Welcome to the Digital Child Health

Welcome to the Digital Child Health

Launch EventsHosted by:

Claire Walker - NorthJames Bolt – South

Pam Hall – Mids and East

• Share work to date on the publication of ‘Healthy Children’

• Give an overview of the vision of Healthy Children

• Share scope and approach of the Digital Child Health Transformation programme and its ambitions

• Explore the opportunities and challenges for new service models in response to the vision

• Agree next steps

Objectives

Timings Agenda

13:00 - 13.10 Welcome to the Digital Child Health Launch Event – House Keeping and Introductions

13.10 - 13:20 Healthy Children: Transforming Child Health Information an Overview

13:20 - 13:40 The Clinical Perspective – “what this means for parents, young people and professionals”

13:40 – 14:00 Q&A Session

14:00-14:45 Breakout Sessions – Redesigning our Services

14.45 – 15:00 Coffee Break and Networking Opportunities(make use of flip charts to record comments etc?)

15:00 -15:30 Digital Child Health Transformation Programme Introduction

15-30 -15-45 Q&A Session

15:45-1600 Wrap up & Next steps

Healthy Children: Transforming Child Health Information an overview

Jo GanderSenior Programme LeadDigital Child Health NHS England

Why focus on children’s health and information?

Public Health England and the NHS Outcomes Framework 2015/16 stress that a focus on children’s health is essential and that we should be striving to provide the best start in life possible for our children.

The recent National Maternity Review has highlighted that this begins not just with the newborn child but with the mother’s experiences in pregnancy and the birth itself.

The importance of ensuring this good start for the future health of children for the sustainability of the NHS and the economic prosperity of Britain is one of the key themes of the Five Year Forward View.

We need to redesign information services to support the new emphasis on: • the importance of early interventions and preventive measures

• integration across different care settings, particularly joining up maternity and newborn care

• the need to enfranchise children, young people and parents as equal partners in their care.

We also need to take on the challenges posed by the current organisation of information services.

CHIS Evolution

Section 7A (NHSE)

Commissioned by PCT2011

- 2013

2013 -

2015

2015 -

2016

Delivered by: New Providers LSP

?LA Delivered by: Provider Trusts LSP CSU

Section 7A (NHSE) LA Delivered by: Provider Trusts AQP

£ ?

"Our ambition is to know where every child is and how healthy they are and which give appropriate access to

information for all involved in the care of children”

“The importance of ensuring this good start for the future health of children for the sustainability of the NHS and the economic prosperity of Britain is one of the key themes of the Five Year Forward View”

‘Healthy Children’ sets out the case for

restructuring our information services and systems for children, young people, parents and families so they can

contribute fully to improving their health and wellbeing and collaborate easily with professionals across the

spectrum of care.”

"Information is not enough by itself. There have to be

personalised transactions, leading self-management

“There is a clear pathway to improvement “

Tailor the health system to meet the needs

of children and young people, their parents and

carers

Health and Social Care 2015 Children and Family Act 2012

Key Policy Drivers

Collaboration for the development of ‘Healthy Children: Transforming Child Health Information’ Professional Bodies

Royal Colleges- Paediatricians and Child Health- Nursing- Midwives- PsychiatristsBMAAssociation of British Paediatrician NursesDirectors of Children’s Social ServicesNational Childbirth TrustNational Children’s BureauChildren’s CommissionerAssociation of Directors of Public HealthSocitm

System Suppliers & CommissionersParents & Young People GroupAssociation for Young People’s Health Young MindsNational Council for Voluntary Youth Services

National OrganisationsNHS EnglandPHENHS DigitalDHNIBLGATech UK

ProvidersAcross LondonBlackpool TeachingHospitals NHS Foundation TrustGreat Ormond Street

Healthy Child Programme

0-5

5-19

Health Visiting

School Nursing

Hearing, NIPE, Bloodspot

Immunisations 0-19 Health Record CHRD Staff

CHIS System Personal Child Health Record

CHIS Services

Current ChallengesPersonal Child Health Record still paper based services still very paper driven and manually intensive

Up to 20% of children unregistered with GPs: very limited information and service access

Services still very paper driven and manually intensive

Closure of LSP programmes left funding and expertise gap for CHIS IT

Population inaccuracies and tracking of children has worsened since the NIT report

Healthcare professionals don't have access to core child health information.

