Cheshire and Merseyside “Healthy Care Matters” Network Presentation to the BACCH Mersey Regional Education Day 30th. June 2010 by Jonathan Smith
Background Former: • Director of Social Services • Strategic Director (local government) • PCT CEO Since February 2005: • Founder, and leader, of the Child Health Development Programme [CHDP] • Based in Cheshire and Merseyside, but doing local, sub-regional, regional, and national work • Specialist children’s service improvement agency • Currently within the NHS: planning to become a Community Interest Company, limited by shares, and operating as a social enterprise
Business Plan Objectives:Health of LAC • To support, and sustain, a Cheshire and Merseyside “Healthy Care Matters” Network, which: ~ attracts the active engagement of LAC Nurses, Children’s Services and Designated (LAC) Doctors/Medical Advisers, from each Children’s Trust area ~ oversees a number of work-streams, which show evidence of helping to improve the health service offered to LAC
How the Network Developed • A recommendation from the Liverpool LSCB, following an SCR • Its focus was: how to guarantee that, when a child in care moves to a placement across a Health administrative boundary, the continuity and quality of their health services remains uncompromised • We engaged LAC nurses, local authority team managers, and risk managers • This project-based ‘coalition’ was morphed into a C&M Network • Leadership: myself and two LAC nurses (2 days per month, each) • Focus: a C&M protocol to solve this problem • Communications: keeping DCSs and PCT CEOs informed
The Network Today • Meets quarterly • Involves: ~ LAC nurses ~ Children’s Services Team Managers ~ Designated Doctors/Medical Advisers • Oversees two major work-streams
Work-Stream 1 LAC Moving Across Boundaries We have produced: • Standards • Protocol • 48-hour process flow-chart • Notification form • Private providers’ protocol • Data collation matrix • Root Cause Analysis form (where things go wrong)
Work-Stream 1 LAC Moving Across Boundaries We have instituted the following change management process: • Review of local arrangements at each meeting • Discussion of any examples of serious failings in the previous quarter, at each meeting • At least annual overview of the performance data from across the sub-region • In September, preceded by individual performance review sessions with the leadership team
Work-Stream 1 LAC Moving Across Boundaries We have the following ‘wicked’ issues: • No success in forging a sub-regional agreement between CAMHS commissioners • A wide variation in the capacity of LAC nurse and admin. teams • Organisational and personnel changes • This is not one of the big priorities for either Health or Local Government • A long history of failure to consistently and systematically improve standards • This is not a commissioned/funded piece of work
Work-Stream 2 Multi-Site Audit [funded by a grant from HQIP for 3 years] “Medical Services for Children in Care and Adopted Children in Cheshire and Merseyside”: • To find out the current compliance of these services with recognised standards, and to repeat the audit on a regular basis, so that progress towards compliance can be monitored. • To be one of three distinct, but connected work-streams. The others will be: ~ Qualitative Research, and ~ Listening to the Voices of Young People and Adopters • To drive the standardisation of documentation across Cheshire and Merseyside.
Work-Stream 2 Multi-Site Audit In relation to the Audit itself, we have: • Designed an Audit Tool for Initial Health Assessments • Piloted the Tool • Progressed through 60% of the base-line assessment process (using 10% of the IHAs from 2009) • Designed a questionnaire for each LAC nurse, and received responses back from the majority In relation to the Qualitative Research, we are: • Seeking to identify where we could access the capacity to undertake this In relation to “Listening to the Voices of Young People in Care”, we: • Have produced, and disseminated, a proposal for a Reference Group • Are seeking £1,050 from each Corporate Parenting Forum
Work-Stream 2 Multi-Site Audit We plan to: • Report the findings from our work, so far, to a meeting on 14.7. • Design, and pilot, an Adoption Audit Tool • Recommend future standards and CQI process • Review our audit tools against up-to-date guidance and examples of best practice • Prepare for the start of the on-going initial health assessments and adoption audits from 1.9. • Brief DCSs and PCT CEOs • Brief doctors involved in the clinical work in relation to both • Report progress, or otherwise, over the two years, to the Healthy Care Matters Network • Support improvement strategies
Looking Ahead • We are planning a C&M conference in November, to look at the full implications of the recently-published national guidance on the Health of Looked After Children. • We need to look to the cross-boundary arrangements with our neighbours: Wales, West Midlands, Manchester and Lancashire.