NHS GRAMPIAN BOARD
Child Health 2020 – A Strategic Framework for Children and Young People’s Health
Aim
· Board members are asked to consider and approve the Child Health 2020 – A Strategic Framework for Children and Young People’s Health.
· The Board is also asked to consider and approve the Child Health 2020 Action Plan in outline form. In particular, the Board is asked to support the establishment of a Programme Board, chaired by the Director of Public Health, to drive further development, refinement and implementation of the Action Plan.
Strategic Context
Improving the outcomes for children and young people is central to the national strategy to make Scotland Wealthier & Fairer, Smarter, Healthier, Safer and Stronger and Greener. A range of national policies have helped shape the development of Child Health 2020 – Getting it Right for Every Child (GIRFEC), The Early Years Framework, The National Delivery Plan for Specialist Children’s Services, The National Guidance for Child Protection in Scotland etc. These policies share the same vision for Scotland ‘to be the best place in the world to grow up’. Child Health 2020 will assist NHS Grampian to review its preparedness for the Bill for Children and Young People, to be debated in the Scottish Parliament in 2014, which will legislate for some aspects of the GIRFEC policy.
Children’s early life experiences are central to shaping their long-term health and wellbeing – from obesity, heart disease and mental health, to how well they do educationally. Children who experience a secure, loving and nurturing home environment are better able to withstand life’s challenge and achieve their full potential. Parents (meaning anyone who is raising a child of any age) are key to achieving the best physical and mental health and wellbeing outcomes for children. The most important factor determining a child’s access to positive early experiences is poverty. Working with our partners to address this is key to improving the health of the whole population and reducing health inequalities.
Child Health 2020 is about working in partnership to make a gradual shift to preventative and early intervention approaches to improve outcomes and reduce demand on specialist services in the longer term. Safe and sustainable services will be provided for those who require them. We will work with parents, carers and families rather than deciding for them. All of these goals are consistent with NHS Grampian’s strategic vision Healthfit 2020.
What happens during pregnancy can have lifelong effects on many aspects of health and wellbeing. The complementary NHS Grampian Maternity Strategy 2010-15 sets out NHS Grampian’s approach to pre-pregnancy and pregnancy care to ensure future parents are supported to identify and manage risks.
The Maternity Strategy and Child Health 2020 are designed to improve health and care services from conception to 18 years of age to achieve our aspiration that…
‘…by 2020, all children and young people of Grampian will have the healthiest possible start in life.’
We strive for improved outcomes for all children and young people but will target our responses to those who need our support the most, to narrow the gap in outcomes.
Discussion
Children and young people in Grampian are healthier today than they have ever been. Compared to the Scottish average Grampian indicators for life expectancy, birth weight, breastfeeding and childhood immunisation are favourable. However, there are areas were outcomes for children and young people can be improved – teenage pregnancy in under 16 year olds, unintentional injuries, alcohol consumption and obesity. Looking at the average can mask the range of health and illness within our population. Inequalities in the health of children exist in Grampian. We recognise that many factors interact to influence outcomes for children – links between good health and educational outcomes, poverty and poor health outcomes etc. Effective partnership working is key.
Process
A Children and Young People Core Group was established to develop the Strategic Framework and Action Plan, chaired by Susan Webb, Deputy Director of Public Health. Dr Simon Hilton, Consultant in Public Health Medicine, was the main author of the Framework document on behalf of the Core Group. The full membership of the Core Group is listed in Section 7 of the Strategic Framework document.
Stakeholder Involvement
Given the breadth of the child health agenda, the numerous relevant policies and partnerships and the wide range of work already happening, an engagement exercise was carried out between April–June 2013. The aim of the exercise was to identify what is currently working well, develop a 2020 vision and a plan of how it will be delivered. Discussions were held with a range of internal and partnership groups, an online survey was available and engagement with children, young people and parents was undertaken through groups and on a one to one basis with users of NHS Grampian services. The feedback from the engagement process was considered at a workshop in June with key stakeholders within and outwith NHS Grampian.
It was clear from this early engagement that producing a strategy that covered in detail everything that could be done to optimise child health was not practical. Whether your focus is on prevention or the provision of specialist services, there are a number of common themes that emerged from the engagement process. These themes, if tackled, would create a more supportive environment for children and young people, parents, partners and our staff to work together to improve child health and to optimise service delivery. In line with published literature the six themes identified include:
1. Putting children, young people and their families at the heart of what we do
2. Acting early and intervening at the right time
3. Safe and sustainable services
4. Integration and partnership
5. Workforce, education and training
6. Knowledge and evidence
Child Health 2020: A Strategic Framework for Children and Young People’s Health consultation document set out a number of goals under these themes. A six week consultation process was undertaken during September- October 2013. A range of techniques were used to raise awareness of the consultation including: a media release, targeted distribution of the consultation paper and feedback questionnaire; information on the NHS Grampian website; Facebook page and Twitter profiles in addition to internal and partnership briefings. To complement the initial engagement process staff drop-in sessions were organised and further focus groups undertaken with hard to reach groups. Two hundred and twenty three people completed the feedback questionnaire.
A further workshop ‘Strategic Framework into Action; took place on the 17th September bringing together a wide group of staff and partners to affirm the themes and develop the Child Health 2020 Action Plan.
