By completing this theme you will be able to demonstrate the ability to:
- Understand the terms integrated care, horizontal and vertical integration.
- Describe existing integrated services both in adult and child health.
- Be familiar with the benefits of integrated care, and the recommendations of the Kennedy Report, RCPCH’s facing the future together document and Simon Steven’s 5 year forward view.
- Outline barriers and enablers of integrated care, and understand how this programme will help you explore this further.
What you need to do over the course of the programme:
- Events: Attend the launch event. Read through the Tips for trainees section
- Project work: Explore some of the areas of interest to you that have arisen from your clinical experience or reading. Follow them up through discussion with the local multi-professional team and consider pursuing one that might be of particular interest or relevance. Remember you may want to do one larger project that encompasses all the themes, or you may choose to do several smaller projects/pieces of work.
- Cascading learning: Share your experiences with your cohort, local champion and wider colleagues. Demonstrate your proficiency with your understanding of integrated care by preparing and delivering a teaching/information session for your local colleagues, describing integrated care and its local or national significance. This teaching session should inspire and generate enthusiasm and support for your integrated care plans. If you are a paediatric trainee, this is your opportunity to help demystify the integrated care aspects of the new RCPCH Progress curriculum. You can show them how easy it is to explore integrated care in your workplace with just a small amount of knowledge and some enthusiasm.
- Write a reflective summary using the Form for trainee to complete for each theme (on the PICH website) or a tool of your choosing to record your reflections.
Ideas for you to consider within this theme:
- Understand your local services. Start to explore the breadth of child health activity that takes place and who does what. Begin by attending a local forum eg CCG meeting, health and wellbeing board, GP hub meeting or other MDT setting
- How integrated are your local services? Do they work together and are they giving the same information to patients/families? For example are parents given consistent local messages e.g. about breast feeding or how to manage an unwell child. Are families getting consistent messages from GPs, health visitors and midwives etc? How does it feel for the patient/parent who receives these type of messages? Observe how the patient/parent responds to this.
- Understanding primary care services from a single locality viewpoint. For one geographical patch, visit GP, HV, children’s centre, nurse covering local school, local social worker, youth centre, etc. Share your observations with key people, e.g. the local Councillor.
- Local variability. Choose one type of service, eg HV, or GP or school nurse, and visit that service in several different locations, individuals or settings. Observe if there is positive deviance, i.e. examples of really good practice that should be shared. Discuss your observations with your fellow PICH participants and consider how you might engage with the local children’s commissioner.
Ideas that have already been developed – to stimulate your thinking:
Case Study 1
Join a local public health promotion event
Paediatric trainees joined a team of health professionals in West London in an immunisation campaign. Posters were distributed at bus stops and banners were put up in public places. Doctors and Health Visitors manned stands for three weeks and had face to face discussions with families:
- Chelsea and Westminster: 230 consultations over 3 days
- The Baby Show: 240 consultations over 3 days
- Westfield: 377 over 5 days
- St Marys: 362 over 5 days
- Hammersmith Hospital: 160 over 5 days
- Total: 1369 over 21 days
Care was taken to have the same messages and the same literature available in baby clinics and GP surgeries. The impact on immunisation uptake is currently being analysed.
Case Study 2
Find a complex case and explore new avenues
A paediatrician managing a girl with oesophageal strictures (following accidental ingestion of bleach) noted the girl’s extreme hospital phobia. Despite play therapy and multidisciplinary support, each hospital visit triggered severe torticollis. The paediatrician talked to the GP and together they arranged GP practice-based joint consultations using the community MDT. The patient improved and the paediatrician gained great insights into the landscape of primary care.
- The Kennedy report PDF
This was a review of children’s services commissioned in 2009 to look at inequalities and variation nationally in care for children
- The BACCH position statement 2012: PDF
British Association for Community Child Health (BACCH) produced a Position Statement in 2012 titled: The meaning of “integrated care” for children & families in the UK. This was a review of the meaning of “integrated care” and its application to services for children and families
- The Kings Fund website: Link
The Kings fund produces a huge amount of interesting resources, many of which relate to intregration of services. Just one example is this animation devised by a trainee working as a Darzi fellow at the Kings Fund, illustrating the ‘crisis in A&E’: Link There is much to explore on their website.
In 2014 Simon Stevens (Chief executive of NHS england) headed up the 5 year forward view to act as a vision statement and 5 year plan for NHS services. It sets out a triple integration agenda, involving greater integration between primary and specialist care; physical and mental health care; and health and social care. With a vision to host services around the needs of patients rather than professional boundaries.
Following on from the 5 year forward view the Long term plan published by NHS England in 2019 sets out the vision for the next 10 years. Professionals involved with child health were thrilled that child health received a priority place in this plan.
This is a strategy for child health produced by the RCPCH last revised in 2015 looking at various areas including acute care, care outside the hospital, emergency care and ongoing needs, including auditing of these standards.
- CC4C whole population segmentation: Whole population segments
This is a system which divides the whole childhood population into six segments: healthy child; vulnerable child with social needs; child with single long-term condition; child with complex health needs; acutely mild-to-moderately unwell child and acutely severely unwell child. For each of these segments, we can envisage a pathway, or more accurately, a team around the child, delivering right care, right place, first time.
- Nuffield trust exemplars of integrated care: nuffield trust report
This is a report produced by the Nuffield trust to give examples of models of care in delivering child health services in 2016