29 November 2017

Quality Improvement support for Community Paediatric Services at Whittington Health NHS Trust

Whittington Health NHS Trust is an integrated care organisation delivering both hospital and community services. Paediatric community services provide a wide range of children’s services including child protection, child sexual abuse and services for children with physical and neurological disabilities, social communication disorders and those with special educational needs.  The service is consultant led and consists of two teams serving the Boroughs of Haringey and Islington.

The Challenge

Pressure on consultant time to support service delivery led to a recognition that there was a need to explore new ways of working. Additionally, the teams working in Haringey and Islington wanted to come together to share learning about how they delivered services and agree joint pathways and models of care where possible, to improve care and experience for children and their families.

Working together with UCLPartners, Whittington Health NHS Trust identified a need to:

  • Have an agreed vision and narrative to describe the services provided and the value of what they deliver to share with families, commissioners, regulators, Trust Board and STPs
  • Bring staff together from both boroughs to share learning, maximise efficiencies in service delivery and improve care and experience for children and their families
  • Improve the data management system which was making it difficult to understand service capacity, wait lists and activity
  • Identify new ways of working to maximise consultant time
  • Review the estates in use in terms of location, cost and suitability
  • Tackle the lengthy wait list for the autism clinics in Haringey
  • Align and harmonise service protocols across both boroughs

Facing the challenge

UCLPartners initiated the project with an engagement event with the Director of Paediatric Services and consultants from both the Haringey and Islington Community Teams to establish the key challenges and areas of focus for improvement.

We worked collaboratively with the paediatricians to design and deliver a series of three workshops that systematically addressed each of the identified challenges.

We undertook the following activities in preparation for these workshops:

  • A review of all consultant job plans
  • Benchmarked activity against national guidance
  • Worked with the finance department to understand the service budget and spend
  • Worked with the trust estates lead to align requirements with the overall trust level estates plan
  • Developed a quality improvement template for each service and coordinated responses into an overall quality improvement plan
  • Produced a slide deck of all activity and outputs following each workshop

Outcomes

  • An agreed vision for the service, reflecting the needs of the local communities
  • Development of a narrative in the form of a slide deck that describes local children and young people’s demographics, the services provided and the activity and impact for those services
  • A set of clinical service groupings to be implemented in the trusts electronic clinical information system. These will be used for capturing activity data and support reporting to the trust board and commissioners, as well as for capacity planning purposes
  • Further to staff and patient consultation, development of a location strategy based around two community hubs, one in Haringey and one in Islington.
  • Submission of a requirements specification for each hub to the Whittington estates strategy lead
  • Development of a paper identifying a range of new ways of working to make best use of consultant time. This included improved process measures and better use of administrative staff, health care assistants and allied health professionals
  • Review of protocols across each service to align and harmonise service delivery, including a proposal for a new model for the delivery of autism services in Haringey
  • Proposal developed for a single point of access for referral into community paediatric services
  • Proposal for the use of a three question patient/parent reported experience tool
  • Development of a quality improvement action plan
  • Business case for a project manager to support implementation
  • Regular meetings planned between both localities to support continued joint working

‘’Thank you for leading and facilitating this work. The buy in has been way beyond my expectations!’’
Dr Neeta Patel, Clinical Director for Children and Young People’s Services, Whittington Health NHS Trust