Our purpose has been to support the delivery of high quality healthcare for children, young people and their families across the East Midlands, now and for future generations. We brought together commissioners, providers and stakeholders via our children’s clinical network group and other working groups. We have supported this aim by reducing unwarranted variation and developing and strengthening pathways of care. Some of this has been achieved by establishing specialist clinical groups, sharing of good practice via regular communication and clinical forums such as the general paediatric surgery network. For all services we support the provision of the evidenced based high quality care as close to home as possible. We also act as a critical friend to those organisations in the region who require clinical expertise.

The primary and secondary care interface

With support from our GP Clinical Lead Dr Rajat Srivastava we recently targeted improving the interface between and primary and secondary care and updating knowledge within primary care around the management of fever and asthma in children. A series of successful training events for the management of asthma and wheeze in primary care trained over 100 GPs and Practice Nurses who gave excellent feedback. Read the report of this work. We plan to continue to support the primary and secondary care interface by providing primary care training for the management of sepsis in children.

Children and Young People’s emotional health and wellbeing

In conjunction with the mental health network, we are facilitating the improvement in the emotional health and well-being, and specialised mental health, of children and young people. For more details please refer to the Mental Health Network page.

General Paediatric Surgery

The General Paediatric Surgery Network operated from 2013 to 2017 and was led by Mr Richard Stewart and then Mr Daniel Colliver. The network aimed to reduce unwarranted variation in outcomes and patient experiences of general paediatric surgery for children across the East Midlands, by supporting providers and commissioners to work together towards the standards of the commissioning framework and maintaining local provision of general paediatric surgery.

We developed three commissioning guidance documents in collaboration with the Royal College of Surgeons, for specific paediatric surgery procedures: emergency appendicectomy and orchidopexy for undescended testis and management of paediatric torsion. These documents have been NICE accredited and widely circulated both locally and nationally for use by local commissioners and by local service providers and members of the care pathway.

We facilitated the paediatric surgery network to conduct multi-professional service reviews of all local general paediatric surgical services. The reviews were based on the East Midlands Commissioning Framework Standards for general paediatric surgery (2012) and responses to self-assessments against these standards. The visits focused on the emergency pathway for general paediatric surgery, and provided local assurance, improved communications between the units, and identification of areas of good practice which were disseminated to improve children’s experience of care. The reviews also identified common themes for action and network review. We shared best practice via our quarterly General Paediatric Surgery Network meetings and ran four training events attended by over 300 surgeons anaesthetists and nurses

Useful links:

• Royal College of Surgeons – National Surgical Commissioning Centre
• Royal College of Surgeons – Standards for non-specialist emergency surgical care of children (2015)
• The British Association of Paediatric Urologists
• The British Association of Paediatric Surgeons
• Association of Paediatric Anaesthetists of Great Britain and Ireland

Transition

This work was led by our Clinical Leads for Transition Dr Nigel Ruggins and Simon Hardcastle. Our aim was to reduce unwarranted variation in the level and provision of care during the transition period from children’s to adult services. Transition is at last now accepted as being much more than simply a transfer of care from children’s to adult services. It is a process that needs careful planning and preparation with patients and families and needs to start years prior to the actual transition taking place.

Prompt cards providing useful guidance at a glance for anyone caring for young people experiencing transition have been developed and widely circulated to adult and paediatric colleagues. We supported the development of national transition benchmarking standards in collaboration with Great Ormond Street Hospital and London South Bank University. We established a group of senior clinicians with responsibility for transition within their acute organisations and used these contacts to share examples of good practice as well as identifying areas needing support. We completed an audit of GP involvement in transition planning and presented the results at a national conference where it was used to lead a workshop around primary care involvement in transition. We hosted several transition events where young people were encouraged to speak about their experiences of transition and gave their ideas on how to improve it.

Specialised Children’s Services

The East Midlands children’s and young people’s population is served by two tertiary level children’s hospitals based thirty miles apart in Leicester and Nottingham. These centres provide specialised children’s care for children with complex medical conditions and surgical procedures, including cancer, neurological/neurosurgical conditions, cardiac and renal disease. These centres also provide intensive care for neonates, children and young people. Both centres work closely with their surrounding district general hospital secondary care services. The aims of this work programme were to support collaborative working between these tertiary centres and facilitate sustainability and improvement across in the East Midlands. The focus of this programme was transport of the critically ill child, to review and propose models of delivery for paediatric radiology across the East Midlands and to develop shared/networked pathways for specific paediatric specialties.

Working with the support of the senior management and clinical teams from both tertiary centres monthly joint working meetings were set up and hosted by the Clinical Network. This group has now evolved into the Nottingham University Hospitals Trust and University Hospitals Leicester Children’s Services Collaborative (NUCSC) Steering Group, to lead on the identification, establishment and oversight of strategic collaborations between children’s services which improve the quality, patient experience, sustainability and cost effectiveness of children’s services provided by one or both organisations.We employed a service improvement lead to work jointly between the two tertiary centres in the region, leading on the paediatric critical care transport project and the development of an East Midlands specialised children’s health services website which will provide service, referral and signposting information for professional staff in district general hospitals, and in primary care.The East Midlands specialised children’s health services website was facilitated by the Clinical Network and launched in early 2016. The delivery of a joint business case with an agreed preferred model for paediatric critical care transport services, linking to the specialised services commissioners, and support for initial implementation.

Our children’s programmes have been led by Dr Jane Williams, Children’s Clinical Director. Jane is a consultant paediatrician specialising in neurodisability. She has chaired national committees, sat on a NICE guideline development group and the editorial board of a scientific journal, published various papers and edited a textbook on childhood disability. Her interests are acquired brain injury in childhood and rehabilitation.