Welcome to the Digital Child Health
- 1. Welcome to the Digital Child Health Launch Events Hosted by: Claire Walker - North James Bolt – South Pam Hall – Mids and East
- 2. • Share work to date on the publication of ‘Healthy Children’ • Give an overview of the vision of Healthy Children • Share scope and approach of the Digital Child Health Transformation programme and its ambitions • Explore the opportunities and challenges for new service models in response to the vision • Agree next steps Objectives
- 3. Timings Agenda 13:00 - 13.10 Welcome to the Digital Child Health Launch Event – House Keeping and Introductions 13.10 - 13:20 Healthy Children: Transforming Child Health Information an Overview 13:20 - 13:40 The Clinical Perspective – “what this means for parents, young people and professionals” 13:40 – 14:00 Q&A Session 14:00-14:45 Breakout Sessions – Redesigning our Services 14.45 – 15:00 Coffee Break and Networking Opportunities (make use of flip charts to record comments etc?) 15:00 -15:30 Digital Child Health Transformation Programme Introduction 15-30 -15-45 Q&A Session 15:45-1600 Wrap up & Next steps
- 4. Healthy Children: Transforming Child Health Information an overview Jo Gander Senior Programme Lead Digital Child Health NHS England
- 5. Why focus on children’s health and information? Public Health England and the NHS Outcomes Framework 2015/16 stress that a focus on children’s health is essential and that we should be striving to provide the best start in life possible for our children. The recent National Maternity Review has highlighted that this begins not just with the newborn child but with the mother’s experiences in pregnancy and the birth itself. The importance of ensuring this good start for the future health of children for the sustainability of the NHS and the economic prosperity of Britain is one of the key themes of the Five Year Forward View. We need to redesign information services to support the new emphasis on: • the importance of early interventions and preventive measures • integration across different care settings, particularly joining up maternity and newborn care • the need to enfranchise children, young people and parents as equal partners in their care. We also need to take on the challenges posed by the current organisation of information services.
- 6. CHIS Evolution Section 7A (NHSE) Commissioned by PCT 2011 - 2013 2013 - 2015 2015 - 2016 Delivered by: New Providers LSP ? LA Delivered by: Provider Trusts LSP CSU Section 7A (NHSE) LA Delivered by: Provider Trusts AQP £ ?
- 7. "Our ambition is to know where every child is and how healthy they are and which give appropriate access to information for all involved in the care of children” “The importance of ensuring this good start for the future health of children for the sustainability of the NHS and the economic prosperity of Britain is one of the key themes of the Five Year Forward View” ‘Healthy Children’ sets out the case for restructuring our information services and systems for children, young people, parents and families so they can contribute fully to improving their health and wellbeing and collaborate easily with professionals across the spectrum of care.” "Information is not enough by itself. There have to be personalised transactions, leading self-management “There is a clear pathway to improvement “ Tailor the health system to meet the needs of children and young people, their parents and carers Health and Social Care 2015 Children and Family Act 2012 Key Policy Drivers
- 8. Collaboration for the development of ‘Healthy Children: Transforming Child Health Information’ Professional Bodies Royal Colleges - Paediatricians and Child Health - Nursing - Midwives - Psychiatrists BMA Association of British Paediatrician Nurses Directors of Children’s Social Services National Childbirth Trust National Children’s Bureau Children’s Commissioner Association of Directors of Public Health Socitm System Suppliers & Commissioners Parents & Young People Group Association for Young People’s Health Young Minds National Council for Voluntary Youth Services National Organisations NHS England PHE NHS Digital DH NIB LGA Tech UK Providers Across London Blackpool Teaching Hospitals NHS Foundation Trust Great Ormond Street
- 9. Healthy Child Programme 0-5 5-19 Health Visiting School Nursing Hearing, NIPE, Bloodspot Immunisations 0-19 Health Record CHRD Staff CHIS System Personal Child Health Record CHIS Services
- 10. Current Challenges Personal Child Health Record still paper based services still very paper driven and manually intensive Up to 20% of children unregistered with GPs: very limited information and service access Services still very paper driven and manually intensive Closure of LSP programmes left funding and expertise gap for CHIS IT Population inaccuracies and tracking of children has worsened since the NIT report Healthcare professionals don't have access to core child health information. Changing commissioning and provider landscape in light of the policy drivers
- 11. Healthy Children – where do we start? With the basic building blocks: A first layer of essential child health information for exchange A first phase of systems exchanging that information - Maternity, Child Health GP systems and Personal Child Health Records A roadmap for growing the scope of the information exchange Adding in new services as they become available, for example, national Failsafe for Healthy Child Programme
