Summary notes from the RHG meeting held at the Health Foundation. For information on the RHG go to https://runninghorsegroup.com

1. Running Horse Group meeting
The Health Foundation
Friday 25th May 2018

2. Meeting Overview
• Mapping the problems faced in Children Health
• Sharing current members’ projects & their
learning
• Thinking about the future and potential to
become a special interest group within the
Health Foundation’s Q network

3. Social
determinants
Patient
involvement
Data
Ethics
Sharing
information
Use of
technology
Finance &
funding
Political
voice of
childrenStaffing
&
morale
Models
of care
Prevention
Quality
Improvement
Innovation
What did attendees think
were the core problems?

4. Healthier
Together
project
(Sanjay)
• Broader approaches to school
measures (eg. School
attendance)
• Other issues in lives of families
that are more pressing eg
deportation, money issues and
employment
Child Health
Festival (Guddi/
Camilla)
• Getting trainees to attend
• Other organizations are not
willing to share/disseminate
knowledge
• Whole Family wellness
• Prevention work – obesity and
allergy
Core Issues Suggested Projects

5. Hospital
services
review
(Nicola Jay)
• Peer networks like this to
generate ideas, learn
from innovators and
elsewhere in the UK
MEDS
IQ
• Seeing what has
worked well as
sharing the
knowledge
Other
• Lack of evaluation of
QI projects affects
sustainability of long-
term funding
• Satisfaction with mediocrity
• How to change culture
• Understanding and measuring
of QI
• Not modernising as fast as the
rest of society eg social,
medical and new ways of
communicating
• Need for innovation – we’re
doing things because we have
always done them that way
Innovation
Core Issues Suggested Projects

6. RCPCH
and US
• Passion of the And Us
team at RCPCH and the
CYP engagement
committee as great
example
YYA
programme
• Persuading people to be
brave enough to embrace
a new way of working
Community
Organising
(Imperial
Citizens UK )
Bob K
Meaningfully
involve children
& young people
in service design
& strategic
priority setting
• No focal point for child health
• Enabling patients and public
to have control and do more
• Voice of the baby – group
need to embrace the 0 of the
0-12yrs too
• Lack of asking what people
want/need for their health
“co-production” is superficial
or absent
• Lack of clarity about what
the “ask” is from CYP
when involving them
• PPI (patient and public involvement)
groups through college or hospital
• Perception of others that
informal/age-appropriate format
means content generated less
serious or important
Core Issues Suggested Projects

7. Child health
Promise
• Data regulation – building
barriers to those outside health
to contribute
Other
• Parental rights versus children
rights
• Long term ventilation
• Consistent messages and
values of the profession
Ethics
Core Issues Suggested Projects

8. PIER
network –
Kate Pryde/
Southampto
n
Child Health
Promise
(Camilla/
Guddi/ RSM)
Working
together
programme
South
Yorkshire
(Nicola Jay)
Healthier
Together
programme
(Sanjay)
• Tension between people and systems
• Sharing GP/other hospital data/social
care data/community/CAMHS data
• Repetition of
evidence/writing/information/access
areas/multiple Drs and lack of
awareness of what else out there or
been done before/not aware of who
is going or has done what
• Understanding data pathways,
systems and networks
Sharing
information
• Consistency/sharing
information – education
programme/Spanning
HVs/ED/midwives/A&E/
GPs
• Creating/joining
effective network -
need face to face
and online
interaction
• Creating strong
relationship -
dancing together!
• Breaking down silos
and building buy-in
without resources
Core Issues Suggested Projects

9. Perinatal and
paediatric
future
technologies
hub for London
(David Cox)
Role of
telemedicine in
NHS 111 project –
Hampshire STP
and Healthier
Together project
Drug
Calculator
Apps (Meds
IQ)
• Capital expenditure limits blocking
investment in tech
• Working in new ways across boundaries
population health integration and digital
health
• Outdated hardware and software hampering
staff
• Transforming care through technology
• Difficulty for vulnerable groups to access and
use technology
• Governance issues blocking tech innovation
Core Issues Suggested Projects

