multi-speciality provider partnerships: commissioning … · multi-speciality provider...
TRANSCRIPT
Multi-speciality provider
Partnerships:
Commissioning safe,
comprehensive &
sustainable CCN Services
Trudy Ward SCN Clinical Lead
UK Children, Young
People & their families
deserve better
• Priority need to tackle child health inequalities in the UK
• Care delivered closer to home/out of hospital where clinically
appropriate and safe
• The CCN role for LTC/palliative/complex needs- well established;
clinically effective and value for money
• Whole system approach required to shift care out of hospitals &
provide in the community
• CYP urgent care/sepsis/deteriorating child & SEND reforms
• Designing services around the individual CYP and not the system
• Integration, collaboration & multispecialty providers
Key messages from policy &
1959-2015
• Equitable, safe, comprehensive &
sustainable children’s community nursing
is critical to realising a whole system
approach to
• reducing avoidable hospital attendances
• delivering care closer to home
• improving patient experience and clinical
effectiveness 24 hours/day, 7 days a week
• Current nursing services in the community are not integrated for CYP with long term conditions, continuing healthcare needs or end of life care- fragmented and fragile service provision with limited accessibility for families
• No formal partnership working or joint plans from the different provider organisations
• Historical gaps in service access for all CYP across SEC- disparity and inequity in service provision.
• The current community workforce is below the recommended staff WTE per population ratio
• Nursing services across community and acute settings are working in silos with a lack of strategic vision and leadership.
• No completed commissioning review of all of these nursing services and no updated and agreed service specifications within contracts. Unreliable funding streams and significant lack of data some challenges.
• The development of community children’s nursing (CCN) teams across Kent, Surrey and Sussex remains fragmented and inequitable.
• Although some CCN services are successfully delivering quality services, very few of the existing CCN services are able to offer a 24/7 service that is especially critical for end of life care.
• Workforce challenges for future registered children’s nurse demand has not been tackled.
• KSS have not embraced the post-qualified workforce challenges for postgraduate children’s nurses. There has been a lack of investment in education to allow for delivery of both primary and community-based care advances roles.
• Non-qualified workforce challenges: There needs to be a skill mix approach with teams working together to provide nursing care across all sectors.
• Shifting towards more out-of-hospital care provides opportunities to extend current services and develop different and exciting ways in which children and young people receive or access care
The South East CCN Audit- familiar?
CCGs should move quickly to
commission equitable services and
ensure that each acute general
children’s service is supported by a
community children’s nursing
service which operates 24 hours a
day, 7 seven days a week for advice
and support for unscheduled and
end of life care, with visits as
required depending on the needs of
the children using the service
• 4% increase (HEE 2015/6) nurse training places
• Workforce planning is not aligned to strategic plans
• An ageing workforce
• Disparity and lack of consistency in preparation for training for contemporary roles across England
• Reduced number of HEIs offering CCN/APNP training
• Lack of clearly defined career pathways and progression
• Children’s training overseas not recognised in UK
• Challenges also with AHP’s and LD nursing
Workforce: children’s nursing
Children’s Nursing Workforce Supply HEE
Secondary and community
providers should work with
Health Education England (Kent,
Surrey and Sussex ) to support
the development of a SEC acuity
tool to determine nurse
workforce requirement.
The Kent Surrey
& Sussex Vision
• A comprehensive children’s community nursing service forms an integrated part of a co-located wider network of multiagency child and family services.
• An integrated service can provide for the existing and future needs of children, ensuring consistent, high quality transition between services such as hospital and home or between health, social care, education or children’s and adult services (Parker et al 2012 in RCN 2014).
The service vision
Community and secondary care
providers should support CCGs
to explore further the concept of
‘Teams within Teams’ across
localities to facilitate a
sustainable model that is
productive and equipped for
multiagency integration.
• A safe service with consistency of care across environments and professionals; there is clarity of level of autonomy, accountability and responsibility within the teams and professionals with robust community accorded clinical governance
• A comprehensive service with integrated and coordinated locality care that caters for all four groups of CYP; the service is responsive and flexible to local population needs and accessible seven days a week, with 24 -hour provision and an on-call service
• A sustainable service with robust workforce planning and development and the innovative use of critical mass of workforce within a locality; the right people with the right skills will be available in the right place at the right time
Attributes of a good CCN service RCN 2014
Components of a comprehensive needs led
CCN service – Kent Surrey & Sussex
Access scope
4 CYP Groups (0-24yrs)
7 Days 8-8 visits
24hr End of Life Care
Integrated delivery
that is locality & community positioned
Sustainable service models and skilled
workforce
Collaborative relationships
Agreed care pathways
Supported by
technology innovations
& performance data review
Clinical nursing leadership
Robust clinical governance; supervision & education frameworks
• There needs to be 24 hours a day, 365 days a year access to end of life nursing care for children and young people at home if that is the families choice (DH/NHS England).
