Paediatric Assessment Unit (PAU)

Workshop

Healthy London Partnership

Children & Young People’s Programme

4th March 2016

01

Transforming London’s health and care together

Professor Russell Viner

Clinical Director

Healthy London Partnership Children & Young Peoples

Programme

Transforming services for

Children & Young People across London

2

Housekeeping

3

London Health Commission

4

Healthy London Partnership – The delivery arm of the London Health Commission

Goal – London to be world’s healthiest global city

5

10 programme aims from London Health Commission

What do children, young people and families think?

6

I need rapid access to

someone I can talk to when I feel depressed

We need easier

access to healthcare

Services are not joined up

I want to know that my GP is

experienced in caring for children

Make sure the school

can look after my son when

he has an asthma attack

I am worried about what will happen next year when I am too old for the children’s clinic

7

Healthy London Partnership Children and Young People Programme Governance

8

HLP C&YP Transformation Board

London Transformation Group (London’s CCGs and NHS England)

London Health Board

CYP Clinical Leadership

Group

CYP Commissioning Advisory Group

Accountable

Information sharing/

endorsement

Programme alignment

Critical Care Clinical

Leadership Group

Surgery Clinical Leadership

Group

Asthma Clinical Leadership

Group

Out of Hospital Care Clinical Leadership

Group

CAMHS Clinical Leadership

Group

Primary Care Board

• CCG SRO (Martin Wilkinson) • NHSE SRO (Will Huxter) • CYP Clinical Director (Russell Viner) • CCG Clinical Lead (Nicola Burbidge) • SPG rep/s (Adam Doyle) • DPH (Dagmar Zeuner) • PHE (Marilena Korkodolis) • DCSS (Linzi Roberts-Egan) • CYP/family rep (Emma Rigby) • Programme Manager (Tracy Parr) • GP lead (Eugenia Lee)

CYP & Families Engagement throughout

U and EC Board

Mental Health Board

Prevention Board

Homelessness Board

Specialised Services Board

Young People’s Steering Group

V0.6

Primary Care Clinical

Leadership Group

Children and Young People – Detailed Deliverables 2015 - 2016

9

Priority A Develop Population Based

Networks

Priority B Reduce variation

in care

Priority D Improve commissioning

Priority C Integration of

care

Priority E Innovative Access

Undertake baseline mapping of provider landscape In depth analysis of CYP mortality based n data from CDOPs Develop standards of care • Acute care (completed) • Asthma (completed) • Surgical networks (completed) • HDU • Out of hospital models of care • Transition to adult services ▪ CAMHs (initial output completed) ▪ Diabetes Undertake baseline mapping of trusts against standards based on operational policies Devise and implement peer review process for acute trusts Acute care – model annual report structure, model operational policies Asthma – delivery plan at pan-London system, SPG level and CCG level Community pharmacy engagement plan Surgical networks – support pilot in SW London linked into 11 DoS HDU – develop funding and co-commissioning models CAMHS – support CCGs in compiling transformation plans ▪ Support CCGs in CAMHS

transformation plan implementation

Out of hospital care • Produce directory of models • Undertake financial modelling

(2016 – 17) Develop workforce strategy for all areas in conjunction with workforce programme

Develop integrated models of care for CYP (move to 2016 – 2017 based on other workstream outputs) ▪ Undertake scoping of models in

relation to CYP care (link in with Vanguard bids and work within HEE) (2016 – 2017)

• Develop CYP commissioning programme (completed)

• Submit funding bid to HEE for first cohort

• Procure educational provider • Recruit first cohort • Support development of new

commissioning models for CYP services (2016 – 2017)

• Support CCGs to develop commissioning strategies to implement CAMHS task force

• Guidance on effective communication with CYP using new media on how to access services effectively

• Development of materials to illustrate when medical advice should be sought

• Develop guidance for model of population based CYP networks including funding

• Understand data requirements to describe needs analysis in population based networks

• Develop data set and data dictionary to enable effective needs analysis CYP

• Work with SPGs to support development and implementation of population based network in each SPG dependent on local requirements

• Develop effective linkages between population based networks and HLP CYP programme

• Undertake evaluation of population based networks and disseminate learning (move to 2016 – 2017)

Priority B Reduce variation

in care

Develop model of primary care to meet needs CYP working with primary care programme Work with GP federation to support incorporation of models into delivery

Children and Young People – Detailed Deliverables 2016 - 2017

10

Priority A Develop Population Based

Networks

Priority B Reduce variation

in care

Priority D Improve commissioning

Priority C Integration of

care

Priority E Innovative Access

Undertake baseline mapping of provider landscape In depth analysis of CYP mortality based n data from CDOPs Develop standards of care • Acute care (completed) • Asthma (completed) • Surgical networks (completed) • HDU • Out of hospital models of care • Transition to adult services ▪ CAMHS (initial output completed) ▪ Diabetes Undertake baseline mapping of trusts against standards based on operational policies Devise and implement peer review process for acute trusts Acute care – model annual report structure, model operational policies Asthma – delivery plan at pan-London system, SPG level and CCG level Community pharmacy engagement plan Surgical networks – support pilot in SW London linked into 11 DoS HDU – develop funding and co-commissioning models CAMHS – support CCGs in compiling transformation plans ▪ Support CCGs in CAMHS

transformation plan implementation

Out of hospital care ▪ Produce directory of models ▪ Undertake financial modelling