- 12. 0d 5d 8d 11d 7w 9w 12m 13m 24m 40m 4y 5y NIPE Bloodspot Hearing NewBaby Review 6-8WeekExam 8/12/16wkImms 12mthReview 12/13mthImms 2/2.5yrInteg Review 3yr4mthImms 4-5yreyesight check SchoolEntryChk Year6Check Year8HPV Booster Imms Public Health England PersonalHealthProfessionalHealth Public Health Commissioners Directors of Public Health & Children’s Services Delivery of Healthy Child Programme (All Children) Delivery of all other care services (Some Children) CHIS / CHRD CHIS / CHRD CHIS / CHRD CHIS / CHRD CHIS / CHRD CHIS / CHRD School NursingPrimary CareHealth VisitingMidwifery Education ServicesVoluntary Services Mental Health Services Emergency & Acute Services Justice ServicesSocial Services Community Services Neonatal Services Maternity Information Systems Screening Information Systems Primary Care Systems GPESCYP Dataset CAMHs Dataset PCHR 90 CHRDs Research & Policy Maternity Dataset SCR National Audit
- 13. Enabling essential information exchange How do we decide what is essential as the core record of a child’s health and development available to professionals and to parents to assist in diagnosis and treatment ? We use what is already agreed as being essential to the foundation of a child’s health: • By the Royal College of Paediatrics and Child Health – the Personal Child Health Record (PCHR) owned by parents • By Department of Health – the Healthy Child Programme • By commissioners – the Maternity and Children and Young People’s Datasets This is only the first layer of interoperability, additional data will be designed and endorsed through a national design authority
- 14. 33 events in first interop layer 14 Maternity Screening Health Visiting Primary Care School Nursing Personal Other E1 Birth Details E2 NIPE E3 Blood Spot E4 Hearing E5 New Baby Review E6 Imms E7 6-8 Wk Review E8 6-8 Wk Review E9 Height & Weight E9 Height & Weight E9 Height & Weight E9 Height & Weight E9 Height & Weight E10 Vitamin K E11 1 Year Review E12 Conditions E13 Special Needs E14 Allergies and Drug Reactions E12 Conditions E14 Allergies and Drug Reactions E14 Allergies and Drug Reactions E15 Accidents & Injuries E15 Accidents & Injuries E17 Family Conditions E18 2/2.5 Yr Integ Review E16 Family Relationsh ips E18 2/2.5 Yr Integ Review E19 School Entry Check E20 Profession al Advice E20 Profession al Advice E20 Profession al Advice E20 Profession al Comment E22/33 Hep B/ BCG Indicated E23 Responsible Professionals E23 Responsible Professionals E23 Responsible Professionals E23 Responsible Professionals E24 Address Add or Change E24 Address Add or Change E24 Address Add or Change E25 Interpreter Required E25 Interpreter Required E6 Imms E26 Rest of NIPE E27 Breast Feeding Status E28 Developm ental Firsts E29 Teeth E30 Parental Comment E31 Personal Comment E33 ‘About Me’ Event recorded once Multiple Events across Systems
- 15. www.england.nhs.uk How – by introducing digital basics Access to key child health data at the point of care Interoperability to allow data sharing between health and care professionals Patient empowerment through the use of personal health records
- 17. www.england.nhs.uk Digital Child Health–Service Transformation The Vision “As a parent and carer I am informed and can make choices that best meet my child’s health and care needs.” I have access to information that enables me to make the best health and care choices for my child • Online record of their child’s health and development. • Can share my own health and wellbeing information with professionals. • Can set their own preferences for information sharing and can see who subscribes to their information. • Can access online peer support networks or health promotion support more easily “As a HCP I can provide the best care options to children and young people as information is real time and available at the point of care ” I have access to real time information at the point of care that helps me to provide a better care experience for children and their families • Core view of child health information at the point of care. • Record information about a child/young person and publish automatically to those in the extended network of care. • Up to date health events will be available in their own health record systems, they will not need to access other systems. • Failsafe management service will alert preventative programmes of care when an intervention is due or has been missed. “As a commissioner I can access he right information to understand the health and care needs of children and young people” I know that children under my care have received the appropriate health interventions to keep them healthy • Failsafe management services will give assurance for safeguarding children. • Commissioners can analyse data and intelligence to make service improvements and modifications “As a provider I have access to IT systems of Choice that meet national data and technical standards” I can provide an information service that underpins the needs of health and care services • Can offer digital services to parents, children and young people which allow them to take ownership of their own care • Have a choice of IT systems that will enable information exchange across extended network of care.
