26 march 2012 liverpool

26 March 2012Liverpool

Ian LewisCo-Chair

Children and Young People’s Health Outcomes Strategy

And Forum

National Context

Children lose out to demands of adults in NHS, says report Failure to provide more than 'mediocre services' argues Sir Ian Kennedy

CHILDREN & YOUNG PEOPLE HEALTH OUTCOME FORUM: ROLE

The Forum, jointly was launched on 26 January and will be reporting to the Government with independent advice later this year on:

– the health outcomes that matter most for children and young people

– how well these are supported by the NHS and Public Health Outcomes Framework

– how the different parts of the health system will contribute and work together in the delivery of these outcomes

CHILDREN & YOUNG PEOPLE’S HEALTH OUTCOME FORUM:

From February to April, •Will identify key outcomes and develop a suite of indicators and measures•Will meet with children, young people, parents, carers, doctors, nurses and other professionals involved in providing care•Will start to meet key individuals

From March – June•Will refine indicators and measures •Will develop its views of system requirements; the ‘strategy’ and outputs

End of June•The Forum will report back to the Government and publish their recommendations

7 key principles are proposed to underpin the development of the NHS outcomes Framework

• Accountability and transparency

• Balanced

• Internationally comparable

• Focussed on what matters to patients and clinicians

• Promoting excellence and equality

• Focussed on outcomes that the NHS can influence but working in partnership with other public services where required

• Evolving over time

The framework will be organised around 5 national outcome goals /domains that cover all treatment activity for which the NHS is responsible

How EFFECTIVE the care provided by the NHS isWhat the patient EXPERIENCE is likeHow SAFE the care provided is

The five domains will cover the range of activities that the NHS should be delivering for all patients

Preventing people from dying prematurely

Enhancing quality of life for people with long-term conditions

Helping people to recover from episodes of ill health or following injury

Ensuring people have a positive experience of care

Treating and caring for people in a safe environment and protecting them from avoidable harm

Effectiveness

Domain 1

Domain 2

Domain 3

Domain 4

Domain 5

Patient experience

Safety


Improvement AreasOutcome Indicator

Overarching Indicator

Supporting Quality Standards

e.g. Mortality amenable to healthcare

A suite of Quality Standards will

support the delivery of improved

outcomes in this domain

Heart diseasee.g. premature mortality

Cancere.g. 1 and 5 yr survival

Strokee.g. premature mortality

e.g. Older peoplee.g. healthy life expectancy age 65

Frames NHS Commissioning Board’s broader responsibilities

SofS holds NHS Commissioning Board to account for progress

Support commissioning of high quality service

Childrene.g. infant mortality; Neonatal

mortality and stillbirths

NHS Outcomes FrameworkChildren’s Indicators to date


Childrene.g. infant mortality; Neonatal

mortality and stillbirths

Children and Young Peoplee.g. Unplanned hospitalisation for asthma, diabetes , epilepsy


Unplanned care – childrenEmergency admissions for LRTI

Helping people to recover from episodes of ill health or following

injury

e.g. children and young peoplee.g. patient/parent survey


Treating and caring for people in a safe environment and

protecting them from avoidable harm

Children Harm due to ‘failure to monitor’

DOMAIN 3: Health Protection

Objective:

The population’s health is protected

from major incidents and other

threats, whilst reducing health

inequalities

DOMAIN 4: Healthcare public

health & preventing premature mortality

Objective:

Reduced numbers of people living with

preventable ill health and people dying

prematurely, whilst reducing the gap

between communities.

Indicators Indicators Indicators

DOMAINS

Vision: To improve and protect the nation’s health and wellbeing and improve the health of the poorest fastest

Outcome 1: Increased healthy life expectancy

Taking account of the health quality as well as the length of life. (Note: This measure uses a self-reported health assessment, applied to life expectancy.) Outcome 2: Reduced differences in life expectancy & healthy life expectancy

between communities Through greater improvements in more disadvantaged communities.

