Revolutionising the workforce for child health services - Hilary Cass

#ntsummit

Revolutionising the workforce for child health services

Dr Hilary Cass OBE, Consultant in Paediatric Neurodisability, Guy’s and St Thomas’ NHS Foundation Trust and Senior Clinical Adviser, Children and Young People, Health Education England @Hilary_Cass

REVOLUTIONISING THE WORKFORCE

FOR CHILD HEALTH SERVICES?

Hilary Cass

Senior Clinical Lead, Children’s Health & Wellbeing

1948: NHS is founded

Designed around needs of adults

‘APPLICATIONS FOR ADMISSION TO CASUAL WARD’

SIR SAMUEL LUKE FILDES, 1874

BUT….WAITING TIMES HAVE IMPROVED A BIT

www.hee.nhs.uk www.hee.nhs.uk

WHAT WE KNOW

1. Children’s workforce is not delivering best

outcomes for children as currently configured

2. Children’s healthcare workforce is not

sustainable as currently configured

0

50

100

150

200

250SD

R p

er

10

0,0

00

Austria

Finland

France

Germany

Greece

Italy

Netherlands

Portugal

Spain

Sweden

United Kingdom

Deaths in children 0-14 years

0

10

20

30

40

50

60

2005-2007 2006-2008 2007-2009 2008-2010

Ingrid Wolfe, Lancet, Mar 2013

DEATHS UNDER A YEAR: PRE-TERM, LBW & STILL BIRTHS

DIRECT AND INDIRECT FACTORS

Social

disadvantage

Health

inequalities

Smoking in

pregnancy

Alcohol in

pregnancy

Obesity in

pregnancy

Maternal

age

0

5

10

15

20

25

30

0

0.05

0.1

0.15

0.2

0.25

0.3

Sweden Portugal Finland Italy Austria Germany Spain UnitedKingdom

Pe

rce

nta

ge w

he

eze

10

ye

ar S

DR

pe

r 1

00

00

0 (

0-1

4 y

ear

s)

Mortality

6-7 age group

13-14 agegroup

Asthma mortality and children with wheeze

Ingrid Wolfe, Lancet, Mar 2013

PERCENTAGE OF CHILDREN AND YOUNG PEOPLE AGED UNDER

25 YEARS WITH DIABETES, HBA1C MEASUREMENT<58

MMOL/MOL (7.5%): PROGRESS

Children and Young Peoples Health

Outcomes: progress

Greece(R), 50.0Ukraine(R), 49.5

Germany, 42.4

Austria, 42.2

Italy(R), 37.5

England, 18.0

0

10

20

30

40

50

60

2009/10 2010/11 2011/12

%

WORKFORCE CHALLENGES – TOO MANY TRAINEES,

BUT NOT ENOUGH TO COVER ROTAS? (FACING THE

FUTURE 2011)

2798

2566 2478

2230

0

500

1000

1500

2000

2500

3000

Tier 1 Tier 2

Staff required

Available staff

CURRENT CHALLENGES - CCTS AND CONSULTANT

GROWTH

THE WORKFORCE CHALLENGE

CHILDREN’S NURSES

Slide courtesy of Fiona Smith

WE’VE BEEN

HEARING FOR

YEARS THAT THE

STATUS QUO CAN’T

CONTINUE….

…BUT IT STILL

DOES

Minor

SHORT-TERM

CONDITIONS

Serious

Day-to-day

LONG-TERM

CONDITIONS

Strategic

Minor

ACUTE

ILLNESS

Serious

SECONDARY CARE

PRIMARY CARE

Children’s Healthcare Needs

The Primary-Secondary Gap

Minor

SHORT-TERM

CONDITIONS

Serious

Day-to-day

LONG-TERM

CONDITIONS

Strategic

Minor

ACUTE

ILLNESS

Serious

SECONDARY CARE

PRIMARY CARE

Rising consultation rate, reduced funding, staffing shortfalls, and recruitment challenges

Changing expectations, changing demographics, changing disease profile and prevalence

Less experienced junior staff, nursing shortfalls, unsustainable workforce model

Managers and

Leaders

Education

Health

Social, Family and Community

Support

Early Years, Child Care and Youth

support

Justice and Crime

Prevention

Sport & Culture

Child and

Family

The Children and Young Peoples Workforce

Core Children’s Workforce

Wider Children’s Workforce

TWO ASPECTS TO IMPROVING CHILD HEALTH OUTCOMES

• Health service design

– Redesign

– Capacity building in community

• Training and sustaining child health workforce

• Broader environment for CYP

– School

– Social Care

– Youth justice

• Training and equipping the wider children’s workforce INCLUDING families and CYP.

KEY DIFFERENCES EUROPEAN MODELS

• More doctors per capita (GP and paediatric) looking after children

• Most countries – mandatory & specific post-graduate training in paediatrics for GPs

• Co-location of primary and secondary care practitioners

• No perverse financial incentives between primary and secondary care

• Choice of first-access professional

PROPOSAL: WOMEN’S & CHILDREN’S HUBS

Hospital(s) or ?network

Women’s and Children’s

Healthcare Hubs

Group

Practice A

Group

Practice B

Group

Practice C

CHILDREN’S SERVICES

•Urgent care – evenings,

weekend days when

surgeries closed

•Health promotion, feeding

advice, pre-school support

•Long-term condition

management including

children with disabilities,

diabetes, eczema etc.

•Other routine outpatients

not needing hospital support

WOMEN’S SERVICES

•Antenatal classes

•Well women services

•Mental health services

•Out of hospital gynaecology

services

•Parenting classes

•Rooms for NCT meetings,

other family support groups

STAFFING AND TRAINING

Hospital

Women’s and Children’s

Healthcare Hub

Group

Practice A

Group

Practice B

Group

Practice C

STAFFING

•GPwSI

•Paediatricians

•Obstetricians/Gynaecologists

•Midwives / HVs

•Children’s nurses

•Mental health staff

•Family planning staff

•AHPs

•Youth workers etc. etc

TRAINING

•Joint training initiatives

•Scope for new hybrid role

development

•Shared competency

frameworks

•Extended education for

parents / young people /

teachers / community

leaders

Paediatrician

Paediatrician

Obs/Gynae

Obs/Gynae

GP

GP Children’s

community nurse

HV


Children’s Healthcare Needs Children’s Healthcare Delivery

Children’s Healthcare Delivery

Paediatric Training • Total 8 years • Deliver general and

specialist paediatric care

GP Training • Total 3 years • Dedicated paeds 0-6 months • Deliver vast majority of

paediatric care

? GP with additional training in paediatrics

? 5 year paediatrician with additional

training in primary care, mental health

Advanced Nurse

Practitioners?

AHPs /

pharmacists?


Key issues

1. Buy in to large scale change

2. Planning workforce against undefined model

3. CPD programmes / access to educational events

for staff not in training programmes

4. Opportunities for extending roles in range of

community settings – including primary care

5. Growing workforce in a challenging financial

environment