- 18. Dr David Low NHS Digital Digital Child Health A Clinical Perspective
- 21. The early years of a child’s life have a lasting impact. What happens in the home and how parents interact with their children is crucial to their development.
- 22. • More robust clinical decision making • Avoids duplication • Better Safeguarding • Reduces risk for ‘Borderline cases’
- 23. Digital aspect - when Commissioning
- 24. Direct interoperability into native Clinical Systems Clinical Digital Environment Portals – multiple logins – lack of confidence I have access to real time information at the point of care that helps me to provide a better care experience for children and their families
- 25. Working and thinking in silos creates access issues a
- 26. Examples - Immunisations/ Medications ProfessionalHealth CHIS / CHRD CHIS / CHRD CHIS / CHRD CHIS / CHRD CHIS / CHRD CHIS / CHRD School NursingPrimary CareHealth VisitingMidwifery Education ServicesVoluntary Services Mental Health Services Emergency & Acute Services Justice ServicesSocial Services Community Services Neonatal Services Maternity Information Systems Screening Information Systems Primary Care Systems SCR Delivery of Healthy Child Programme (All Children) Delivery of all other care services (Some Children)
- 27. Standards for Clinical Safety in IT Systems SCCI 0160 In use of the system by the Health or Care Organisation SCCI 0129 In the system development and modification by the manufacturer https://digital.nhs.uk/clinical-safety
- 29. Reflections on Strategy and Clinical Perspective (10 minutes) ‘Knowing where every child is and how healthy they are’ ‘Appropriate access to information for all involved in the care of children’ What are the opportunities and challenges in delivering the vision?
- 30. Breakout Session – Redesigning our Services You are asked to describe the key considerations if Child Health Information Services (CHIS Services) were to be reconfigured: What are the key considerations when redesigning children's information services /other health and care services. (Each table has different scenario) • Local Authority • Clinical Commissioning Group • Child Health Record Department • STP / Regional Planning • NHS England (S7a) • General Practice
- 31. Break out session Reflections on Strategy and Clinical (10 minutes) Scenario exercise (10 minutes) Group feedback to the room from each table ( 10 minutes ) Discussion on all perspectives (10 minutes )
- 32. www.england.nhs.uk Digital Child Health Transformation Programme Jo Gander Senior Programme Lead
- 33. www.england.nhs.uk 33 Integrated Digital Care Records across health and care Technical adoption Business intelligence Purchasing FrameworksIT Systems of choice Service spec Market Development Commercial arrangements Business Intelligence Datasets Interface Commissioning and Operating Model Core service & contracts Data Sharing e-Consent model Configure national infrastructure to meet technical and data standards enabling local commissioning insight Develop a vibrant, competitive marketplace with choice of suppliers Develop commissioning model that promotes proactive health and care commissioning Collaborate with local service models to make Information accessible at the point of care e-Personal Child Health Record Standards Develop digital tools to provide choice for parents on access to record and support services Develop a trusted consent model for patients and professionals Accreditation Levers & Incentives Develop a commercial model to support procurement of local IT systems of choice Architectural Blueprint Standards National Service Design Interop. National Failsafe Management Service Evalu. Benefits Redesign Fail-safe management services Test / Discovery Preventative programmes to monitor the uptake of the Child Health Development Programme Service Blueprint Achieving transformation
- 34. Central data sharing hub
- 35. www.england.nhs.uk Test Assumptions Trial New Methods Deploy New Services March 2017 1st layer of child health information Q: Can events be standardized for exchange rapidly? Trial 1st layer information in eRedbook (London) Yes Content Agreed Yes Collaboration on standardization Q: Can this standard be widely supported? Events Catalogue for child health information created Q: Can systems be modified for interop Yes Deploy new PCHRs with standard content in other regions June 2017 Systems development Yes Q: Trial a success? National events management service ready to go-live Interoperability between CHIS, Maternity, GP systems and PCHRS Dec 2017
- 36. • We would like feedback from this event please do complete the feedback forms • Contact us to register your interest email [email protected] stating which communities of interests you want to be involved in or have an enquiry How do we keep in touch @tracey_grainger https://www.england.nhs.uk/digitaltechnology/info-revolution/digital- primary-care/child-health/
- 37. Next steps