(Note: These two measures would work as a package covering both morbidity and mortality, addressing within-area differences and between area differences)

OUTCOMES

DOMAIN 2: Health

Improvement

Objective: People are helped

to live healthy lifestyles, make

healthy choices and reduce health inequalities


Across the life course




THE PUBLIC HEALTH OUTCOMES FRAMEWORK

DOMAIN 1: Improving the Wider

Determinants of Health

Objective:

Improvements against wider factors which

affect health and wellbeing and health

inequalities



THE PUBLIC HEALTH OUTCOMES FRAMEWORKThe Domains

Improving the Wider Determinants of Health

Objective

Improvements against wider factors which affect health and wellbeing and health inequalities

Indicators

•Children in poverty •School readiness (Placeholder)•Pupil absence•First time entrants to the youth justice system•16-18 year olds not in education, employment or training •People with mental illness or disability in settled accommodation•People in prison who have a mental illness or significant mental illness (Placeholder)•Employment for those with a long-term health condition including those with a learning difficulty/disability or mental illness•Sickness absence rate •Killed or seriously injured casualties on England’s roads•Domestic abuse•Re-offending•The percentage of the population affected by noise (Placeholder)•Statutory homelessness•Utilisation of green space for exercise/health reasons•Fuel poverty•Social contentedness (Placeholder)•Older people’s perception of community safety (Placeholder)

1


Health improvement2

ObjectivePeople are helped to live healthy lifestyles, make healthy choices and reduce health inequalitiesIndicators

•Low birth weight of term babies•Breastfeeding•Smoking status at time of delivery•Under 18 conceptions•Child development at 2-2.5 years (Placeholder)•Excess weight in 4-5 and 10-11 year olds•Hospital admissions caused by unintentional and deliberate injuries in under 18s•Emotional well-being of looked after children (Placeholder)•Smoking prevalence – 15 year olds •Hospital admissions as a result of self-harm•Diet (Placeholder)•Excess weight in adults•Proportion of physically active and inactive adults•Smoking prevalence – adult (over 18s)•Successful completion of drug treatment•People entering prison with substance dependent issues who are previously not known to community treatment•Recorded diabetes•Alcohol-related admissions to hospital •Cancer diagnosed at stage 1 and 2 (Placeholder)•Cancer screening coverage•Access to non-cancer screening programmes•Take up of the NHS Health Check Programme – by those eligible•Self-reported well-being•Falls and injuries in the over 65s

Key Themes

Promoting HealthAcute illnessLong term conditionDisabilityPalliative CareMental Health

Cross cutting Issues 1Integrating servicesGeneral PracticeSafeguardingLooked after childrenInequalityTransition to adult servicesChoice

Cross cutting Issues 2Information and dataTechnologyEducation & Workforce developmentClinical leadershipAligning NHS, PH and care outcomesLevers of funding – PbR / CQuiNs Networks – local / hub; specialised; national

‘No decision about me without me’

Life Course

Premature/ LBWEarly YearsSchool childTeenagerYoung Adult


To identify additional outcome indicators / measures

Themes- Promoting Health and Preventing illness- Acutely sick child- Long term conditions (including disability and palliative care)- Mental Health


Key issues to consider:

o Importance of the Outcome

o Deliverability

o Coverage – the range of children and young people’s health

services

Developing a Patient Centred PathwayPathway Stage

PREVENTION

HEALTH PROMOTION

PRESENTATION

ASSESSMENT /DIAGNOSIS – REFERRAL(S)

DISCUSSION ABOUT DIAGNOSIS AND MANAGEMENT OPTIONS

INTERVENTION(S)MANAGEMENT / TREATMENT

– IMMEDIATE /ACUTE

INTERVENTION(S)

MANAGEMENT / TREATMENT – LONG TERM CONDITION

END OF LIFE CARE

OFF TREAMENT - FOLLOW UP - DISCHARGE

PREVENTION

Developing a Patient Centred PathwayPatient Questions /Statements Pathway Stage

How do I stay healthy?

How do I stay out of hospital?

PREVENTION

HEALTH PROMOTION

I have a problem – can you help me?