Changing commissioning and provider landscape in light of the policy drivers

Healthy Children – where do we start?With the basic building blocks:

A first layer of essential child health information for exchange

A first phase of systems exchanging that information - Maternity, Child Health GP systems and Personal Child Health Records

A roadmap for growing the scope of the information exchange

Adding in new services as they become available, for example, national Failsafe for Healthy Child Programme

0d 5d 8d 11d 7w 9w 12m 13m 24m 40m 4y 5y

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Public Health England

Per

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nal H

ealth

Pub

lic

Hea

lth CommissionersDirectors of Public Health & Children’s

Services

Delivery of Healthy Child Programme(All Children)

Delivery of all other care services (Some Children)

CHIS / CHRD

CHIS / CHRD

CHIS / CHRD

CHIS / CHRD

CHIS / CHRD

CHIS / CHRD

School NursingPrimary CareHealth VisitingMidwifery

Education ServicesVoluntary ServicesMental Health Services

Emergency & Acute Services

Justice ServicesSocial ServicesCommunity ServicesNeonatal Services

Maternity Information Systems

Screening Information Systems

Primary Care Systems

GPESCYP Dataset CAMHs Dataset

PCHR

90CHRDs

Research & Policy

Maternity Dataset

SCR

National Audit

Enabling essential information exchangeHow do we decide what is essential as the core record of a child’s health and development available to professionals and to parents to assist in diagnosis and treatment ?

We use what is already agreed as being essential to the foundation of a child’s health:

• By the Royal College of Paediatrics and Child Health – the Personal Child Health Record (PCHR) owned by parents

• By Department of Health – the Healthy Child Programme

• By commissioners – the Maternity and Children and Young People’s Datasets

This is only the first layer of interoperability, additional data will be designed and endorsed through a national design authority

33 events in first interop layer

14

Maternity Screening Health Visiting Primary Care School Nursing Personal Other

E1 Birth Details E2 NIPE

E3 Blood Spot

E4 Hearing

E5 New Baby

ReviewE6 Imms

E7 6-8 Wk Review

E8 6-8 Wk Review

E9 Height & Weight

E9 Height & Weight

E9 Height & Weight

E9 Height & Weight

E9 Height & Weight

E10 Vitamin K

E11 1 Year

Review

E12 Conditions

E13 Special Needs

E14 Allergies and Drug Reactions

E12 Conditions



E15 Accidents & Injuries

E15Accidents& Injuries

E17 Family

Conditions

E18 2/2.5 Yr Integ Review

E16 Family

Relationships

E18 2/2.5 Yr Integ Review

E19 School Entry Check

E20 Professional Advice



E20 Profession

al Comment

E22/33 Hep B/ BCG

Indicated

E23 Responsible Professionals




E24 Address Add or Change



E25 Interpreter Required

E25 Interpreter Required

E6 ImmsE26 Rest of NIPE

E27 Breast

Feeding Status

E28 Developm

ental Firsts

E29 Teeth

E30 Parental

Comment

E31 Personal Comment

E33 ‘About Me’

Event recorded

once

Multiple Events across

Systems

www.england.nhs.uk

How – by introducing digital basics

Access to key child health data at the point of care

Interoperability to allow data sharing between health and care professionals

Patient empowerment through the use of personal health records

www.england.nhs.uk

Digital Child Health–Service TransformationThe Vision

“As a parent and carer I am informed and can

make choices that best meet my child’s health

and care needs.”

I have access to information that enables me to make the best health and care choices for my child

• Online record of their child’s health and development.

• Can share my own health and wellbeing information with professionals.

• Can set their own preferences for information sharing and can see who subscribes to their information.

• Can access online peer support networks or health promotion support more easily

“As a HCP I can provide the best care options to

children and young people as information is real time and available at

the point of care ”

I have access to real time information at the point of care that helps me to provide a better care experience for children and their families• Core view of child health

information at the point of care.

• Record information about a child/young person and publish automatically to those in the extended network of care.

• Up to date health events will be available in their own health record systems, they will not need to access other systems.

• Failsafe management service will alert preventative programmes of care when an intervention is due or has been missed.

“As a commissioner I can access he right information to understand the health and care needs of children and young people”

I know that children under my care have received the appropriate health interventions to keep them healthy

• Failsafe management services will give assurance for safeguarding children.

• Commissioners can analyse data and intelligence to make service improvements and modifications

“As a provider I have access to IT systems of Choice that meet national data and technical standards”

I can provide an information service that underpins the needs of health and care services

• Can offer digital services to parents, children and young people which allow them to take ownership of their own care

• Have a choice of IT systems that will enable information exchange across extended network of care.

Dr David Low NHS Digital

Digital Child Health A Clinical Perspective

Potential

Right Information, right time, right person

The early years of a child’s life have a lasting impact. What happens in the home and how parents interact with their children is crucial to their development.

• More robust clinical decision making

• Avoids duplication• Better Safeguarding• Reduces risk for

‘Borderline cases’

Digital aspect - when Commissioning

Direct interoperability into native Clinical Systems

Clinical Digital Environment

Complex point to point sharing modelsGood Practice! – sharing constrained to same system

Portals – multiple logins – lack of confidence

Point of need capture

- Sharing to many organisations Clinically agreed event

based information

I have access to real time information at the point of care that helps me to provide a better care experience for children and their families

