Healthy Start Implementation Process

1
Healthy StartImplementation Process

• Eulalee Green
• Health Development Manager
• Registered Dietitian
• eulalee.green_at_nhs.net
• 07939 831 821

2
Overview

• Background
• The Project Plan
• Future Plans

3
Background

• 2005-2008 35 children with rickets
• 2007-2009 20/22 children with tuberculosis had
  vit D
• deficiency
• 2004-2007 17 hypocalcaemic seizures at 1-2
  months old
• 2 required PICU,
• 1 long term complications
• 2008 2 infant cardiac failure due to vit D
  deficiency
• 20 of paediatric fracture patients are vit D
  deficient
• Source Dr Michie, Consultant Senior Lecturer in
  Paediatrics, Ealing Hospital

4
Background

• Rates over 5 years (2003 2008)
• 23 electoral wards

Average Number Congenital Malformations Children 0-5 yrs old In Each Electoral Average Number Congenital Malformations Children 0-5 yrs old In Each Electoral
Expected 14 (range 9 - 23)
Actual 70 (range 41 - 114)
Ratio Actual Expected 5
5
Healthy Start Project

• Early 2009 DoH identified high seizure rates in
• Ealing
• June 2009 HS project started
• Aim
• Reduce neonatal hypocalcaemic seizures (vitamin
  D)
• Reduce congenital malformation rates (folic acid)

6
Milestones

1. Baseline data
2. Stakeholder Interviews
3. Map current processes
4. System redesign
5. Implement and monitor
6. Health Staff training
7. Community Publicity
8. Monitoring
9. Outcome evaluation
10. Roll-out to non-PCT sites

7
Baseline Data

• 8 sites over 3 neighbourhoods
• 20,750 Children 0-4 yrs
• 11,000 women pregnant or with a child lt12mths old

Uptake 2007 2008 Uptake 2007 2008 Uptake 2007 2008 Uptake 2007 2008 Uptake 2007 2008
Area Adult Sold Adult Free Child Sold Child Free
Acton, Central Ealing Hanwell 1 0 42 224
Northolt Greenford 5 10 27 133
Southall 0 0 140 170
Total for Ealing 6 10 209 527
8
Stakeholder Interviews

• Public Health Strategic Lead
• Universal Children Services client advice
• Maternity Services client advice
• Family Nurse Partnership
• GP Services Paediatricians client advice
• Health Centres supplement sales budget
• Children Centres client advice
• Supplies Department distribution to centres
• Accounts Department- reporting to DoH reclaim
  funds

9
The Process (July 2009)

• Account Department had unwritten process
• Centres had different processes
• Quarterly returns not submitted
• Monies banked incorrectly
• Wrong account and supply codes used
• Staff confused about recommendations
• GP MW not involved

10
System Redesign (Aug 2009)

• Draft Flow Chart, FAQ, Leaflet
• Key stakeholders meeting
• Prepare final documents
• Pilot at one site
• Roll-out to other PCT sites
• Deliver training for Reception Staff
• Implement system and monitoring

11
Health Staff Training (Sept 2009)

• Practice Managers 25 managers
• Pharmacists 2 sessions, about 40 pharmacists
• Health Visiting Team 4 neighbourhood meetings
  40 staff
• Midwives Queen Charlottes Ealing Hospital
  about 30 staff
• Ealing Hospital 45 minute presentation hour
  from 900 am to 600 pm - up to 135 staff
• Clinic administrators 10 staff
• Children Centre Staff (delivered by the Children
  Centre Dietitians)
• Corum outreach team 30 staff

12
Community Publicity (Sept 2009)

• Baby TV film
• Poster
• Two articles a year, in Ealing Matters, Team Talk
  Core Brief, and Nutrition Today
• Weaning Groups 6x a week CCD
• Breastfeeding Peer Supports CCD
• Switch-Script on GP system

13
Monitoring(2009 2010)

• PH collates HS uptake
• Vouchers held by the centre for 12 months
• Every month figures and copies of banking slip
• Compile quarterly sheets
• Quarterly figures sent to Accounts

14
Uptake Data
Uptake 2007 2008 Uptake 2007 2008 Uptake 2007 2008 Uptake 2007 2008 Uptake 2007 2008
Area Adult Sold Adult Free Child Sold Child Free
Acton, Central Ealing Hanwell 1 0 42 224
Northolt Greenford 5 10 27 133
Southall 0 0 140 170
Total for Ealing 6 10 209 527
Uptake 2009 2010 Uptake 2009 2010 Uptake 2009 2010 Uptake 2009 2010 Uptake 2009 2010
Area Adult Sold Adult Free Child Sold Child Free
Acton, Central Ealing Hanwell 49 144 437 378
Northolt Greenford 39 73 164 327
Southall 661 83 819 309
Total for Ealing 749 300 1,420 1,014
15
Outcome Evaluation

• Difficult to obtain and time consuming
• Hospital coding errors, so need to hand search
  patient records
• Hypocalcaemic seizures only 2 between 1 Sept
  2010 to 28 Feb 2011

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Process in 2010

• Written Process (FAQ Flow Charts)
• Distribution sites submitting correct information
  
• HV, CNN MW understand vitamin recommendations
• Accounts Department some problems
• GP some problems
• Not distributing from non-PCT sites

17
Problems

• Process monitoring
• Outcome monitoring
• Accounts department not including HS as one of
  its priority
• Distribution of refund
• HS vouchers infant vitamin voucher not from 1
  mth

18
Future Plans

• Investigate how families are using vouchers
• Access GP training programme
• Re-look at non-PCT sites
• Write in to the SOP for
• GP antenatal booking
• 1st Antenatal appointment
• New birth visit
• Training staff at birth registration offices
• Children Information Services website
• Local library services

19
Plea to the DoH

• Children vitamin vouchers from 1 mth
• Constant messages on HS sites and leaflets to
  include drops from 1 month for African,
  Afro-Caribbean, Middle Eastern and Asian babies
• Request hospitals to remove paediatric as
  diagnostic code
• Request GP, midwifery and health visitor IT
  systems, include auditable fields for vitamin D,
  folic acid, and breastfeeding