Supporting an integrated national clinical network for

Paediatrics

Eilísh Hardiman

Group CEO

Children’s Hospital Group

2 April 2014

“There can be no keener revelation of a society's soul

than in the way in which it treats its children”

Nelson Mandela

Children in Ireland - Irish population 4.6 million in 2013 (CSO)- Population growth rate 1.6% for last 5 years, 1.1% annually to 2021- Birth-rate per 16.3 per 1000 in 2013 – highest in Europe with over

72,000 births annually for last 2 years- Population under 16 years – 1.25 million or 23% of the population

- Growing up in Ireland - Majority of under 9’s are very healthy (73%), healthy with a few problems (25%), with 2% unwell/quite ill

- Lifestyle issues – 25% of 3 year old children are overweight or obese- Chronic disease - 16% reported of 3 year olds longstanding illness

- Asthma, eczema, allergies, heart abnormality, MSK illness

- Annually approximately 244,000 ED attendances

What is best for children?• Clinical care and treatment needs to be as near the child’s

home as clinically appropriate. The vast majority of paediatric services are delivered on a same day basis and delivered locally

• The sickest children and young people have better clinical outcomes if treated in a hospital that has:- a high caseload volumes (scale) requiring a critical

mass of 32 clinical specialties and sub-specialties- combined with advanced medical technology and ICT - an integrated approach to education, research and

innovation in- facilities designed using evidence-based design with- responsive retrieval transport service

TRI-LOCATION

Mothers

Staff

Children’s Hospital

Adult Hospital

Staff

Maternity Hospital

Adolescents

Infants

Staff

What is best for children?- In Ireland this mean:

- 1 national tri-located children’s hospital - linked to regional hospitals with paediatric units and - local paediatric centres to support

- Urgent care,- OPD access- GP diagnostic access - Rapid access to paediatric opinion and - home based care

- better integrated by contemporary ICT - within an integrated national clinical network for paediatrics and - shared care model of working.

Current Paediatric Services

Crumlin, TempleStreet and TallaghtLetterkennySligoCastlebarGalwayPortiunculaLimerickTralee

Acute Paediatric Services WaterfordWexfordKilkennyPortlaoiseMullingarCavanDroghedaCork Clonmel

19 Neonatal Units11 Level 1 4 Level 2 4 Level 3

H

H

H

CUH, Temple StreetEstablished 1872154 Beds (in-pt and day care)8,200 in-pts, 8,400 day casesVoluntary Hospital Owned by the Sisters of Mercy

OLCH, CrumlinEstablished 1956227 Beds (in-pt and day care)10,300 in-pts, 17,500 day casesVoluntary Hospital Owned by the Board of OLCH

NCH at TallaghtOpened 1998-Harcourt St (1821)66 Beds (in-pt and day care)7,200 in-pts, 2,900 day casesVoluntary Hospital under Charter for AMNCH Owner by the Minister

Activity for Children’s Hospitals

Inpatients78% Greater Dublin Area

Day care65% Greater Dublin Area

Out-patients72% Greater Dublin Area

Greater Dublin AreaDublin, Meath (part), Kildare, Wicklow

Activity outside local Dublin area DONEGAL

In-patients - 1.35% Day care - 1.30%

CORKIn-patients - 2.15%Day care - 2.18%

GALWAYIn-patients - 1.45% Day care - 1.63%

LIMERICKIn-patients - 1.07% Day care - 1.22%

Most children in Ireland receive their paediatric care close to home

Vision for children's services- A National Children's Hospital independent trust that puts children, young people

and their families central to its functioning and decision making

- An integrated national model of care for paediatric services with the new children's hospital at the centre of an integrated national clinical network linked with paediatric units in regional hospitals, local paediatric services and community / home based services

- The configuration of paediatric services in geographically based Hospital Groups to support appropriate local access to paediatric services, with support from the Children’s Hospital Group

- National paediatric and neonatal ambulance retrieval services to ensure the timely transfer of the sickest infants and children to the appropriate hospital

- The successful integration of the three children's hospitals into a single organisation before moving to the new hospital facilities

- A new state-of-the-art children’s hospital tri-located on a campus with St James’s Hospital and a maternity hospital that will provide safe, high quality tertiary / quaternary specialist paediatric services for the island and secondary paediatric services for the greater Dublin area, with transition of services to commence by end of 2018