How quickly?PRESENTATION

What is wrong with me?How quickly can I find out?Am I in the right place? Are you the best person for me to see?

ASSESSMENT /DIAGNOSIS – REFERRAL(S)

I need clear and accurate information, delivered with empathy. Can you help me decide what is best?

What choices do I have?


I want best treatment. How do I know I am getting it? How does it compare with elsewhere? What are the effects of treatment?


– IMMEDIATE /ACUTE

How do I know I am getting best treatment? How do I maintain normality? How can I prevent getting worse / returning to hospital? Might this include self-treatment?

How does it affect my daily living? What kind of choices do I have?

INTERVENTION(S)


END OF LIFE CARE

Do I need to watch out for anything?

Can I just come back if I have a problem again?Would I benefit from being reviewed?

OFF TREAMENT - FOLLOW UP - DISCHARGE

How do I stay healthy and out of hospital? PREVENTION

Developing a Patient Centred Outcomes ApproachPatient Questions /Statements Pathway Stage Outcome measures / Indicators


How do I stay out of hospital?

PREVENTION

HEALTH PROMOTION

Immunisation rates

I have a problem – can you help me?

How quickly?PRESENTATION Out of hours attendances at ED (A and E)

What is wrong with me?How quickly can I find out?Am I in the right place? Are you the best person for me to see?

ASSESSMENT /DIAGNOSIS – REFERRAL(S) Time 1st symptom to diagnosis

– Long term condition

I need clear and accurate information, delivered with empathy. Can you help me decide what is best?

What choices do I have?


Patient /parent reported experience

I want best treatment. How do I know I am getting it? How does it compare with elsewhere? What are the effects of treatment?


– IMMEDIATE /ACUTEHospital acquired infection rates

How do I know I am getting best treatment? How do I maintain normality? How can I prevent getting worse / returning to hospital? Might this include self-treatment?

How does it affect my daily living? What kind of choices do I have?

INTERVENTION(S)


END OF LIFE CARE

International comparator benchmarking eg survival

Do I need to watch out for anything?

Can I just come back if I have a problem again?Would I benefit from being reviewed?

OFF TREAMENT - FOLLOW UP - DISCHARGE Emergency admission rates

How do I stay healthy and out of hospital? PREVENTION

Long term complication rates

Developing a Patient Centred Outcomes Approach


I have a problem?

What is wrong with me?How quickly can I find out?Who is the best person to see?

Can you give me clear information, in a way that helps me decide what is best for me?

I want the best treatment?How do I know I’m getting it?

How do I maintain normality?Might this include treating myself?How might it affect my daily living?What kind of choices are there?

Do I need to keep watch on or do anything?

Would I benefit from being seen/assessed?

At each stage

1. What happens now?

2. What is needed?

3. Could it be better?

4. How might it be better? – describe it

5. What would it take?

6. What is the evidence for each of these questions/answers!!!

Outcomes – the Different Approaches

For this Strategy to deliver what we all want, need to recognise that different types of outcomes will emerge. Reassuring in that this is already reflected in the outputs so far

Envisage a mixture of:

o Stand alone outcomes e.g. Mortality; Reducing medication errors

o Grouped outcomes e.g. Pregnancy (independent outcomes but interdependency between them)

o Outcomes that will require a basket of measures to identify achievement eg. “compound outcomes” e.g. To reflect appropriately integrated care for children with complex needs.


Overarching themes and emerging issues – from all groups

These may form the basis of overarching outcome measures, which seek whole system input and commitment to deliver.

