Children’s Strategic Clinical

Network - Overview

Tracy ParrSCN Lead Children and MaternityChildren EnglandDecember 10th 2013

London Strategic Clinical Networks

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What is a Strategic Clinical Network (SCN)?

• Area requiring large scale change

• Resistant to previous attempts to improve

• Strategic approach

• Contrast with Operational Delivery Networks

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Clinical areas covered by SCNs

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London’s Children

• Population of London 7.8 million (ONS 2011)

• 2,049,576 children aged 0 – 19 in London

• Approx 1.7 million children in Kent Surrey

Sussex, and East of England many of whom

access specialised services in London

• 134,186 live births in London 2012 (ONS)

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Why a Children’s SCN?

UK has a higher all-cause childhood

mortality rate compared with Sweden,

France, Italy, Germany and Netherlands

London has higher than expected mortality for 1 – 19 year olds

6Data courtesy of London Health Programmes

Hospital mortality for children in London is rising compared to other areas of UK

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Nearly half of children are not reviewed by a consultant surgeon within 12 hrs of admission

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At weekends this worsens to less than 30% consultant review within 12 hours

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Over 50% of hospitals do not have a paediatric anaesthetist available

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Attendance at A & E by children is very high in London

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ACCIDENT & EMERGENCY attendances, ages 0-17, London 2010-11

Source: PHE ChiMat using HES Data

0 100 200 300 400 500 600

BarnetHavering

HarrowCity of London

Richmond upon ThamesRedbridge

Barking and DagenhamBexley

Waltham ForestBromley

Kingston upon ThamesCamden

HillingdonLONDON

SuttonLambeth

Kensington and ChelseaCroydon

Hammersmith and FulhamIslington

EalingNewham

SouthwarkTower Hamlets

MertonBrent

HounslowEnfield

LewishamGreenwich

Westminster, City ofHackneyHaringey

WandsworthEngland

Accident & Emergency attendances, rate per 100,000 population aged 0-17

Accident & Emergency attendances, rate per 100,000 population aged 0-17, England LAs, 2010-11

96.6 - 243.9

244.0 - 301.9

302.0 - 336.9

337.0 - 413.9

414.0 - 880.6

National quintilesrate per 100,000

0

100

200

300

400

500

600

700

800

900

London - lowest

London average

England average

London - highest

26 London boroughs have A and E attendance higher than the national average for children

Data courtesy of ChiMat

Some boroughs have high rates of admission to hospital for asthma

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ASTHMA Emergency hospital admissions, ages 0-18, London 2011/12

Source: DMIT using HES Data

0 50 100 150 200 250 300 350 400 450

WestminsterWandsworth

Richmond and TwickenhamHavering

EnfieldBarnet

KingstonGreenwich

Kensington and ChelseaHillingdon

Tower HamletsHounslow

BromleySutton and Merton

HaringeyBexley

CamdenHammersmith and Fulham

LONDONNewham

BrentCity and Hackney

SouthwarkHarrow

RedbridgeEaling

LewishamBarking and Dagenham

LambethIslingtonCroydon

Waltham ForestEngland

Emergency hospital admission rate per 100,000 population aged 0-18

Emergency hospital admission rate per 100,000 population aged 0-18, England PCTs, 2011/12

74.8 - 142.0

142.1 - 162.0

162.1 - 210.0

210.1 - 262.0

262.1 - 495.7

National quintilesrate per 100,000

0

50

100

150

200

250

300

350

400

450

500

London - lowest

London average

England average

London - highest

Solutions to the care of children

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“Children’s services should be seen as a whole system,

designed within a framework of pathways and networks

which enable the right things to be done, at the right time

and place, using teams that work together within a

managed network.”

RCPCH 2013

Issues across healthcare systems

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“It is clear that in relation to service failure, problems

often occur at the borders between one organisation or

team and another”

Learning from Investigations

Healthcare Commission

February 2008

Initial work

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• Implement networks of care across all children's providers

• Identify standards of care within the networks building on existing standards:

• Service specifications for specialised services

• All existing standards for children in-hospital care (eg RCPCH, London Health Programmes, RCA, RCS)

• General practice outcome standards

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London Strategic Clinical NetworksDecember 2013

Children’s Strategic Clinical NetworkChildren’s Commissioning Group

Strategic Clinical Leadership Group

Patients and public

SCN Oversight Group

GovernanceClinical Senate

Assurance

Children’s Network Children’s Network

Children’s Network Children’s NetworkSTA

ND

AR

DSS

TAN

DA

RD

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Primary care

Tertiary care

Secondary care

Cardiology Pathway GroupChair: Owen MillerSCN Lead: Andy Martin

Neuroscience Pathway GroupChair: TBCSCN Lead: Andy Martin

Diabetes Pathway GroupChair: Peter Hindmarsh/Martha Ford-AdamsSCN Lead: Sara Nelson

Nephrology Pathway GroupChair: Lesley ReesSCN Lead: Sara Nelson

Surgery Pathway GroupChair: Simon EcclesSCN Lead: Suzanne Sweeney

Critical Care Pathway GroupChair: Duncan MaCraeSCN Lead: Andy Martin

Oncology Pathway GroupChair: Julia Chisholm/Darren HargraveSCN Lead: Caroline Moren

Asthma Pathway GroupChair: John MoreiraSCN Lead: Sara Nelson

Gastrointestinal Pathway GroupChair: Ian SandersonSCN Lead: Suzanne Sweeney

Neonates Pathway GroupChair: Sandy CalvertSCN Lead: Suzanne Sweeney

Patient and Public Involvement (PPI)SCN Lead: Andy Martin

Mental HealthSCN Lead: Andy Martin

Health in the Justice SystemSCN Lead: Sara Nelson

CommissioningSCN Lead: Sara Nelson

Immunisation, Healthy Child and SafeguardingSCN Lead: Suzanne Sweeney

Data and InformationSCN Lead: Andy Martin

Programme ManagementSCN Lead: Andy Martin

Information TechnologySCN Lead: Sara Nelson

Education & Workforce SCN Lead: Sara Nelson

CommunicationsSCN Lead: Suzanne Sweeney

Community care

Collaborating with:

► Academic Health Science Networks► Clinical Commissioning Groups (CCGs)

► Health and Wellbeing Board► Local Education and Training Boards

►Public Health England► Regulatory bodies

► Royal Colleges► Voluntary sector

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ENABLERS EN

ABLE

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Linking with other organisations

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Networks• Establishment of a Regional CYP&F voluntary and community sector network

• Regional networks and resources on engaging with health & schools

• Supporting local networks and effective representation• Briefings on effective engagement and representation

Patient and Public Involvement in SCN

• Critical part of our work

• Challenges

• Options

• Discussion

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