Findings
Theme 1 - Putting children, young people and their families at the heart of what we do:
Children and young people have involvement with the NHS across a range of services. There is currently no co-ordination of feedback to provide an overview of the views of children, young people and their families. Information was gathered from a range of sources and further work undertaken to complement the routine information available. A DVD will be shown at the start of the Board Meeting to provide an insight into the range of feedback received. Most children, young people and families told us about their positive experiences of the NHS. However, a few also shared examples where we did not always get it right. The Action Plan recommends co-ordination of the information received across services and to demonstrate how this feedback has informed service improvement.
Theme 2 - Acting early and intervening at the right time:
Feedback suggests that we spend more time reacting to problems as they arise rather than proactively supporting children to be healthy. In general, public health programmes are seen as an add-on rather than routine practice. There was support for a gradual shift towards early intervention and prevention but concern was expressed regarding capacity to deliver this change and the evidence base for some programmes.
The Action Plan recommends, an Early Intervention and Prevention Briefing paper, to set out the evidence base for, and suggested guidance on how transformational change will be delivered. As part of this process, available funding streams such as the Early Years Change Fund will be reviewed to ensure appropriate targeting of resources.
Theme 3 - Safe and Sustainable Services:
NHS Grampian provides a wide range of high quality services locally and tertiary care for the North of Scotland. Improvements continue to be made but a number of challenges remain. The challenges we face mean that we must examine how we deliver services to help ensure they are as safe and sustainable as possible. This may mean that how we deliver care may change. The Action Plan recommends a review of particular low volume specialities to ensure long term sustainability, implementation of key recommendations of the North of Scotland Paediatric Sustainability Review and a review of school nursing/ health visiting in the light of national work.
Theme 4 - Integration and Partnership Working:
Whilst the most important partnership is with children and families themselves, we must work across departments/organisations to make the biggest difference to child health. The Early Years Collaborative and Integrated Children’s Services Plans illustrate what is working well but families, professionals and different organisations shared experiences of when joint working could be better. The Action Plan recommends programme co-ordination within NHS Grampian to build support for change, remove internal NHS barriers, tracking of progress/outcomes and capturing and spreading innovation. These arrangements would generate a forum for executive and operational leads to communicate and engage partnerships with enthusiasm and consistency.
Theme 5 - Workforce, education and training
Children and young people come into contact with a range of generalist staff and specialist staff. There are challenges around recruitment and retention across all areas of children’s services, in capacity of community and specialist staff e.g. health visitors and paediatric medical staff. New roles and more flexible working practices are being developed but more needs to be done. The Action Plan signals the need to co-ordinate workforce planning across community and specialist child health services and to ensure appropriate training for those in generalist roles in order to deliver the ambitions of Child Health 2020.
Theme 6 - Knowledge and evidence
The review of evidence and data highlighted gaps in robust data on positive health indicators such as mental wellbeing, inclusion of relevant child health indicators in the governance and performance arrangements within NHS Grampian and a lack of an electronic information recording system for community child health staff. The Action Plan recommends urgent action to identify IT requirements for staff working with children and for a business case to be considered as part of NHS Grampian E-Health prioritisation process. In addition, once appropriate data sharing agreements with partners are in place, routine monitoring of child health in Grampian will be reported to NHS Grampian Board
There was high level of support for both the development process and the different elements of the strategic framework. The interest shown in child health matters was welcome but some respondents expressed concern that Child Health 2020 may not result in change, illustrating the importance of the action plan and the governance around its implementation. The Action Plan therefore recommends the establishment of a Programme Board to drive its further development and implementation.
An Equality Impact Assessment has been carried out and appropriately considered.
Resource implications
Child Health 2020 aims to maximise the use of existing available resources. However, additional resources may be required to implement certain recommendations, for example the IT system. These will be subject to the NHS Grampian budget setting process, in approving Child Health 2020 the Board is not being asked to approve additional resources for child health.
Key Risks
Child Health 2020 contributes to the controls for a number of risks in the Strategic Risk Register including:
· Strategic Risk 610 Involvement and Engagement: The Action Plan clearly sets out improvements to involvement and engagement for child health
· Strategic Risk 851 Delivery strategies to meet the future health needs of the population: Child Health 2020 sets out an improvement programme in line with Healthfit 2020 to meet the future health needs of this population group.
· Strategic Risk 853 Patient Safety: The Action Plan clearly sets out a programme of review to ensure services are safe and sustainable in the future
· Strategic Risk 1134 Sustainable Workforce (Skills and Numbers): The Action Plan sets out actions to consider the impact of national policies/reviews on workforce capacity and skill mix.
· Strategic Risk 1262 Evidence and Intelligence Informed Strategy: Child Health 2020 Strategic Framework and Action Plan has used available evidence and intelligence to inform strategic planning.
Conclusion
Child Health 2020 has been produced through a robust process and provides an aspirational but achievable vision, with a clear plan for implementation.
Recommendations
1. That the Board approves the Child Health 2020 strategic framework;
2. That the Board approves the outline Action Plan as part of the framework;
3. That the Board supports the initiation of a Programme Board under the chairmanship of the Director of Public Health.
Background papers/supporting information
Director of Public Health 2012 Annual Report
Report of Engagement and Consultation on Child Health 2020: A Strategic Framework for Children and Young People’s Health
Executive Lead
Professor Sir Lewis Ritchie, Director of Public Health
Names of Persons Submitting Paper
Dr Simon Hilton, Consultant in Public Health Medicine
Ms Susan Webb, Deputy Director of Public Health
(on behalf of the Children and Young People Core Group)
Date
20 November 2013
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