Integrated child health: time to move centre-stage

‘You can’t stay in your corner of the forest waiting for others to come to you. You have to go to them sometimes.’  A.A. Milne

A colleague reflected that one could spend a lifetime going from conference to seminar around child health, and it is easy to see how that would change relatively little.  There was something a little different this week at Effective Patient Centred Integrated Care for CYP and their families – three key themes, facilitated by the fantastic group of speakers*, helped to create a great sense of shared purpose:

1. the ambition and collaboration in the room (and outside it too: #childpatientcare), with a vision and energy to grow connections and keep the conversations going

2. the determination to focus on outcomes that really matter to children and young people

3. a feeling that we are starting to understand how we meaningfully put the voice of children & young people at the heart of everything we do.

Outcomes for children and young people in the UK are nowhere near as good as they should be, but there is a strong desire to move onto solutions. There is also a cogent economic argument that we should be investing in children. The message was clear – the deep involvement of children, young people, their families and carers is critical to the future of the NHS. The work to develop new care models, to design sustainability and transformation plans (STPs) and to plan Accountable Care Organisations and Partnerships (ACOs and ACPs) needs to have children and young people at their heart, and we all have a role in making sure that happens.

So how do we get there? When we think about levers for change it is easy to jump straight to policies, payment mechanisms and incentives, but five very different approaches stood out in our discussions:

1. We must think beyond fixed models of care to defining and adopting a loose set of integrating activities. Networking, coordination, cooperation and collaboration are four types of ‘friendly’ behaviours that will help us to achieve this.

2. We must take a whole population approach. We need to change the way we design services to a more preventative, proactive, needs-based way of working. Segmentation models such as the one described here are key to making this a reality, and will help us to coordinate a focus on inequalities, mental health and the social determinates of health.

3. There is potential to ask children and young people ‘what matters to you?’ and then link this to understanding how far their experience of care matched this. This helps us think about how we focus health and care services on outcomes that are important to children and young people. It is clear that we need to move beyond the idea of selected process measures to a diverse richness of personalised outcome measures.

4. We should build on the strength of well established multi-disciplinary working in paediatrics and child health. This means developing collective leadership that crosses organisational and inter-agency boundaries.

5. The single biggest lever we have to transform the health and care system is our connections and relationships. Everything we do should be focused on growing, developing and nurturing these. We need to better understand each other’s realities and perspectives. Conversations are key and we need to work to understand and utilise the amazing potential of the social capital that sits within our networks and communities. Our future workforce needs the right training and support to be able to achieve this.

Sir Ian Kennedy’s Getting it Right for Children and Young People (2010) is now six years old, but still as relevant as ever, and well worth a re-read – not to lament how little has changed since then, but to recognise the opportunities we all have to work together to making things better for children and young people.

“Finally, at the centre of any system for providing services are the professionals. The challenge for them is to re-engage with the system so as to change it for the better. It cannot change without them. The prize at stake is the chance to be the professionals they want to be. The greater prize is services for children and young people that they and the NHS can be rightly proud of.”

It is time to leave our corner of the forest and move to where the others are.

* these reflections with thanks to all of the speakers who facilitated such rich discussions:

Jackie Cornish, Carol Ewing, Sahra and Habon from @RCPCH_and_Us Network, Emma Sparrow @Emma_rcpch, Kath Evans @KathEvans2, Mitch Blair @blair_mitch, David Taylor-Robinson, Russell Viner, Rosalind Smyth, Andrew Long @amlong12, Steve Cropper, Hilary Cass @Hilary_Cass, Rupert Dunbar-Rees @rupsdr, Amanda Allard @amanda_allard, Dan Lumsden, Damian Roland @Damian_Roland, Mando Watson @mandowatson