(2016 – 17) Develop workforce strategy for all areas in conjunction with workforce programme

Develop integrated models of care for CYP (move to 2016 – 2017 based on other workstream outputs) ▪ Undertake scoping of models in

relation to CYP care (link in with Vanguard bids and work within HEE) (2016 – 2017)

• Develop CYP commissioning programme (completed)

• Submit funding bid to HEE for first cohort

• Procure educational provider • Recruit first cohort • Support development of new

commissioning models for CYP services (2016 – 2017)

• Support CCGs to develop commissioning strategies to implement CAMHS task force

• Guidance on effective communication with CYP using new media on how to access services effectively

• Development of materials to illustrate when medical advice should be sought

• Develop guidance for model of population based CYP networks including funding

• Understand data requirements to describe needs analysis in population based networks

• Develop data set and data dictionary to enable effective needs analysis CYP

• Work with SPGs to support development and implementation of population based network in each SPG dependent on local requirements

• Develop effective linkages between population based networks and HLP CYP programme

• Undertake evaluation of population based networks and disseminate learning (move to 2016 – 2017)

Priority B Reduce variation

in care

Develop model of primary care to meet needs CYP working with primary care programme Work with GP federation to support incorporation of models into delivery ▪ School nursing

▪ Use of pharmacies to support

asthma care

▪ Learning from asthma deaths

Background Information (1 of 2)

11

A Paediatric Assessment Unit (PAU) is a facility within which, children with acute illnesses, injuries or other urgent referrals (from GPs, Community Nursing teams, Walk-in Centres (WICs), NHS Direct (NHSD) and Emergency Departments) can be assessed, investigated, observed and treated without recourse to inpatient areas. For example: Paediatric Short Stay (PSS), Paediatric Assessment Units (PAUs) and Paediatric Short Stay Assessment Units (PSSAU). We are looking at the PAU provision across London which takes acute admissions for a maximum period of 24hrs. This unit is separate to the paediatric day unit (although we recognise in some hospitals these may be combined).

Background Information (2 of 2)

12

The RCPCH proposed the development of PAUs in the paediatric emergency pathway, to allow discharge for those who were improving after initial treatment (i.e. asthma, croup, gastroenteritis) or not deteriorating (i.e. fever in infant). Despite the widespread adoption of and investment in PAUs across the UK, their impact has been poorly evaluated.

-

50,000

100,000

150,000

200,000

250,000

<1 1-4y 5-9y 10-14y 15-18y

London FCEs for CYP 0-18 years, 2014-15

Ogilvie (2005). Hospital based alternatives to acute paediatric admission: a systematic review. ADC 90: 138-42 • 25 studies included • PAU

– 40% of children attending acute assessment units in paediatric departments, and over 60% of those attending acute assessment units in A&E departments, do not require inpatient admission.

– 1-7% returned within 72 hours of discharge • Effect on inpatient admissions

– 10-47% reductions in inpatient admissions after opening a PAU

– Reduced costs due to fewer admissions

What do we know about the impact of PAUs?

Thompson Coon et al (2012). Interventions to reduce acute paediatric hospital admissions: a systematic review. Archives of Disease in Childhood; 97(4): 304-311

• 4 papers on effects of a short-stay assessment unit.

Findings from each study: – 77% of children admitted after presenting with acute

gastroenteritis in where no PAU versus 42% in PAU – 31% admitted for an overnight stay in the year prior to the

opening of the PAU versus 24% in the year after i.e. reductions of ~ 23 to 45% in admission rates

• Perceptions – Parents and staff preferred the PAU to traditional A&E

What do we know about the impact of PAUs?

-

50,000

100,000

150,000

200,000

250,000

<1 1-4y 5-9y 10-14y 15-18y

FCE 2014-15 PAU amenable?

London FCEs for CYP 0-18 years, 2014-15

• 12 have a PAU

• 1 has a PAU opening in a few weeks

• 1 has a Clinical Decision Unit within A&E and an Ambulatory Facility adjacent to the Paeds Ward

• 6 operating >5 years

0 2 4 6 8

Adjacent A&E

Adjacent Paeds ward

Adjacent UCC

Near Paed Ward

Location

PAU Survey of London Trusts: 14 responses thus far

0 5 10 15

From A&E as unclear re…

Direct GP referral

Referral other community…

Outpatients

Direct 'Passport'…

Ward Reviews

MRI/bloods

Cohorts of patients accepted

0 2 4 6 8

To 15 years

To 16 years

To 17 years

To 18 years

To 19 years

age range

Type of patients

0 5 10 15

Emergency Medicine

Paeds

Joint

service management

0 1 2 3 4 5

3

4

5

6

7

8

11

Not stated

beds

Column1

Service Management and Beds

0 2 4 6 8

January 15

June 15

December 15

Numbers seen per month

>400 250-400 100-250 <100

0 2 4 6

<=10

11 to 20

21 to 30

31 to 40

41 to 50

>50

Numbers admitted as inpatients from PAU each month

Column1

Those seeing <100 were those with 3 beds

Numbers seen & admitted