Posted on: 14 February 2019
This week’s leadership message comes from Mathew Mathai. Mat is a consultant general paediatrician at Bradford Teaching Hospitals NHS Foundation Trust.
Hello my name is Mat…
As a consultant general paediatrician at Bradford Teaching Hospitals NHS Foundation Trust (BTHFT) a lot of my work is at the ‘coal face’ of acute paediatrics. Over the last 10 years there has been a significant increase in demand on secondary care services i.e. hospitals. This is unsustainable. With changes to the workforce and developments in technology, the NHS is ripe for innovation and transformation. The recently published NHS Long Term Plan will be a key driver for this work in the coming years.
In Bradford there is system level buy-in for improving quality and value with the shared vision that ‘the key to delivering effective emergency and urgent care is ensuring that the whole system is designed to support self-care and community care at home’ (Institute for Innovation and Improvement).
Just in case you didn’t know, Bradford is one of the youngest Districts in the country, and it just keeps growing. This increase is largely due to “natural change”- there have been around 3,600 more births than deaths (The 2016 mid-year estimate for Bradford’s population is 534,300 people, an increase of 3,100 (0.6%) people since June 2015.) More than one-quarter (30.2 per cent) of the District’s population is aged less than 20 and nearly seven in ten people are aged less than 50. Bradford has the third highest proportion of fewer than 16 year olds in England. You can find out more here.
So as you can imagine, we have a lot to do to give our children the best start in life, and to keep them healthy and well.
At the BTHFT, our acute children’s service includes a paediatric accident and emergency (A&E) department and a children’s clinical decision unit with an assessment and (24 hour short stay) observation unit linked to a 41-bedded inpatient ward.
The West Yorkshire and Harrogate Health and Care Partnership’s vision for urgent and emergency care is that we should provide a highly responsive service that delivers care as close to home as possible. Here in Bradford we want to minimise the disruption, inconvenience and cost for families looking after unwell children and young people by providing high quality care in the right place and at the right time.
With this firmly in view, we have developed a service with families called the ‘Ambulatory Care Experience’ (ACE). In collaboration with Bradford City Clinical Commissioning Groups and GPs, ACE aims to provide an alternative to a hospital referral or admission for children and young people who have become acutely unwell with common childhood illnesses but who need a period of observation after initial assessment for up to three days.
Referrals are accepted from GPs, advanced nurse specialists, A&E and the paediatric ward at the Bradford Royal Infirmary. Ongoing clinical assessments and monitoring are undertaken in the community by specially trained children’s nurses. They are supported by consultant paediatricians who provide regular phone call advice and take full clinical responsibility for every child in the service.
The ACE service model is simple. All pathways follow a standard format, from referral to discharge. Importantly each pathway includes a care bundle that provides health education and promotion to prevent readmission and keep children well in the future.
ACE has been designed for adaptation and replication by other like-minded teams. New clinical pathways are being developed and new partners and networks are being established with the hope of delivering this urgent ambulatory care model across the West Yorkshire and Harrogate Health Care Partnership.
This is not only a new service; it is a new model of care and uses novel clinical pathways. It is a standardised intervention that lends itself not only to replication but also to research to study its impact on improving quality. We are fortunate to have a nationally renowned team in York University undertaking a robust academic evaluation of the service and our pathways.
Children, young people and families are at the heart of what we do and the feedback received from them has been extremely positive:
“Thank you, a wonderful service. We had a GP appointment where she told us we would have to go to the hospital. I panicked a bit as I had another child at school to consider (how he would be picked up), no change for parking and no food with me to take - all on top of worrying about how my little boy was breathing. When this service was suggested by the on-call paediatrician it was a huge relief. We couldn’t have asked for better care.”
“Great idea as I have two children with asthma wheezing issues - and other children. Care at home is ideal together with medical support; it means they can all remain together with their primary carer and in their home environment with minimal fuss.”
“As a person with a disability I struggle to take my daughter to the hospital each time she’s poorly. It has put my mind to ease knowing that she can get looked after by the nurses from ACE Team at home. So I’d like to thank all the staff who helped care for my daughter – and also a big ‘thank you’ from my daughter herself.”
The ACE project has been an exciting collaboration between general practice and secondary care and it has been a springboard to bridging other gaps between home, community and hospital acute care. It has been a real privilege working with such an inspiring team of nurses, doctors, educators, pharmacists, managers, clerical staff and commissioners all committed to improving the quality of urgent care for our children and young people.
It has been a team effort. We were therefore delighted to be crowned winners of the Health Service Journal (HSJ) Improvement in Emergency and Urgent Care Award in 2018.
I hope my blog gives you a flavour of what it is like on the front line of paediatric hospital care – and how together with our partners we are trying new ways of working to make a positive difference to people’s lives and importantly sharing the learning far and wide so others can benefit too.
If you would like to know more please get in touch or visit us here.
Have a great weekend!
Mat
‘Looking out for our neighbours’
‘Looking out for our neighbours’ is a West Yorkshire and Harrogate Health and Care Partnership social marketing campaign that aims to prevent loneliness and its associated health risks by encouraging communities to look out for vulnerable people, thus reducing demand on health and care services through early help and preventing ill health. Since November 2018, we've been gaining insight from communities and co-creating the campaign design with them. The campaign will launch from March 15 2019. We're really excited to launch a campaign across the whole of our area that aims to inspire people to engage in simple activities that will positively impact on the wellbeing of their neighbours. Communication colleagues are aware – please share this message with any other organisations who may want to get involved. They can pledge their support here. You can also read more read more here.
