First child health events workshop

The PRSB is working with health, education and social care organisations as well as families and parents to create a single online picture of a child’s health and care history.

The aim is to replace the current mix of paper and electronic records held in different places with a single digital record. This will contain standardised information that is available at the point of care, so that people experience services that are more joined-up, safer, better quality and more timely.

Almost 70 professionals, parents and IT system suppliers attended the first child health events workshop, which took place last week (5 April) at the Royal College of Physicians in London.

Bringing a range of professional expertise and personal experience to the table, the group discussed the headings and content for the digital child health strategy information standard.

The PRSB has been working in partnership with NHS Digital’s child health programme to help implement NHS England’s digital child health strategy, and recognises the need for a multi-disciplinary approach.

From community care like midwifery and health visiting, to hospital admissions and GP visits, children see a wide range of health professionals, all of whom will be responsible for recording information about their health. This becomes even more complex for children with extra needs, who may also be seen by social care professionals, therapists, secondary care and family nurse partnerships. By liaising with both parents and professionals, we can get a clearer idea of what information needs to be recorded for each sector in order to ensure a joined-up approach to healthcare and records.

Kicking off the discussion, Dr Andy Spencer, chair of the information for quality committee, Royal College of Paediatrics and Child Health, said the project aimed to ‘get information right’ to provide better care and reduce variability in outcomes.

He went on to outline the project objective: to develop a set of requirements for community child health records which can support the healthy child programme, an early intervention initiative by government to prevent medical problems and issues before they happen.

Other speakers included Dr David Elliman, community paediatrician at Whittington Health, Professor Helen Bedford, professor of children’s health at University College London and Great Ormond Street Institute of Child Health, Martin Orton, director of delivery & development at the PRSB, and Alison Golightly, maternity & child health information consultant at NHS Digital, who is responsible for creating the digital child health strategy.

Speaking at the event, Alison said that knowing where every child is and how healthy they are is integral to the digital child health strategy. However, it will require collaboration between different groups and needs to be taken one step at a time. The child health events workshops are the first step in determining standards for the information that needs to be shared between professionals and parents. During the workshop, the group discussed the information surrounding child health events that needed to be recorded, and the best ways this could be done.

Covering topics such as feeding, birth weight and factors that could affect a child’s health during pregnancy, the group discussed appropriate headings, as well as the quality and type of information that needed to be recorded for the different people involved in a child’s care.

The group established that language is really important for defining headings, to avoid confusion or misrepresentations. Parents in the group also pointed out that terminology needed to be appropriate for both clinicians and parents, so that shared records were clear to everyone who was involved in a child’s care.

All attendants agreed that clear records were essential to their work, and could benefit all aspects of the health and social care system.

The views expressed by participants in the workshop will inform the development of standards for recording a child’s birth and early development history. The first of three online survey consultations will go live in May 2017, with the second and third workshops for Child Health Events taking place in June and July respectively. The final report should be delivered in September before it goes out for endorsement, and is likely to be published in late 2017/early 2018.

Read about the digital child health information standard or contact info@theprsb.org or read NHS England’s strategy, Transforming child health information.

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Personalised care and support planning for people with severe mental illness

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides more detailed explanations about each element of the plan, including advice on how the planning process might be best conducted.
These questions might form a checklist for current plans to be compared with. 

1. Does the plan include an About Me section in which the service user, in their own words, can indicate the information they want to be available about their lives, their values, their interests, and priorities, available for all those who may care for them?
2. Is the approach to developing a care plan patient centred and engaging, allowing plans to be based on patient priorities goals, and aspirations, along with the actions they plan to take and the support that they will receive?
3. Is there space for a “formulation” to be recorded in which the person receiving care and the professionals who provide it, share and record the personal meaning and the origins of the person’s difficulties?
4. Are relevant procedures and therapies recorded?
5. Where relevant, are one or more contingency plans included for anticipatable disruptions, exacerbations, or deterioration, and do they include advice on what to do and points of contact for those called upon to respond?
6. Where relevant are additional supporting plans incorporated, (an example being an “educational and health plan” for someone with a neurodevelopment disorder)
7. Is a version of the plan available to a service user (if they wish to have it) in a form and format that they can understand and find to be of value?
8. How is a version of the plan available to the GP and other key parts of the health and care system?

Work conducted by PRSB and partners recently has looked specifically at the suitability of this approach to the development and documentation of care and support plans for people with Severe Mental Illness. This resulted in an updated version of the standard (v1.4), for use by any service and for any group of service users, but with some modifications to ensure that it meets the needs of this community. The approach to a patient centred process of identifying goals, hopes, and values, and the support needed to achieve them, is fully compatible with and can be conducted using, specific tools in use in mental health, such as DIALOG, DIALOG+, and ReQoL, for example. 

Where analysis indicates the need for improvement in the content and process of personalised care and support planning for patients with Severe Mental Illness, specific improvement projects should be instituted to co-design with service users and their representatives, and the relevant staff groups, new approaches, and documentation that would be of value in delivering improvement. The toolkit includes a range of existing resources that could be used to engage in this improvement work, including signposting to relevant existing approaches informed by patient experience-based design.

Moving to a single holistic plan

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides A key development, consistent with national policy on support for Personalised Care across all health and care sectors, is the move towards an individual with complex needs having a single, integrated, care plan, rather than a series of plans developed by different parts of the health and social care system in isolation of one another. For a patient with severe mental illness, the related concerns and challenges might form a very prominent part of such an integrated plan; many will also have concurrent health challenges and needs. The intention is that the relevant services work together to plan and wrap support around the patient and their family in an integrated way, rather than as a series of sequential or disconnected encounters in which the service user or their friends and family have to adopt the role of the integrator.

A starting point would be to agree priority groups of service users who may already have more than one care plan because they need care from more than one part of the system of health and social care. This could be initiated by looking at service users registered with some sentinel practices or PCNs. Alternatively, the approach might focus initially on people with defined co-morbidity or risk that entails collaborative care with agencies beyond specialist mental health services.

The focus here is on the process of care planning and agreement on what should be shared, rather than solely on the technology used;

1. What is the process to agree which professional will initiate care planning and act as the “lead point of contact” for the service user?
2. Will initial plans be agreed with the service user in joint consultations or sequentially? Where and how will they be conducted?
3. What will be the process to agree the elements of the plans which should be available to professionals and potential authorised users beyond the immediate care teams, (A&E services, Ambulance Services, Social services, etc.) with the service user’s consent?
4. How will elements of the plan be updated following consultations in a way which is proportionate, to allow contact and progress notes to be maintained by the service conducting the consultation, whilst avoiding unnecessary work for partners in care if there is no significant change to the personalised care and support plan?
5. What are the implications for workload, logistics, and administration arising out of these decisions?

The answers to these questions and others will best be elicited through focused joint working, grounded in real, or at least realistic examples. This will entail process mapping, and co-design with a range of professionals, service users, and families. Resources from the toolkit and outputs from the Simulation element of this project will be valuable. Some organisations would adopt an approach such as a Rapid Process Improvement Workshop, planned over several weeks and conducted over a number of sequential days, to develop prototype ways of working that could be tested in the field.