Developing a community child health service for the 21st century

Section 15: Recommendations

The report has been presented to the Children and Young People's Health Support Group. Next steps will be decided by the Scottish Government.

Recommendations

1. Model of care

1.1 All services adopt a combined (co-managed acute and community services) model whether in a directly managed unit or a CH(C)P or other configuration. CCH services should renew their focus on the care of vulnerable children in the context of Equally Well and other Scottish Government policies.

1.2 Services to review CCH co-working with CAMHS and ensure management arrangements facilitate delivery of best practice for children and young people with emotional and behavioural disorders.

2. Infrastructure

2.1 Review IM and T systems in use across combined paediatric services to:

2.1.1 Ensure all paediatricians in that system can access patient information readily both in CCH and the acute sector

2.1.2 Phase out paper systems eg for call/recall

2.1.3 Enable electronic access to clinical investigative facilities and access to online results for all CCH paediatricians

2.1.4 Ensure a standardised method of monitoring children and young people with disability such as the National Support Needs System

2.2 Make available online to all practitioners appropriate clinical guidelines and pathways for common childhood presentations including shared pathways for "overlap" conditions with CAMHS.

3. Standards, performance and outcome measures

3.1 By applying the priorities of the Healthcare Quality Strategy for NHSScotland (May 2010) to CCH services, ensure children, young people and their families receive the best care possible.

3.2 As part of the implementation plan, the specification for CCH services should be consulted upon and adopted as the benchmark for CCH services across Scotland with a related set of required outcome and performance measures for CCH including:

3.2.1 Adopting the 18 week RTT should be in place for all CCH clinics

3.2.2 Auditing CCH outpatient clinic facilities in relation to the BACCH standards ( Annexe 12) and make improvements if necessary

3.2.3 Monitoring and reporting of DNAs in CCH clinics with measures in place to minimize DNAs especially for hard to reach families

3.2.4 Introduction of measures of parent/child/carer satisfaction as a routine.

4. Workforce

4.1 SGHD/ RCPCH/ NHS Education Scotland and NHS Boards to undertake paediatric workforce modelling and a requirements analysis to enable delivery of the appropriate model of CCH across Scotland as part of a combined service and including consideration of regional MCNs for tertiary level CCH problems.

4.2 Address the predicted likely shortfall of CCH trained doctors by innovative workforce redesign including enhanced skills for nurses and allied health professionals in the care of vulnerable children, children with complex conditions and children with disabilities.

5. Training

5.1 RCPCH to consider adopting a 'generic' model of paediatrician with competencies across traditional community and acute general paediatrics, whilst retaining the required number of trained paediatricians with specialist competencies such as paediatric neurodisability according to population needs.

5.2 RCPCH to review CCH competencies required for paediatricians aiming for CCT in general paediatrics.