- Satellite centres at Connolly and Tallaght Hospitals by 2016, providing emergency / urgent care and better local access to general paediatric OPD services, diagnostics and to support community and home based services

- An academic health sciences network to support greater integration of clinical service with education, innovation and research to deliver better health and wellbeing outcomes for children and young people

Vision for acute children's services

Building a network – first steps- HSE National Clinical Programmes for Paediatrics and Neonatology to complete an

integrated national model of care for paediatric services in Q3 2014 to guide the development of an integrated national clinical network across Ireland

- Children's Hospital Group Board established Sept 2013, Hospital Group progressing, starting with agreeing core values, common vision and mission

- Each Hospital Group has to develop a 3 year Strategic Plan for services including paediatric, neonatal and maternal services to support appropriate local access to these services and implement the national model for paediatrics

- National Neonatal Transport service in place 24/7 since Dec 2013 to ensure the timely transfer of the sickest infants to the appropriate hospital, with a National Paediatric Transport service under development

- Government decision to build a national children's hospital and two satellite centres

Supporting an integrated clinical network for Paediatrics

- Several models of an integrated clinical network exist in Irish and other healthcare systems

- Span of control varies from: - standardised clinical pathways collaboratively developed by the centre, shared across the system and

implemented locally (HSE Clinical Programmes) - medical staff employed by the centre and work in / rotate into local based services, integrated ICT

systems across several locations (networked services in US system)- a managed network of services with greater control of local services by the centre (Cancer Control)- NHS Trusts with acute and non acute and social services managed by one structure

- A good example already exists in the Irish healthcare system. It is achieving world standard healthcare outcomes for the most complex of paediatric treatments, using an integrated clinical network for oncology and haematology paediatric services

National Peadiatric Oncology and Haematology Service

One national centre ‘Hub’

OLCH, Crumlin

• Shared Care• Every child who develops cancer has

their diagnosis made & treatment planned at the centre

• 60% of children, components of treatment delivered by one of sixteen hospitals or at home and in accordance with protocols agreed with the centre

16 local centres‘Spokes’

Local Paeds Units

•Paediatric Cancer• Haemophilia and related diseases• Haemoglobinopathies (SCD)• Haematopoietic Stem Cell Transplantation

National Peadiatric Oncology and Haematology Service

- Policy and service imperative to reconfigure paediatric Haem / Onc services - International evidence of shared care model in cancer management- Reconfiguration of services and reassignment of existing resources, coupled

with new investment - Shared Care Manager and Clinical Nurse Specialists- Formation of representational shared care group - Parents are primary providers of care with home care supported by phone

access to the centre- Development of Supportive Care Guidelines – available on line - Provision of regular regional paediatric cancer study days- Development of Online Information Resource- Continuous evaluation, audit and improvement of the service- Strong integration with research and clinical trails (100% participation)

• Support and leverage service reconfiguration / integration plans by Hospital Groups

• Implement shared / networked care for specific specialities

• Build on the HSE Clinical Programmes for Paediatrics and Neonatology to standardise care

• Underpin standardisation with integrated clinical systems

• Demonstrate effectiveness of satellite centres in the provision of the majority of same day services and support community / home based care

Building a clinical network

Key steps in providing quality care

20

To provide high quality neonatal care to all 72,000 babies born in Ireland annually:

Effective screening, nutrition, immunisation programme for all healthy newborns Provide high quality neonatal intensive care and surgical care for ill newborns Seamless transfer from Level 1 to Level 2 through to Level 3 Neonatal Intensive Care ‘Right baby, right place right time’ To put an efficient retro-transfer programme in place

Quality

All babies should have equal, rapid access to neonatal intensive care and surgical treatment irrespective of geographical location. Eradicate ‘post code’ disadvantage

Access

Reduction in unnecessary costs by prompt identification & timely treatment of remedial problems

Eradicate fragmentation and duplication of newborn specialist and intensive care services Rationalisation of Neonatal Intensive Care Re-engage the wider paediatric community-GPs, AMOs, Public Health Nurses to reduce the

‘drift’ to hospital care with minor problems

Cost