10. Broaden the
Frame of
sustainability
Health
Economics
training for
doctors
Engaging
with
managers
• Cost and narrative –
making the argument for
an economic impact
Core Issues Suggested Projects

11. • Developing political strategy
to make short-term wins and
long term wins
• Translating evidence into
policy – both locally and
nationally
• Lack of national priority for
children
Political
voice of
children
• National policy and drivers
• Rewards, need per charge and reward
intent from think tanks
• <5% of medical research is for CYP
Core Issues

12. Everyone
Can
Groove
(Guddi)
Create
educational
work schedules
for all
paediatric
trainees
Randomised
Coffee Trials
at Addie’s –
70+ people
turned up
Working
together
programme/
Vanguarding
(Nicola Jay)
Joy in work
“sprinkling
glitter”
Hospital
services
review
(Nicola Jay)
Staff resilience
programme
(Chloe &
Evelina)
Staffing
&
morale
• Staff wellbeing and
burnout
• Recruitment and
retention
• “Own worst enemy”
• Workforce skill mix
• Morale of staff  all
about the discretionary
effort
• Health Foundation Spark tool
• Personalised work schedule in
enshrining protected time for
trainees to solve some of
these issues
• Common enabler along projects
– enthusiastic and committed
staff
• Funding and local sustainability
• Develop skills in QI/L&M/ Policy etc
• Short -termism – fill rota slot for SpR shift tonight versus
moral/feeling valued/promoting motivation
• Workforce strategy is still Dr centric, and still based on
Consultant numbers
• Lack of common training pathways in paediatric and
public health
Core Issues Suggested Projects

13. @mumba
be2gether
Sending young
people
appointment
reminder as well
as their parents –
in trial
Improved
ambulatory
service
PICH
(Chloe M)
Reducing
variation in
acute
asthma
care
CC4C
Bob K
+Mando
Hospital
services
review
(Nicola Jay)
Healthier
Together
(Sanjay)
• System fragmentation
• Models of care – need to
respond to new demands
• Risks associated with
service fragmentation
• Enthusiasm of people
who want to make things
better
• Resistance to change
• Joined up data (WSIC –
NW London)
• Change takes time
• “difficult people”
• Connecting care children’s hubs in pilot-
Hampshire – Healthier Together/Hampshire
Children’s STP
• Networks and children’s engagement
Models
of care
Toolkit to share with other
regions/spread
Core Issues Suggested Projects

14. Trauma
prevention
work
What does the
implementation
of prevention
look like?
• Strategic intention to focus
on prevention boy National
Services 5YFV
• No network to tap into
Working
together
programs/
vanguard
(Nicola Jay)
• Committed motivated
people who are on board
with integrating prevention
Prevention
• Political interest in
prevention
• Long term
outcomes not
appealing to short
political cycles
Core Issues Suggested Projects

15. Huddles
(RCPCH
SAFE)
QI Education
QI IQ HUB
(RCPCH)
QIPS forum
(RCPCH))
Diabetes QI
collaborative)
SAFE (RCPCH)
Quality
Improvement
• Lack of QI
network
• Variable
standards of QI
implementation
Core Issues Suggested Projects

17. Current RHG network

18. Potential activities of
RHG network

19. The Big Picture:
National Policy
Political Influence
Media Pressures
Socio-Economic impact
The Local Context:
Staffing
Relationships (Intra/Inter Department)
Responsivity to change
Regulatory Pressure (CQC etc.)
We are all pulled in two directions
(which are related but not always
easy to deal with simultaneously)

20. Next steps…
Opportunity to become a Special interest group within Q network
https://q.health.org.uk/community/special-interest-groups/
Applications to become a Q member will reopen on 14th June 2018
https://q.health.org.uk/join-q/
Before deciding to become a SIG, working group meeting to establish:
(i) Purpose of the RHG network within current paediatric landscape
(ii) Identify a strategy to develop the network
(iii) Consider relationships with other paediatric networks
Date of working group meeting TBC – (July/Aug 2018)