These include:o Measures of children, young people and parents being

empowered to make choices, through better information, building resilience and self-esteem

o Patient experience measures routinely including young people in all healthcare settings

o Measure of time from first presentation to NHS service to established diagnosis for a range of conditions

o Internationally comparable outcomes for a range of conditions eg mortality / HbA1c

o Safety outcomes of relevance to children and young people


PUBLIC HEALTH AND PREVENTION THEME PROPOSALS (17/4)

PREGNANCY TO 5 YEARS

1 – Ensuring babies have the best possible health at birth

2 – Providing babies and young children with good nutrition and ensuring they maintain a healthy weight as they grow and develop

3 – Supporting attachment between parents and their babies / young children

4 – Helping young children to develop and achieve to the best of their potential

5 – Reducing the number living with preventable ill health

5 TO 19 YEARS

6 – Helping C and YP to live healthy lifestyles

7 – Helping C and YP to be involved in decisions about their health and well being

8 – Helping to develop and achieve to the best of their potential

ALL AGES

9 – Reducing the impact of the causes of inequalities

10 – Protecting the health of C and YP

11 – Supporting C and YP to have good mental health and positive sense of well being

12 – Increasing prevention of admissions of babies, C and YP to A and E or hospital

13 – Preventing babies, C and YP from dying prematurely

LTC, DISABILITY, PALLIATIVE CARE THEME PROPOSALS (17/4)Outcome Description A: 1- 4 Generic Outcomes/Life Goals

1 Educational attainment and progress

2 Pupil absence

3 Quality of life of child, young person or their family

4 Emotional wellbeing

B: 5 -10 Process/Patient Experience

5

Time taken to diagnosis

6 Key worker – coordinator of care

7 Integrated care – a single plan

8

Knowledge and understanding to enable the child or young person to manage their condition

9

Provision of a service for each disease/disorder/condition over a lifetime

10

Transition, Independent living and autonomy

LTC, DISABILITY, PALLIATIVE CARE THEME PROPOSALS (17/4)

C: 11 - 25

Examples of specific diseases, disorders and conditions

11 Acquired brain injury

12 Cerebral Palsy

13 Feeding/swallowing problems

15 Diabetes

16 Asthma

18 Palliative care: Improving the quality of end of life experience

19 Palliative care: Improving symptom management

20 Supporting continence

21 Cancer

22 Atopic excema

24 Epilepsy

ACUTELY ILL CHILD THEME PROPOSALS (17/4)

GROUPED OUTCOMES:

1 – REDUCE RE-ADMISSIONS FOLLOWING CARE

2 – IMPROVE UNEXPECTED MORTALITY (Perinatal; infant; under 5s; TYA; condition specific)

3 - REDUCE MORBIDITY (Post –neonatal care)

4 – IMPROVE PATIENT SAFETY (Infection; drug errors; unrecognised deterioration)

5 – IMPROVE TRAUMA RELATED OUTCOMES

6 – REDUCE INAPPROPRIATE TRANSFERS, MOVEMENT, WHERE TREATMENT TAKES PLACE ( ED attendances in and out of hours; <24 hour hospital stays)

7 – PREM and PROMs (Pain scores; experience scores; timely access to services)

8 – IMPROVE TIME TO DIAGNOSIS (meningitis / septicaemia; SUFE)

CAMH and Behaviour THEME PROPOSALS (17/4)

OUTCOMES BASED ON MENTAL HEALTH STRATEGY OBJECTIVES:

1. More children and young people will have good mental health (linked to PH outcomes)

2. More children and young people with mental health problems / diagnoses will recover (depression / anxiety / behaviours / phobias / etc – linked to IAPT)

3. More children and young people with MH problems will have good physical health (physical problems / behaviours)

4. More Children and young people will have a positive experience of care and support

5. Fewer children and young people will suffer avoidable harm (adverse incidents; inappropriate environments)

6. Fewer children and young people will experience stigma and discrimination

THE NEW SYSTEM

NHS

NHS Commissioning

Board

Monitor (economic regulator)

Clinical Commissioning Group

Department of Health

CQC (quality)

Providers

Public Health

England

(Local health improvement

in LAs)

Local authorities (via health & wellbeing boards)

HealthWatch

Local HealthWatch

What are the key issues you would like addressed in the strategy?

What system levers could be used to achieve improved outcomes?

Which should be recommended?

What else would you like to say?


