Models of care: Background

We explain why we have included models of care as a workstream within the project.

Children and young people in the UK have worse health outcomes than those in other comparable countries, and large inequalities persist. Over the last 45 years, mortality data show a shift away from acute infectious illness and towards chronic long term conditions – however, child health care services have remained hospital focused.

Children have the right to the best health care possible, and there has been a strong narrative since the Marmot Review in 2010 for giving children the best start in life. Elsewhere in this project, we have looked closely at forecasting future paediatric healthcare activity. Our forecasts suggest that, if drivers of increased activity are not addressed, there will be further rapid increases in CYP emergency and outpatient activity over the next 20 years, requiring significant additional investment in both services and workforce if quality is not to fall. Without concerted action to reduce child poverty, healthcare activity will increase, and outcomes worsen. Contrary to these pessimistic scenarios, our findings suggest that development of integrated care for CYP at scale in England has the potential to dramatically reduce or even reverse these forecast increases, reducing strain in the system whilst improving outcomes for CYP and family and young people’s experience of care.

Integrated care is widely accepted as having a positive impact on care. In 2018, NHS Providers wrote ”It is now widely accepted that trusts need to work collaboratively within health and care systems to make best use of collective resources and improve services for patients. No trust is an island capable of meeting the health and care needs of the population it serves on its own. This means focusing on the needs of a local population and overcoming barriers between hospitals, mental and physical health services, local authorities, primary care and the wider public health system, including schools and housing.”[1]

In the last few years, new models of care for children’s health services have begun to emerge. From 2015-2018, the models of child health appraised (MOCHA) group spent three years identifying and critically assessing the differing models of child primary care that are used in Europe. It reached a number of useful conclusions.[2]

In England, there has been a notable shift in the NHS towards integrated care:

  • 2014: NHS Five Year Forward View published
  • 2016: 44 Sustainability and Transformation Plans were introduced, bringing together healthcare stakeholders. Local workforce action boards (LWABs) were set up to support workforce planning.
  • 2017: Next Steps on the NHS Five Year Forward View was published, with emphasis on integrated care. STPs were rebranded to Sustainability and Transformation Partnerships and more support for the most developed to become Accountable Care Systems (ACSs).
  • 2018: ACSs rebranded into Integrated Care Systems (ICSs)
  • 2019: NHS Long Term Plan published, stating all STPs must become ICSs by 2021. NHS Interim People Plan was also published, setting out importance of STP and ICS strategic local plans that should be completed by November 2019.

As this timeline demonstrates, a lot can shift in a relatively short space of time. We wanted to focus on models of care in this project to get a sense from our members of what has and hasn’t worked for them in the last ten years, and what they think are the key ingredients for the future. We’ve shared their views in our Context section, and then used them to shape our Future section, on shaping paediatric models of care for the future.


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NHS Providers. No trust is an island – a briefing for governors on working collaboratively in health and care systems.


Models of Child Health Appraised website

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