- 38. www.england.nhs.uk National Engagement Partners – high level Professional Bodies Commissioners (LGA/ NHSE /CCGs) Transformation Initiatives (STP. LDR, NMC) Partner Organisations – NHS Digital, PHE, CCGs, LA, Existing CHIS System Suppliers (LPF/SBS) Potential new suppliers Service Providers Children & Young People Governance Boards Department of Health Workforce Ministers Maternity Providers Parent and Carer Groups
- 39. Levels of involvement • Doers - services who are willing to get their hands dirty trying out different ways of sharing data. • Thinkers – services who are willing to publically offer views, advice or critiques. • Watchers – services who just want to follow progress. Everyone to consider at a local level Child Health Information, from an operational and commissioning perspective
- 40. Progressing options for regional and locality based responses to enable a transformational use of child health information A review of the configuration S7a CHIS Services in response to the transformation changes, led by NHS England Building of the technical building block of the new national infrastructure, including proofs of concept, led by NHS Digital Progress of regional pilots and trials different child health commissioning approach and technology A wide ambition, so what will you see first?
- 41. Service redesign workshops to agree potential new service models for Child Health Information (end Feb for 6 months) 1st part is for CHRDs to complete situational questionnaire to help understand the current local landscape (January – please support) Additional focussed events for different stakeholder communities e.g. • technical forums (led by NHS Digital) • Commissioning • Clinical Next steps
Editor's Notes
- #9: 827 downloads since publication
- #12: In one sense the solution is very simple, we put in basic modern digital capabilities that are available in other industries
- #13: Introducing digital basics across the eco-system, starting with the Healthy Child Programme. So it is not the technology that is complex, nor is it necessarily the content of clinical records, rather it’s the environment which is complex. Children’s health information is in all systems in episodic format, children receive even the basic programme of care from different professionals who use different systems which do not talk to each other. Because of environmental complexity – the number of professionals involved, the number of systems being used and the quantity of information to be standardized to enable exchange – this will be a 5 year programme of work.
- #14: In one sense the solution is very simple, we put in basic modern digital capabilities that are available in other industries
- #20: The direction of travel….
- #21: NHS and Social care providing good standards of care with the resources available. However - Huge potential in NHS and Social Care to improve… We are failing the children of this nation – by not providing enough support for them to reach their potential. Through Digital – we can support NHS and Social care to provide that level of support required.
- #23: Trafford Manchester Staffordshire Hampshire More robust decision making among professionals - based on sufficient, accurate and timely intelligence Working together avoids duplication of process across agencies. Greater efficiencies in process can mean re-allocation of resources to other areas Better Information sharing across partners – enables better safeguarding of the children and young people involved as concerns which initially appear to be of a low level when seen in isolation, are sometimes recognised as part of a long standing pattern of abuse and neglect which needs a response when information is pooled together Reduces the risk of ‘borderline cases’ slipping through the net without any action being taken
- #24: Emphasis - importance of Digital being incorporated into all procurements and commissioning. NOT just about commissioning to manage todays requirements but to incorporate and support planned digital innovations during the contract cycle. Please consider Clinical safety compliance for all ISN’s Need for interoperability Meet national professional standards Useability
- #25: Please stand up If you are a parent If you have any interaction with the NHS or social care And sit back down if you have ever had to repeat any information to staff?
- #27: The only way we have been managing to get info around the system to date is using a paper based parent held record – the redbook… To demonstrate the benefits and different touch points for sharing of immunisation information and medication information… emphasis on direct semantic interoperability
- #28: All Health IT systems MUST be compliant with NHS Safety Standards SCCI 0129 and 0160 ACCEPTABLY SAFE - Health and Care IT systems must be safe in accordance with organisational risk apatite Both establish requirements for systematic approach to clinical risk management Supported by NHS Digital - implementation guidance and other supporting guidance docs Mandated by NHS England