Meetings – influencing system contribution

• NHS Commissioning Board• Public Health England• Healthwatch• Monitor• Care Quality Commission• DH and DfE Ministers• MHRA• Health Education England• Royal Colleges – RCGP; RCPCH; RCN; RCPsych• NICEWe need to hear additional suggestions


Outputs

Not a doorstop!!

Recommended outcome measures and indicators to match NHS and PH Outcome Domains.

Recommendations to SoS

For

NHS; NCB; CCGs; PHE; HEE.


Forum update to SoS – Easter letter

We updated SoS before Easter on progress to date. We also raised specific issues requiring early consideration :

- Children’s training for GPs- National strategic networks for :

- children and young people’s specialist services- maternity and neonates

- Public Health England structure and need for a life-course approach


Opportunities to Feedback via DH Website

Engagement materials available on DH website (slidepack and downloadable feedback form) to support groups to run their own consultation and send back to

[email protected]

Online feedback made directly via

http://healthandcare.dh.gov.uk/outcomes-form/


mailto:[email protected]

What will be included in each domain




e.g. Composite indicator based on

Patient Reported Outcome Measures for a range of long-

term conditions




Children and Young Peoplee.g. Unplanned hospitalisation for

asthma, diabetes , epilepsy

Working Age adultse.g. ability to work

e.g. avoidable admissions

Older Peoplee.g. ability to live independently

e.g. avoidable admissions





What will be included in each domain

Improvement Areas Outcome Indicator



e.g. Emergency hospital admissions for acute conditions usually managed in

primary care;

and

e.g. Emergency bed days associated with

repeat acute

admissions




Planned caree.g. PROMs for elective surgery

Unplanned care – childrenEmergency admissions for LRTI

Unplanned care – older peopleOutcome Indicator

Unplanned care – adultsOutcome Indicator




Helping people to recover from episodes of ill health or following injury

Improvement Areas Outcome Indicator



e.g. Composite Patient Experience

Indicator




e.g. A&E, in-patient, out-patient e.g. patient survey

e.g. mental health services e.g. patient survey

e.g. children and young peoplee.g. patient/parent survey

e.g. maternity servicese.g. patient survey

e.g. end of life care e.g. bereaved relative survey





e.g. primary care servicese.g. patient survey




A suite of Quality Standards to

support delivery of improved outcomes

in this domain

Safe Treatmente.g. Never Events, VTE, Falls

Safe dischargee.g. Emergency Readmissions

Safety culturee.g. Openness about mistakes

Patient Environmente.g. minimising avoidable infections

Vulnerable Groupse.g. Maternity, Older People

Frames NHS Commissioning Board’s

broader focus



Treating and caring for people in a safe environment and protecting them from avoidable harm

e.g. Number of incidents

reported (rising);and

Severity of harm (decreasing);

andNumber of similar

incidents (decreasing)

Children Harm due to ‘failure to monitor’


Health Protection

Objective

The population’s health is protected from major incidents and other threats, whilst reducing health inequalitiesIndicators

• Air pollution•Chlamydia diagnoses (15-24 year olds)•Population vaccination coverage•People presenting with HIV at a late stage of infection•Treatment completion for TB•Public sector organisations with board approved sustainable development management plan•Comprehensive, agreed inter-agency plans for responding to public health incidents (Placeholder)

3


Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, whilst reducing the gap between communities.

Indicators

•Infant mortality •Tooth decay in children aged 5•Mortality from causes considered preventable•Mortality from all cardiovascular diseases (including heart disease and stroke)•Mortality from cancer•Mortality from liver disease•Mortality from respiratory diseases•Mortality from communicable diseases (Placeholder)•Excess under 75 mortality in adults with serious mental illness (Placeholder)•Suicide•Emergency readmissions within 30 days of discharge from hospital (Placeholder)•Preventable sight loss•Health-related quality of life for older people (Placeholder)•Hip fractures in over 65s•Excess winter deaths•Dementia and its impacts (Placeholder)

4

26 march 2012 liverpool

Documents

key outcomes

injuryensuring people

conditionshelping people

patientspreventing people

nhs iswhat

health system

young peoplee

delivery of improved