Service Improvement Projects

The aim of Connecting Care Children's Hubs (CCCHs) is to improve the delivery of care to children and young people by increasing the connections between GPs, health visitors and paediatricians. The core elements of the hubs are that they are centered in primary care and built around a monthly multi-disciplinary team (MDT) meeting followed by a clinic in which a paediatrician and a GP see children together. The project, which was funded by NHS England, began in April 2018 and was led by the Hampshire Isle of Wight (HIOW) Sustainability, Transformation and Partnership (STP) children's programme team:

12 CCCHs were initially piloted across Hampshire and the Isle of Wight:

Impact of the CCCHs:

In addition, the introduction of the hubs was associated with reduced rates of urgent GP appointment, A&E attendances and admissions to hospital:

The NHS is now looking into ways to roll out the CCCHs across Hampshire, IOW and Dorset so that all children can benefit from them.

To hear more about the hubs from the people involved about them, click here.

Parents commonly call NHS 111 when they are concerned about their child. The current system used by NHS 111 involves call handlers going through a series of pre-written questions (NHS pathways) to decide what is required. Unfortunately, this process almost always results in parents being advised to seek a face to face appointment with a doctor. However, at this face to face appointment, most parents are simply told that their child requires no specific treatment and that they can be managed at home. This process is often inconvenient and frustrating for parents and children alike.

We secured funding from NHS England in 2019 to create a new way of delivering NHS 111 services for children. Phone calls about children with common illnesses such as sore throats, ear infections, rashes and cough and colds will be filtered into a specific children's service (paediatric desk) where trained paediatric nurses and GPs will decide whether they can be managed at home or not. If they can, they will provide you with clear information on what to look out for and what to do at home to keep your child comfortable (safety netting).

Phase 1 of the project was completed in July 2019 and the results from it can be accessed by clicking here.

Phase 2 is due to begin in October 2019 and will involve children of all ages being managed by the desk, as well as a broader range of illnesses and the ability to 'talk' to a parent with a video call if required; this will allow the clinician to gather even more information about your child before they make their decision about whether they need to be seen or not.

Antibiotics can be lifesaving in children with severe infections. This includes conditions such as sepsis and meningitis. However, overuse of antibiotics results in antibiotic resistance; which means that the normal antibiotics used to treat your child may be less likely to work when your child needs them most. Most mild infections in children get better by themselves; antibiotics rarely make a difference to how long your child will take to get better. For this reason, a project was set-up between pharmacists and general practitioners in West Hampshire to improve antibiotic prescribing in young children.

The intervention involved pharmacist-led in-house training based on the Healthier Together resources and regional antibiotic guidelines, as well as review of antibiotic prescribing data within each GP practice.

The results show that this simple intervention was highly effective in improving antibiotic prescribing in primary care. It is planned to roll-out this approach across Hampshire and Dorset.

In February 2018, the Mental Health Foundation released worrying statistics that 1 in 10 children suffer from depression or anxiety related issues, with almost half of cases involving children under the age of 14. What is of greater concern is that over half of schools in the UK are not in a position to help these children even though they are often the first point of contact for anxious parents looking for help.

The Healthier Together team decided to partner with the charity Simon Says in 2018 to develop educational resources to support teachers and children about mental health. The “Let’s Talk About Mental Health” project aimed to:

• tackle the myths that surround mental health issues
• reduce the stigma associated with it
• reduce the barriers to seeking help by raising awareness of sources of support
• Focus on depression, anxiety, self-harm and bereavement
• promote a supportive and understanding community in schools and the wider community.

The resources were piloted in 6 schools across Hampshire, with 30 teaching staff involved and nearly 400 year 3 and 4 pupils (aged 7 to 8 years) participating.

To view the resources developed, click here.

The feedback from teaching staff included:

Children were surveyed before and after the project:

To view the final report, click here.

The resources are currently being reviewed by the education and public health teams from across Hampshire to decide how best to integrate them into the school curriculum.

When we work with and alongside children and families, rather than make decisions for them, we deliver far better care. This is the basis of restorative practice; it is founded on the principles of working ‘with’ people, rather than doing ‘to’ or for others. If done well, it helps to build trust between families and the organisations which are there to help them, encourages families and young people to make safe and healthy decisions and decreases crime and antisocial behaviour.

This project has brought together leaders from various organisations involved in supporting families, including the NHS, local government, social services, education and the criminal justice system. By working together, they can improve the way that services are delivered across Hampshire.

This short video was produced by the Wessex maternity, children and young people clinical network

Clear to watch a video from Wessex Clinical Senate and Networks on Restorative Practice

1) Lees A, Tapson K, Patel S. A qualitative evaluation of parents’ experiences of health literacy information about common childhood conditions. Self Care 2018;9(1)1-15.

