For the Nuffield Trust Health Policy Summit 2016, Hilary Cass talks about how we need to reconsider health services for children in the UK and what implications that may have on the workforce.

1. #ntsummit
Revolutionising the workforce for child health services
Dr Hilary Cass OBE, Consultant in Paediatric Neurodisability,
Guy’s and St Thomas’ NHS Foundation Trust and Senior
Clinical Adviser, Children and Young People, Health Education
England @Hilary_Cass

2. REVOLUTIONISING THE WORKFORCE
FOR CHILD HEALTH SERVICES?
Hilary Cass
Senior Clinical Lead, Children’s Health & Wellbeing

3. 1948: NHS is founded
Designed around needs of adults

4. ‘APPLICATIONS FOR ADMISSION TO CASUAL WARD’
SIR SAMUEL LUKE FILDES, 1874
BUT….WAITING TIMES HAVE IMPROVED A BIT

5. www.hee.nhs.ukwww.hee.nhs.uk
WHAT WE KNOW
1. Children’s workforce is not delivering best
outcomes for children as currently configured
2. Children’s healthcare workforce is not
sustainable as currently configured

6. 0
50
100
150
200
250
SDRper100,000 Austria
Finland
France
Germany
Greece
Italy
Netherlands
Portugal
Spain
Sweden
United Kingdom
Deaths in children 0-14 years
0
10
20
30
40
50
60
2005-2007 2006-2008 2007-2009 2008-2010
Ingrid Wolfe, Lancet, Mar 2013

7. DEATHSUNDERAYEAR:PRE-TERM,LBW&STILLBIRTHS
DIRECT AND INDIRECT FACTORS
Social
disadvantage
Health
inequalities
Smoking in
pregnancy
Alcohol in
pregnancy
Obesity in
pregnancy
Maternal
age

8. 0
5
10
15
20
25
30
0
0.05
0.1
0.15
0.2
0.25
0.3
Sweden Portugal Finland Italy Austria Germany Spain United
Kingdom
Percentagewheeze
10yearSDRper100000(0-14years)
Mortality
6-7 age group
13-14 age
group
Asthma mortality and children with wheeze
Ingrid Wolfe, Lancet, Mar 2013

9. PERCENTAGE OF CHILDREN AND YOUNG PEOPLE AGED UNDER
25 YEARS WITH DIABETES, HBA1C MEASUREMENT<58
MMOL/MOL (7.5%): PROGRESS
Children and Young Peoples Health
Outcomes: progress
Greece(R), 50.0
Ukraine(R), 49.5
Germany, 42.4
Austria, 42.2
Italy(R), 37.5
England, 18.0
0
10
20
30
40
50
60
2009/10 2010/11 2011/12
%

11. WORKFORCE CHALLENGES – TOO MANY TRAINEES,
BUT NOT ENOUGH TO COVER ROTAS? (FACING THE
FUTURE 2011)
2798
2566
2478
2230
0
500
1000
1500
2000
2500
3000
Tier 1 Tier 2
Staff required
Available staff

12. CURRENT CHALLENGES - CCTS AND CONSULTANT
GROWTH

13. THE WORKFORCE
CHALLENGE

14. CHILDREN’S NURSES
Slide courtesy of Fiona Smith

15. WE’VE BEEN
HEARING FOR
YEARS THAT THE
STATUS QUO CAN’T
CONTINUE….
…BUT IT STILL
DOES

16. Minor
SHORT-TERM
CONDITIONS
Serious
Day-to-day
LONG-TERM
CONDITIONS
Strategic
Minor
ACUTE
ILLNESS
Serious
SECONDARY CARE
PRIMARY CARE
Children’s Healthcare Needs

17. The Primary-Secondary Gap
Minor
SHORT-TERM
CONDITIONS
Serious
Day-to-day
LONG-TERM
CONDITIONS
Strategic
Minor
ACUTE
ILLNESS
Serious
SECONDARY CARE
PRIMARY CARE
Rising consultation rate, reduced funding,
staffing shortfalls, and recruitment challenges
Changing expectations, changing demographics,
changing disease profile and prevalence
Less experienced junior staff, nursing shortfalls,
unsustainable workforce model

18. Managers
and
Leaders
Education
Health
Social,
Family and
Community
Support
Early Years,
Child Care
and Youth
support
Justice and
Crime
Prevention
Sport &
Culture
Child
and
Family
The Children and Young
Peoples Workforce
Core Children’s Workforce
Wider Children’s Workforce

19. TWO ASPECTS TO IMPROVING CHILD
HEALTH OUTCOMES
• Health service design
– Redesign
– Capacity building in
community
• Training and sustaining
child health workforce
• Broader environment
for CYP
– School
– Social Care
– Youth justice
• Training and equipping
the wider children’s
workforce INCLUDING
families and CYP.

20. KEY DIFFERENCES EUROPEAN MODELS
• More doctors per capita (GP and paediatric)
looking after children
• Most countries – mandatory & specific post-
graduate training in paediatrics for GPs
• Co-location of primary and secondary care
practitioners
• No perverse financial incentives between primary
and secondary care
• Choice of first-access professional

21. PROPOSAL: WOMEN’S & CHILDREN’S HUBS
Hospital(s) or ?network
Women’s and Children’s
Healthcare Hubs
Group
Practice A
Group
Practice B
Group
Practice C
CHILDREN’S SERVICES
•Urgent care – evenings,
weekend days when
surgeries closed
•Health promotion, feeding
advice, pre-school support
•Long-term condition
management including
children with disabilities,
diabetes, eczema etc.
•Other routine outpatients
not needing hospital support
WOMEN’S SERVICES
•Antenatal classes
•Well women services
•Mental health services
•Out of hospital gynaecology
services
•Parenting classes
•Rooms for NCT meetings,
other family support groups

22. STAFFING AND TRAINING
Hospital
Women’s and Children’s
Healthcare Hub
Group
Practice A
Group
Practice B
Group
Practice C
STAFFING
•GPwSI
•Paediatricians
•Obstetricians/Gynaecologists
•Midwives / HVs
•Children’s nurses
•Mental health staff
•Family planning staff
•AHPs
•Youth workers etc. etc
TRAINING
•Joint training initiatives
•Scope for new hybrid role
development
•Shared competency
frameworks
•Extended education for
parents / young people /
teachers / community
leaders
Paediatrician
Paediatrician
Obs/Gynae
Obs/Gynae
GP
GP
Children’s
community nurse
HV

23. www.hee.nhs.ukwww.hee.nhs.uk
Children’s Healthcare Needs Children’s
Healthcare Delivery
Children’s
Healthcare Delivery
Paediatric Training
• Total 8 years
• Deliver general and
specialist paediatric care
GP Training
• Total 3 years
• Dedicated paeds 0-6 months
• Deliver vast majority of
paediatric care
? GP with additional
training in paediatrics
? 5 year paediatrician
with additional
training in primary
care, mental health
Advanced Nurse
Practitioners?
AHPs /
pharmacists?

24. www.hee.nhs.ukwww.hee.nhs.uk
Key issues
1. Buy in to large scale change
2. Planning workforce against undefined model
3. CPD programmes / access to educational events
for staff not in training programmes
4. Opportunities for extending roles in range of
community settings – including primary care
5. Growing workforce in a challenging financial
environment