Diversity, Flexibility

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Diversity, Flexibility Responsiveness

• Keys to transforming community services for
  children young people in Rotherham
• Julie Devine

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• The way we deliver care is changing
• Shaping the way services are delivered is
  challenging
• 5 years ago services looked very different
• Fractionalised disparate working in isolation
• Became Complex Health Needs Team

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Making this happen

• Gap / needs analysis / parent and child
  participation
• Motivation and commitment of staff. Can do
  philosophy
• Commissioner / provider interface
• World class commissioning needs world class
  providers

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Community Childrens Healthcare Assistants
Community Childrens Nurses
Nurse Education Advisor for Schools
Paediatric Macmillan Nurse
Play Therapist
Child / Family Counsellor
Project / data / research co-ordinator
Liaison Nurse
Special School Nurses
Team Leader
Respite Lead
Diabetes Nurse Specialist
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Virtual Team
Social services lead
Main stream school nurses
Tertiary centres
Children young peoples groups
Lead paediatrician
G.Ps
Charities
Voluntary agencies
Housing department lead
Local hospice
Pharmacist
Adult services
Therapists
Education
Secondary care settings
Spiritual/ religious lead
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Collaboratively We Have Strength

• Strength in knowledge
• Strength in skills
• Strength in diversity
• Strength in resources
• Strength in flexibility and responsiveness

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Service Innovation

• 24/7 wrap around services for those with
  palliative / end of life need
• Clear palliative care pathway and end of life
  plans in place
• Specialist nurse and CCNs prescribers providing
  effective, timely symptom control
• 24/7 on call to senior nurse

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• HCA support to provide hands on care to support
  parents
• Counsellor child and family support
• Local pharmacy support
• Nationally recognised award winning team
• Locally 80 planned end of life care took place
  at home with the support of the Complex Health
  Needs Team (2007)

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Activity / Innovation

• 350 - 400 children young people are in receipt
  of services at any one time
• 85 significant technical needs (VHIU)
  vulnerable to increased hospital admission
• 1740 visits/interventions were as an alternative
  to hospital care in the past year (2007)
• In addition 803 CCN contacts as an alternative to
  GP visit

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Activity / Innovation contd.

• One of only a few health respite services in the
  country
• School holiday provision working alongside LEA
  partners
• Nurse Education Adviser (only one in region)
• Childrens counsellor

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Alternative to PICU / HDU

• Numbers of children requiring long term
  ventilation is increasing (Murphy, 2008)
• Nationally 111 children refused admission to PICU
  (2006) because PICU was full (NORCOM, 2007)
• Equated to 39 of bed occupancy on PICU in 2006
  (Sheffield Childrens Hospital)
• Detrimental impact on child and family
  functioning

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• Over the last two years 6 children with mid /
  long term ventilation needs would have needed to
  be monitored in PICU / HDU for significant
  lengths of time without our services /
  interventions
• HCA carers / 24/7 support senior nurse via on
  call
• Carers / nurses that follow the child
• In reach local hospital, HDU, PICU and school
• From referral to home an average of 12 weeks

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Cost comparison

• Cost of caring for a child on PICU - 2342 per
  day
• Cost of caring for a child on HDU - 1200 per day
• This represents a significant financial burden on
  Primary Care Trusts.
• Cost of caring for a child in their own home -
  478 per day
• Economic costs not solely felt by organisation

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Chance to improve equity for other children
young people / business opportunities

• As a team we have developed the knowledge and
  skills to deliver safe and effective care to this
  most vulnerable group
• Strong infrastructure to support this development
  and ensure children and families are well
  supported
• Already over border working

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Aiming High

• Short break services for children and young
  people both in and out of the home
• Crisis intervention
• School holiday provision via extended schools
• 100 of families said they coped better during
  school holidays and just over 1/3 of these
  families felt that their child showed positive
  changes in their behaviour

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Aiming High contd.

• 91 of families and siblings said they would like
  to access events that would include siblings
• Sibling groups planned for summer this year
• We have jointly commissioned 2 mini buses
• Developed links with other sectors to extend
  opportunities for children and their families

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The Future

• Expansion to provide choice to those children
  with minor illness
• AE at Rotherham 51 of attendees are children
• 80 self referred (first port of call)
• Primary diagnosis was viral infection
• Build upon our resource of first contact
  practitioners
• Explore alternatives closer to home in the
  home
• To jointly develop clear pathways for this cohort
  of children and young people

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To continue to

• Work in partnership with children and their
  families utilising specialist knowledge,
  providing expertise and care in a variety of
  settings to fit in with the childs day to day
  life
• Provide real choice around place of care
• Build upon alternative to hospital and GP
  activity where appropriate
• Provide flexible, responsive services to meet
  ever changing needs and demands