Models of care: Conclusions

We set out our vision for paediatric models of care in 2040 and the enablers (what needs to happen) to achieve it.

“Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” (World Health Organisation 1946)

Throughout this work we have focused on what the future could be, rather than saying what it definitely will be. By doing this, we are aiming to highlight what needs to happen to make our dream for paediatric care models of the future a reality.

Our vision for 2040

In 2040 we hope to see…

  • Life reimagined through the lens of the children and families we care for, exhibiting compassion for their needs and equity of care for all families.
  • A whole population approach to care that builds on six broad patient segments as oppose to stratification by patient pathways.
  • Paediatric models of care that are truly child centred, rather than built to suit existing systems, with communication and adaptation as the key ingredients in any system.
  • Developmentally appropriate care that is easily adaptable to changing biopsychosocial profiles.
  • Care models that take vulnerability into consideration and explore social circumstances in all encounters that include personal and community factors.
  • Reduced clinical variation for single chronic health problems, with every child being seen in the right place at the right time by the right professional through connected care.
  • Enhanced care models for children with long term conditions that focus specifically on improving quality of care and quality of life.
  • More children and families empowered to know when to seek care, with reduced pressure on emergency department attendances.
  • Optimisation of technology to support fully integrated systems across paediatric care, allowing remote monitoring and seamless interconnectivity.
  • Child and family engagement embedded in every paediatric service across the UK

Enablers

In order to achieve our vision for 2040, we think the following needs to happen…

Family and patient centred care

  • Care models need to reflect patient flows and may differ based on rurality or urban living but should all be part of a system response.
  • Services need to reflect cultural identities and be delivered in a culturally competent way which reduces bias and inequity.
  • Increased focus is needed on putting parents at the centre of care. A key example is neonatal care, where we should be striving for a single family room experience for the whole neonatal stay. This will require investment in the neonatal care infrastructure to achieve spacious units and optimum staffing.
  • Paediatric departments should use the tools provided by the RCPCH &Us service to build diverse children and young people’s engagement into their service using a mixed methods approach.

Prevention of ill health

  • There should be a renewed focus on the first 1000 days of life, a critical time to prevent physical or psychological harm from developing.
  • Horizontal integration between health services, local government (social services) and education should be prioritised for improvement, to provide and maximise opportunities for all children.
  • Evaluation of screening tools for adverse childhood experiences should be supported, enabling professionals to assess these in a developmentally appropriate way.
  • Educational packages for core minor illnesses should be development to empower families to self-care at home and ensure consistent messaging from healthcare professionals when advice is sought.

Service design and navigation

  • All service offers should ensure consistency across a working week to ensure families are aware of what is available and when.
  • Specific focus should be placed on resourcing service characteristics that support a biopsychosocial approach, including dedicated young people’s clinics and integration between paediatrics and other professionals (including primary care and adult physicians).
  • Principles for achieving consensus in conflict should be implemented in all paediatric services, with a particular focus on building and embedding the communication principles required for end of life care into routine paediatric care to help reduce disharmony.
  • Development of self-identified care maps should be prioritised, allowing families to navigate a complex system and know who to contact and when. These maps should be available on all health care systems to all health care providers at each visit.
  • Care-coordination for children with medical complexity should be prioritised for improvement, ensuring care is connected and access points are clear so that illness can be treated in a timely fashion.
  • Consideration should be given to developing a national way to measure the impact of short-stay paediatric assessment units on the patient and family experience.

Service development

  • Networked national strategies should be developed for other long term conditions such as asthma, using successful implementation of this model in paediatric diabetes as an example.
  • Children and young people’s mental health services should be redesigned to remove the disconnect between community services and children’s psychiatric inpatient units.
  • National roll out of standardised coding, such as SNOMED-CT, should continue across the UK, with special consideration given to descriptions for medical complexity.
  • UK-wide roll out of a standardised paediatric early warning system tool should be prioritised, to allow rapid communication across systems of a child’s condition and deterioration.
  • Pilots for paediatric staff supporting NHS 111 should be evaluated and continued as appropriate.
  • Consideration should be given towards how to optimise outcomes for women during neonatal care, including measuring the entire journey in addition to specific points.
  • Neonatal care needs investment in fully integrated and interoperable systems, bringing technology into the 21st century.
  • Continued consideration should be given to how NHS 111 and primary care professionals can support paediatrics with reducing emergency department attends.

Team development

  • Increased recognition should be given to the role of the multidisciplinary team, including non-clinical roles, in delivering high quality, responsive and sustainable services and creating an empowered and healthy workforce.
  • Adequate time should be given to all paediatric teams to identify the presence of dysfunctional traits that may be affecting their performance, followed by support to take corrective action.
  • Renewed focus is needed on ensuring we have a paediatric workforce that offers diversity in professional background to enhance richness as well as diversity in ethnicity, gender, age and other characteristics.
  • All paediatric teams engaging in QI activity should define their team effectiveness for children using the five domains of focus.
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