What else has been happening this week?
West Yorkshire Joint Health and Overview Scrutiny Committee
The committee met on Monday in Halifax Town Hall. West Yorkshire and Harrogate Health and Care Partnership was on the agenda to discuss urgent and emergency care, mental health and a report from NHS England about vascular services. You can read the papers here.
National Primary Care and System Transformation Group
Our Partnership CEO Lead, Rob Webster attended a session with national primary care leaders to discuss workforce; primary care transformation and the commissioning of health, dental and optical (eyes) services. There was also a discussion on leadership, partnerships and change as well as buildings and technology.
All Party Parliamentary Group on Arts, Health and Wellbeing
There was a meeting at the House of Lords on Monday which Rob attended. The All-Party Parliamentary Group on Arts, Health and Wellbeing (APPGAHW) was formed in 2014 and aims to improve awareness of the benefits that the arts can bring to health and wellbeing. During 2015–17, the APPGAHW conducted an Inquiry into practice and research in the arts in health and social care, with a view to making recommendations to improve policy and practice. Partners in the inquiry include The National Alliance for Arts, Health and Wellbeing, King’s College London, the Royal Society for Public Health and Guy’s and St Thomas’ Charity. You can find out more about this work here.
Local place based planners meeting (Bradford District and Craven; Calderdale, Harrogate, Kirklees, Leeds and Wakefield.
The local area planners met on Tuesday. Colleagues received an update on the NHS Long Term Plan and the importance of local area priorities. Some of our six local areas will be taking the opportunity to review their plans to reflect further health outcomes. The NHS Long Term Plan is part of our local area plans and it’s important to note that other priorities, such as good employment and housing are also critical to a person’s health and wellbeing.
Colleagues working in the six local places gave an update on the work taking place in their areas. For example the Kirklees Health and Wellbeing Plan has been refreshed and work continues between the council and clinical commissioning groups for further integrated work, for example around frailty.
There was an event in Leeds last week which discussed the wider social determinants of health and city infrastructure. Primary care networks also known as local care partnerships are developing across our local areas to include community, mental health, social care, pharmacy, hospital and voluntary services working together. The Wakefield local plan was published in November. This includes the new model of care work and covers wider social determinants of health. Work continues to progress a mental health alliance. A review by Public Health England on the work of health inequalities will take place in the next few weeks. Colleagues are looking at the Wigan Deal and the work they have done as an example of good practice.
Colleagues also discussed the timelines for the Partnership’s five year plan and how this will be developed over the coming months ahead of publication in the autumn. The draft plan will also be discussed at the first meeting in public of our new Partnership Board in June.
West Yorkshire and Harrogate Priority Programme Group
The group met on Thursday. The meeting was chaired by Ian Holmes, Director for the Partnership. The meeting includes colleagues working on West Yorkshire and Harrogate priorities including cancer, digital, preventing ill health, workforce, mental health, maternity and improving planned care. Other colleagues at the meeting included those from NHS England and the Academic Health Science Network.
Mental health
Leeds Community Healthcare NHS Trust has been awarded a four-year contract by the Office of the Police and Crime Commissioner (PCC) West Yorkshire, acting on behalf of regional PPC’s across Yorkshire and the Humber, to deliver regional healthcare and forensic services in Police Custody settings across Yorkshire and Humberside. Following a competitive tender process, the Trust has been awarded a contract to provide a newly integrated and transformed service that supports and cares for people within Police custody settings. The Trust’s Police Custody Healthcare Team provides; physical assessment and treatment, substance misuse assessment and treatment, mental health assessments and assess fitness for people to be interviewed and/or detained. The team also take forensic samples and undertake blood screening for alcohol and drug levels. You can find out more here.
Yorkshire and Humber Care Record
The Yorkshire and Humber Care Record (exemplar for NHS England’s Local Health and Care Record programme) is progressing at pace. £1m in funding has been received and a further £2m is due at the end of March 2019. The project team have been engaging with clinicians, information governance and technical colleagues across the area via a series of workshops. Citizens across the region have also been engaged to understand their views on data sharing. The Joined Up Yorkshire and Humber report can be read here. Key team members are now in place with procurement underway to recruit additional resources to ensure smooth and efficient running of the programme.
In December 2018, partners took a big step forward by testing and succeeding in sharing synthetic (pretend) patient data between Rotherham Health Record and Leeds Care Record. We are now marching forward with the following organisation becoming pilots in sharing key patient information (e.g. medications, test results) by the end of March 2019:
- Yorkshire Ambulance Services
- Leeds Teaching Hospitals
- Rotherham Metropolitan District Council
- Rotherham General Hospital
- Doncaster & Bassetlaw Teaching Hospital
- Humber Teaching NHS Foundation Trust
The pilot involves clinical and care staff to ensure the work is relevant to improving care of people. It will also be overseen by information governance and cyber security colleagues to ensure patient data remains safe and only viewed appropriately by clinical and care staff providing care.
What’s happening next week?
- A meeting will take place on Wednesday with NHS England colleagues to discuss dental commissioning.
- The West Yorkshire and Harrogate Public Health Coordination Group meets on Friday.
- Mental health communication colleagues from across the area meet on Friday.