Working and thinking in silos creates access issues

a

Examples - Immunisations/ MedicationsP

rofe

ssio

nal H

ealth

CHIS / CHRD

CHIS / CHRD

CHIS / CHRD

CHIS / CHRD

CHIS / CHRD

CHIS / CHRD

School NursingPrimary CareHealth VisitingMidwifery

Education ServicesVoluntary ServicesMental Health Services

Emergency & Acute Services

Justice ServicesSocial ServicesCommunity ServicesNeonatal Services

Maternity Information Systems

Screening Information Systems

Primary Care Systems SCR

Delivery of Healthy Child Programme(All Children)

Delivery of all other care services

(Some Children)

Standards for Clinical Safety in IT Systems

SCCI 0160

In use of the system by the Health or Care Organisation

SCCI 0129

In the systemdevelopment and

modification by themanufacturer

https://digital.nhs.uk/clinical-safety

Reflections on Strategy and Clinical Perspective (10 minutes)

‘Knowing where every child is and how healthy they are’

‘Appropriate access to information for all involved in the care of children’

What are the opportunities and challenges in delivering the vision?

Breakout Session – Redesigning our ServicesYou are asked to describe the key considerations if Child Health Information Services (CHIS Services) were to be reconfigured:What are the key considerations when redesigning children's information services /other health and care services. (Each table has different scenario)

• Local Authority • Clinical Commissioning Group • Child Health Record Department • STP / Regional Planning • NHS England (S7a)• General Practice

Break out sessionReflections on Strategy and Clinical (10 minutes)Scenario exercise (10 minutes) Group feedback to the room from each table ( 10 minutes )Discussion on all perspectives (10 minutes )

www.england.nhs.uk

Digital Child Health Transformation Programme

Jo GanderSenior Programme Lead

www.england.nhs.uk 33

Integrated Digital Care

Records across health

and care Technical adoption

Business intelligence

Purchasing FrameworksIT Systems

of choice

Service spec

Market Developmen

t

Commercial arrangements

Business Intelligence

Datasets Interface

Commissioning and Operating

ModelCore service & contracts

Data Sharing

e-Consent model

Configure national infrastructure to meet technical and data standards enabling local commissioning insight

Develop a vibrant, competitive marketplace with choice of suppliers

Develop commissioning model that promotes proactive health and care commissioning

Collaborate with local service models to make Information accessible at the point of care

e-Personal Child Health

RecordStandards

Develop digital tools to provide choice for parents on access to record and support services

Develop a trusted consent model for patients and professionals

Accreditation

Levers & Incentives

Develop a commercial model to support procurement of local IT systems of choice

ArchitecturalBlueprint

StandardsNational Service Design

Interop. National Failsafe

Management ServiceEvalu.

Benefits

Redesign Fail-safe management

services

Test / Discovery

Preventative programmes to monitor the uptake of the Child Health Development Programme

ServiceBlueprint

Achieving transformation

Central data sharing hub

www.england.nhs.uk

Test Assumptions

Trial New Methods

Deploy New Services

March 2017

1st layer of child health information

Q: Can events be standardized for exchange rapidly?

Trial 1st layer information in eRedbook (London)

Yes Content Agreed

Yes

Collaboration on standardization

Q: Can this standard be widely supported?

Events Catalogue for child health information created

Q: Can systems be modified for interop

Yes

Deploy new PCHRs with standard content in other regions

June 2017

Systems development

Yes

Q: Trial a success?

National events management service ready to go-live

Interoperability between CHIS, Maternity, GP systems and PCHRS

Dec 2017

• We would like feedback from this event please do complete the feedback forms

• Contact us to register your interest email [email protected] stating which communities of interests you want to be involved in or have an enquiry

How do we keep in touch

@tracey_grainger

https://www.england.nhs.uk/digitaltechnology/info-revolution/digital-primary-care/child-health/

mailto:[email protected]




Next steps

www.england.nhs.uk

National Engagement Partners – high level

Professional Bodies Commissioners (LGA/ NHSE /CCGs) Transformation Initiatives (STP.

LDR, NMC) Partner Organisations – NHS

Digital, PHE, CCGs, LA, Existing CHIS System Suppliers

(LPF/SBS) Potential new suppliers Service Providers

Children & Young People Governance Boards

Department of Health Workforce Ministers Maternity Providers Parent and Carer Groups

Levels of involvement

• Doers - services who are willing to get their hands dirty trying out different ways of sharing data.

• Thinkers – services who are willing to publically offer views, advice or critiques.

• Watchers – services who just want to follow progress.

Everyone to consider at a local level Child Health Information, from an operational and commissioning perspective

Progressing options for regional and locality based responses to enable a transformational use of child health information

A review of the configuration S7a CHIS Services in response to the transformation changes, led by NHS England

Building of the technical building block of the new national infrastructure, including proofs of concept, led by NHS Digital

Progress of regional pilots and trials different child health commissioning approach and technology

A wide ambition, so what will you see first?

Service redesign workshops to agree potential new service models for Child Health Information (end Feb for 6 months)

1st part is for CHRDs to complete situational questionnaire to help understand the current local landscape (January – please support)

Additional focussed events for different stakeholder communities e.g.• technical forums (led by NHS Digital)• Commissioning• Clinical

Next steps