• There needs to be 24 hours a day, 365 days a year access to children’s community nursing advice and support for unscheduled care, with as a minimum visits from 8am to 8pm, 7 days a week (RCPCH/RCN/RCGP).
• There needs to be 24 hours a day, 365 days a year access to children’s community nursing advice and support for children with long term conditions, complex needs and disability, with, as a minimum, visits from 8am to 8pm, 7 days a week (NHS at Home DH).
24/7
• Joined up, high quality**, community positioned models of care, which effectively reduce the need for hospital attendances and admissions ** robust community accorded clinical governance
• Scope, advancement & innovations in nursing to deliver core, specialist and advanced practice across a range of settings
• Nursing that is primary and community positioned in addition to nursing in hospital- for all 4 groups of CYP
• New approach needs to maintain the excellence in the children’s community nursing specialism that has existed for those children with long term conditions, complex needs, disability and life limiting conditions together with integrating new advanced children’s nurse practitioner roles to diagnose and treat children with acute short term conditions
• Maximising the critical available RNC resource & evidential skill mix
The nursing vision: think child not base
All 4 groups of CYP
Education Social Care
Palliative EOLC
Safeguarding
Administrator
Nurse Counsellor
Safeguarding
Short breaks
Advanced Community
Nurse
Specialist Health Visitor
Special School
Nursing
Rapid Response
Care
CORE COMMUNITY
NURSING
Epilepsy Specialist
Nurse
Diabetes Specialist
Nurse
Cystic Fibrosis
Specialist Nurse
Specialist Health Visitor
Children’s Community
Matron
Head of Children’s
Community Nursing
Practice Educators
Paediatric Nurse
Practitioner CYP ADVANCED
Nurse Practitioner
CYP ADVANCED
Nurse Practitioner
Paediatric Nurse
Practitioner
Administrator
CORE COMMUNITY
NURSING
Advanced Community
Nurse
Nurse Counsellor
Palliative EOL Care
Short breaks
Rapid Response
Care
Special School
Nursing
Acute tertiary/
local
Healthy Child Programme
Child Development
Team
Hospices Primary Care
• Agreed clinical pathways across providers
and settings will avoid duplication in roles
and expose gaps
• Specialised service specs need to be
aligned with local CCG service specs
• ……AHP’s eg community respiratory
physiotherapists
Nursing roles: who is responisble for
what?
• CYP urgent care pathways
• RCPCH/RCN/RCGP Standards 2015
• Primary care, acute hospital & community collaborations
• New work stream within majority of CCN services
• Data on demand/need a challenge
• Requires whole system approach & sign up
CYP: Acute short term conditions
• Tertiary, local acute, primary care,
community health services alongside
education
• Business continuity regarding nursing –
align specialised commissioning with local
commissioning
• Agreed collaborative care pathways
CYP: Long term Conditions
Specialist CCN roles that incorporate:
• Keyworking/case management/lead professional; transition co-ordination
• Emotional support throughout childhood
• Liaison, information and signposting
• Specific nursing care & management
• Education and training parents/family & wider children’s workforce
• Multiagency & multi-provider partnerships
• Special school nursing & SHV’s
CYP: Complex needs & disability
• Good will & skilled workforce not sustainable with addition of acute short terms conditions work and expansion of 7 days- 24/7 for other groups of CYP
• Children are not always given the choice to die at home as there are not enough trained community children’s nurses to provide 24/7 children’s palliative care in the community RCN June 2015
• NHS provider/Charity provider formal partnerships – joint KPI’s & governance
CYP: Life Limiting, Life threatening
conditions & End of Life Care
Care Pathways for LTC should clarify roles and
outcomes using Clinical Nurse Specialists and
CCN Specialist Practitioners to ensure business
continuity across primary, secondary and
community providers.
CCGs and providers should work with Together
for Short Lives.
Providers should build on current strategies to
build on good practice in advance care planning
for CYP.
CCGs and providers have to accelerate
discussions on the implications of the recent
NHS England report Developing a New Approach
to Palliative Care Funding.