for children and young people
- DRAFT Earlier screening, risk assessment and health optimisation – Reference Guide – Elective Recovery – FutureNHS Collaboration Platform
- Best Practice – Preassessment standards in Children
- Paediatric general surgery and urology GIRFT Programme national specialty report
- Ear, nose and throat surgery GIRFT Programme national specialty report
- Paediatric trauma and orthopaedic surgery GIRFT programme national specialty report
- Royal Manchester Children’s Hospital discharge standard operating procedure
Validation and prioritisation of waiting lists
Publication reference: PRN00262