Paediatric Quality Indicators Workshop

Introduction to developing and

commissioning pathways

Simon Lenton, Children’s & Young Peoples Outcome Forum

CYP HOF

Scope1. Identify the health outcomes that matter most for

children and young people.

2. Consider how well these are supported by the NHS and public health outcomes frameworks

3. Set out how different parts of the health system – DH, NHSCB, PHE, HEE and others will contribute to delivery of these outcomes, and how they will work with each other and with other partners to this end.

Systems thinking

A health system has been defined as

“all organisations, people and actions whose primary intent is to promote, restore

or maintain health.”

Its purpose is to “improve health and health equity in ways that are responsive, financially fair and make the best use of available resources”. (WHO)

Integrated care – a culture

"integrated care demands a culture of its own, one that spans differing organisational and professional mindsets, eliminates boundaries and biases.

It shares a common space to facilitate a much needed interagency collaboration and interdisciplinary teamwork on behalf of the patient"

(Kodner 2009)

Ref: BACCH – “the meaning of integration”

What do we all want?

• Right interventions• Right children• Right professionals• Right place• Right time• Right support• Right cost

Safety, good experience, great outcomes

“All in place and working well together”

Partnerships - key criteria• a collaborative relationship among multiple

organisations in which risks and benefits are shared in pursuit of a shared goal.

plus shared

• values – principles – practice

plus

• leadership

to createsynergy and alignment

Commissioning

“the process of allocating public resources to achieve the greatest gains in health within a defined population”.

Truly effective commissioning requires strong collaboration

between commissioners, providers and regulators, with integration of functions whenever possible

Start here

Not Here

With thanks to Charlie Keeney

What is the CFHC approach?

• Distil the Conventions into simple concepts

• Easily understandable framework for change

• Transcend the concept and language issues

• Adopted and adapted by health care systems

• The new model must create alignment – at a high level between politicians – planners and financiers, between agencies – between patients, clinicians and managers

• Drive learning and improvementCFHC = Child Friendly Health Care

Development of the CFHC approach

Human rights

Children’s rights

Principles

CFHC

approach

Needs Services Outcomes

Principles for children’s services

• Participation

• Promotion

• Protection

• Prevention

• Provision– pathways

PATHOGENIC APPROACH

- Individual

- Family

- Community

- Society

PROTECTION

SALUTOGENICAPPROACH

- Individual

- Family

- Community

- Society

PROMOTION

Promotion and protection a new framework

Health and illnessWhat creates health?What creates illness?

Slide: adapted from Fabrizio Simonelli

Promotion

• Healthy eating

• Screening

• 20 disability

• Competent staff

Prevention

• Primary

• Secondary

• Tertiary

• Quaternary

Protection

• Fluoridisation

• Domestic violence

• Poverty

• Drug errors

Alignment and synergy

needs services outcomes

health harming

determinants

Society

health promoting

determinants

communityinterventions

health harming lifestyles

health promoting lifestyles

lifestyleinterventions

Provision based on pathwaysPurpose, values, evidence and learning.

needs outcomesp r a i

Needs Outcomes

Health

Equity

Sustainable

Prevention Recognition Assessment Interventions

Protection

Promotion

Concern

Screening

Family

Child

Social

Psychiatric

Child

Family

Community

Short term condition pathway

Condition

Community Educational

Medical

Behavioural

Surgical

Pathway componentsPurpose, values, evidence and learning.

PurposePrinciples

needs outcomes

healthequitysustainable

participationpreventionprovision

p r a i

Pathway componentsPurpose, values, evidence and learning.

PurposeValues/rights

needs outcomes

healthequitysustainable

participationpreventionprovision

Learning

LearningEvidence

p r a i

quantitativequalitativeeconometric

measuresfeedbackimprovement

Long term condition

Initialpathway

Transition pathway

NeedsCondition

FamilyCommunity

OutcomesEffectiveness

EfficiencyEquity

Reviewpathway

Network of services

Environment

Initial, review and transition pathways

Myriad of measures!!!

needs c outcomesc c c c

Child

Community

Family

Determinants

Harm Exposure

Effectiveness

EquityEfficiency

AccessibilityAffordability

Acceptability

Outputs

Components

ProcessStructure

Environment

c = component

Key measures

Health service outcomemeasures

Life course outcomemeasures

Healthimpact

measures

Health measures

Health service impact

measures

Health service measures

Public service

measures

Determinants and lifestylemeasures

Needs Outcomes

Wholepathway

NHS CB

PHLA

CCG

Commissioners

AcademiesPersonal budgetsHealth insurance

‘CJS’

WorkforceResearch

Innovation???

Commissioning pathway components

p r a i

NHS CB

Pregnancy care CMV

(primary)

Cochlear

Implants

(specialist)

Booking <12 w

Timeliness

CCG

Genetic

counselling

Paediatric

audiology

assessment

SaLT

Parent support

Yield

Hearing@12m

LA

Hearing

Advisers

Hearing loops

Language dev

Ed achievement

PH

MMR

immunisation

Neonatal

Screening

Healthy Child

Uptake

needs outcomes

Commissioning – what should it look like in the future?

• a shift from contracting services towards commissioning programmes of care

• supported by a series of measures that reflect quality and can identify the weakest link in the pathway

• commissioning for quality improvement being integral to the contracting process

• a pooled commissioning budget and the capacity to vire resources within a network.

• network collaboration by different service providers whether NHS Trusts/social enterprise/private sectors

• a reduction in the number of commissioners involved or integrated working of the commissioners involved.

Thank you

Health service

outcomes

Public health outcomes

Health outcomes

Life coursepathway

Review cycle

Social impact

Environmentalimpact

Health impact

Review cycle

Service pathways

Sustainable

Equity

Life coursepathway

Health outcomes

Life coursepathway Bringing outcomes together

Quality Compass

Efficacy

Effectiveness

Efficiency

Equity

Acceptable

Accessible

Affordable

Appropriate

Safety, experience and outcomes

Quality, innovation, prevention, productivity

Managed networks

• “Linked groups of health professionals from primary, secondary and tertiary care, working in a co-ordinated manner, unconstrained by existing professional and Trust/Health Authority boundaries, to ensure equitable provision of high quality and clinically effective services.”

A later definition describes the function of managed networks is being

• "a group of organisations, services and professionals working collaboratively to continually improve the services they provide through a process of learning from innovation and quality improvement".

•

CYP HOF

Purpose

The strategy will aim to maximise health outcomes for all children and young

people, showing how all parts of the health system, with partners, will contribute to

enabling every child and young person to reach their full potential

Needs Outcomes

Network

NHS

PrivateLA

Social Enterprise

Providers

‘CJS’

‘Public health’

Needs Outcomes

Network

Quality

OrganisationalProfessional

Economic

Regulators

Implications of integrated pathway based networks (1)

1. Combined commissioning strategies across health, education, social care and criminal justice systems.

2. Provider organisations sharing the same knowledge base and approach to implementation of evidence-based guidelines.

3. Shared governance systems across organisations.4. A shared approach to measurement and improvement5. Financing systems where resources follow patients

through pathways and networks - introduction of program budgeting.

Implications of integrated pathway based networks (2)

6. Workforce planning based on the right skill mix to ensure competent teams working in networks.

7. Integrating public health approaches to prevention across all pathways.

8. Greater emphasis on both equity of access and outcomes.

9. Combining regulation to ensure effectiveness, efficiency and equity bringing together quality and economic regulators and a greater emphasis on equity