Developing a community child health service for the 21st century

Section 1: Introduction

In 2009 the expert Ministerial advisory group, the Children and Young People's Health Support Group, commissioned a project to look at the provision of Community Child Health ( CCH) services in Scotland to ensure such services are sustainable and fit for purpose. The emphasis of the project has been on the role of paediatricians working in the community and the teams they are associated with in delivering care to Scotland's children and young people. Co-dependencies with other agencies and professions including nurses and AHPs have been examined, together with infrastructure and workforce issues.

Dr Zoë Dunhill, a recently retired paediatrician and former Clinical Director of the Royal Hospital for Sick Children and its associated services, was appointed as the project consultant in March 2010.

Terms of reference

The following questions were posed at the beginning of the project:

• How is the service being delivered at present?
• What models are successful?
• What should a Community Child Health Service be offering in Scotland according to the evidence?
• How does this fit with overall SG/ COSLA policies?
• How would the quality of the service be measured? By what outcomes?
• What workforce do we need to deliver this model of care?
• What are the implications for training and recruitment of the workforce?
• What changes do we need to make to ensure the service is responsive and sustainable?

Project deliverables

The following were listed at the outset:

a. Engagement of stakeholders

b. A questionnaire to establish the status quo of CCH services for all Health Boards in Scotland

c. A questionnaire for all paediatric trainees in Scotland

d. A report for the Children and Young People's Health Support Group summarising the results of the above and recommending a way forward.

Methodology

A variety of stakeholders and colleagues were consulted during the course of the project. A literature search was conducted using search terms: community child health; community paediatrics; paediatric models of care and related topics. Publications by RCPCH (especially census material), GMC, BACCH, Scottish Government, Department of Health England and ISD Scotland were consulted amongst many others. Relevant professional meetings and conferences were attended. Information was obtained from NES Deaneries and the Scottish Government Workforce Division about doctors in training.

Two questionnaires were designed and circulated using electronic methodology - one to all 14 health boards in Scotland and the other to paediatric trainees in Scotland. RCPCH and SACCH also devised a questionnaire for paediatricians undertaking CCH work across Scotland.

The questionnaire results were subject to further analysis using Excel.

A revised draft specification for CCH services was drawn up with the help of an informal consultation group of paediatricians, building on work by Dr Fawzia Rahman and published on the BACCH website ¹⁰ . A revised workforce scheme was also developed from an original document also published by BACCH in 1999. This scheme was tested on some indicator Scottish populations.

Sponsors and stakeholders

The project was sponsored by the Child and Maternal Health Division of the Scottish Government Health Directorate under the aegis of the Children and Young People's Health Support Group, Chaired by Malcolm Wright.

A Steering Group ¹¹ was convened in early 2010 and Chaired by Dr Jim Beattie, RCPCH College Officer for Scotland (to January 2011) and Clinical Director at RHSC Yorkhill. The group met on 4 occasions during 2010 to approve the terms of reference for the project and oversee progress.

Dr Helen Gibson of the Scottish Association for Community Child Health ( SACCH) acted as liaison with that organisation and undertook a survey of paediatricians in Scotland regarding community child health work which she shared with the Steering Group ¹² .

Links were made with academic community paediatricians in Scotland and England; AHPs working with children across Scotland and Child Health Commissioners. Visits were made to the three regional planning child health groups across Scotland to appraise them of the project and hear their comments.

There was also close liaison with the NHS Education Scotland ( NES) Obstetrics and Gynaecology and Paediatrics Speciality Training Committee.

The Lead GP for Paediatrics, Dr Chris Boardman of the RCGP, was contacted. Through him there was sight of the RCGP's Child Health Strategy (2010).

Dr Kathy Leighton, Royal College of Psychiatrists CAMHS Lead for Scotland, was invited to join the steering group.

Dr Sue Bloomfield, Director of the School of Community Paediatrics in Edinburgh, gave a presentation on the new GP Paediatric scholarship scheme.

Contact was also made with the Chairs of the RCPCH College Specialty Advisory Committees in Community Child Health and Neurodisability, Martin McColgan, the College Workforce Officer and Dr David Shortland, RCPCH Vice President for Health Services.

Contact was made with Clinical Directors in Nottingham and Derby as well as with many colleagues in the Community Child Health Service across Scotland too numerous to be named. Relevant colleagues within Scottish Government departments were also involved.