Alf Nicholson, National Clinical lead in Pediatrics, RCPI

Professor Alf Nicholson

April 2014

Paediatric Lead Programme –

The first 2 years

What is it all about ?

“If I had to reduce my message … to just a few words, I’d say it all had to do with

reducing variation.”

Dr. W. Edwards Deming

1990

2000

International trends in under 5 mortality rates.

10

9

7

9

12

6

11

7

6

4

5

7

5

9

4.5

6

3 3

5

3

8

0

2

4

6

8

10

12

14

Ireland UK Sweden Norway EU average Japan USA

Prob

abili

ty o

f dea

th b

efor

e ag

e 5

yrs,

per

100

0 liv

ebirt

hs

Source: WHO Health statistics and the European HFA-DB

2008

The Clinical Leads on Tour

A succesful and sustainable health system – how to get there from here Fineberg NEJM 2012 ;366:11:1020-1027

Redouble efforts to enhance the quality and safety of health care

Keep patients out of hospital Find out what families want and honour it Smooth patient flow through the system Learn from peers and the evidence Value accountability above autonomy Adopt many strategies to reach one big

goal

Background changes in disease priorities for child

healthmany ‘killer’ diseases have disappearedemotional and behavioural problems affect 10 – 20%

changes in parental expectationloss of confidence in primary care provisionfaster access to specialist care‘informed’ client group

changes in healthcare provisionreorganisation of infrastructure

Childhood cancer survival (Ireland) by deprivation category, 1994-2005 (Walsh PM et al Eur J Cancer 2011)

Childhood cancer survival to 5 years: Ireland (2000-2005) v Europe (2000-2002)

Public Health Expenditure as % GDP

6.0

7.0

8.0

9.0

10.0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

%

Source: DoHC Key Trends 2013, CSO National I&E Accounts., DoF Budget 2014.

2009 9.6%

2013 8.5%

OECD Average 9.3%

Whole systems plan for child health

Hospital visits Formal site visit to every paediatric

department in year one Visit to all (34) tertiary specialities in

Paediatrics in year two Extensive discussion across disciplines

Follow up visit if required

Immediate feedback and resume of all tertiary visits looking for common themes

Visitation reports

Set proforma to each tertiary subspeciality

Following tertiary visits model of care document by June 2014

Report card 2014 184 page visitation document now HSE

policy

National Charter for children (in collaboration with patient reference group)

24/7 neonatal transport with additional appointments

Report card 25 algorithms developed for use by first

responders and GP’s and launched at ICGP AGM

Visitation of 34 tertiary subspecialities in Paediatrics -> Model of care document

National diabetes audit and model of care for type 1 DM

A national model of care for children and young people Avoid ‘postcode disadvantage’

Improve primary-secondary interface

NETS + PETS

Adolescence and transition

Strengthen regional care / networks and outreach clinics

New models for urgent care delivery

National manpower plan for Paediatrics