This article reports the findings from a qualitative service evaluation of health literacy resources for parents of children aged 0-4 on six common paediatric conditions (abdominal pain, asthma/wheeze, bronchiolitis, diarrhoea/vomiting, fever and head injury). These have been launched across Wessex as part of the Healthier Together (HT) project and consist of a website and paper-based resources designed to provide easily accessible facts about common childhood conditions, advice on actions to take in the event of certain symptoms and when and where to seek medical help. Eighteen semi-structured interviews were conducted to investigate parents’ experiences of and reactions to the resources. We investigated perceived effects on parental understandings and feelings about childhood illness and help seeking behaviours. We discuss findings under four main headings: Parental interaction with HT resources, Parents’ anxieties concerning their children’s health, Positive evaluation and Areas for improvement. Parents positively evaluated the aims of the project and the information provided. A small number gave examples of resulting behaviour change and several anticipated future changes. Parents expressed anxiety about childhood illness and making treatment decisions. They required simple and easy to navigate resources including prominent risk assessment information. Communication by health professionals that reassures and empowers parents was also seen as important. Whilst this was a small study we believe that the findings are of relevance to others producing, disseminating and explaining health information aimed at parents and other patient groups.

2) Fake E, Lees A, Tapson K, Patel S. Parental views on the management of young children with respiratory tract infections in primary care – a pilot study. Self Care 2018;9(4)23-34

BACKGROUND

Local primary care data shows a 24% increase in the rate of acute presentations with common self-limiting infections for children aged 0-4 years between 2015/16 – 2016/17. As rates of serious illness have decreased, this means increasing numbers of presentations could be managed elsewhere. Although parents rarely expect antibiotics, they are often perceived to want them by clinicians; potentially resulting in more antibiotic prescriptions and driving future health-seeking behaviour.

AIMS

To explore parent expectations, concerns and opinions about the primary care management of children presenting with respiratory tract infections (RTIs).

METHODS

Semi-structured interviews with parents of children aged 0-4 years presenting to primary care clinicians with symptoms of a respiratory tract infection. Analysis involved thematic review

RESULTS

Parents used experience or ‘parental instinct’ when deciding to consult; this was due to seeing a similar illness before and receiving treatment, or alternatively having never seen this illness and being unsure of what to do. Parents saw the usefulness of written information describing actions to take and when to consult when their child was unwell. There was an about even split between those preferring paper and those preferring web-based resources. All parents sought input from a clinician for reassurance.

CONCLUSION

Better understanding of parent expectations when consulting clinicians with unwell children could facilitate a more effective consultation. Parents expect reassurance about their child’s illness, but inconsistent advice and management from healthcare professionals, such as prescribing antibiotics, act to increase parental anxiety and potentially drives future health-seeking behaviour. Changing the way clinicians communicate, including the use of consistent messages, may have a positive impact during current and future acute illnesses.

3) Donovan E, Wilcox CR, Patel S, Hay AD, Little P, Willcox ML. Digital interventions for parents of acutely ill children and their treatment-seeking behaviour: a systematic review. British Journal of General Practice 2020; 70 (692): e172-e178.

Background Consultations for self-limiting infections in children are increasing. It has been proposed that digital technology could be used to enable parents’ decision making in terms of self-care and treatment seeking.

Aim To evaluate the evidence that digital interventions facilitate parents deciding whether to self-care or seek treatment for acute illnesses in children.

Design and setting Systematic review of studies undertaken worldwide.

Method Searches of MEDLINE and EMBASE were made to identify studies (of any design) published between database inception and January 2019 that assessed digital interventions for parents of children (from any healthcare setting) with acute illnesses. The primary outcome of interest was whether the use of digital interventions reduced the use of urgent care services.

Results Three studies were included in the review. They assessed two apps and one website: Children’s On-Call — a US advice-only app; Should I See a Doctor? — a Dutch self-triage app for any acute illness; and Strategy for Off-Site Rapid Triage (SORT) for Kids — a US self-triage website for influenza-like illness. None of the studies involved parents during intervention development and it was shown that many parents did not find the two apps easy to use. The sensitivity of self-triage interventions was 84% for Should I See a Doctor? compared with nurse triage, and 93.3% for SORT for Kids compared with the need for emergency-department intervention; however, both had lower specificity (74% and 13%, respectively). None of the interventions demonstrated reduced use of urgent-care services.

Conclusion There is little evidence to support the use of digital interventions to help parent and/or carers looking after children with acute illness. Future research should involve parents during intervention development, and adequately powered trials are needed to assess the impact of such interventions on health services and the identification of children who are seriously ill.

4) Patel S, Hodgkinson T, Fowler R, Pryde K, Ward R. Integrating acute services for children and young people across primary and secondary care. British Journal of General Practice 2020; 70 (693): 158-159.

Children and young people under 18 years of age currently account for approximately 25% of attendances to primary and secondary care but only 12% of hospital admissions. The fact that children are the most likely age group to attend emergency departments unnecessarily suggests that high levels of parental anxiety is driving health seeking behaviour. This observation justifies initiatives to deliver integrated acute services for CYP which achieve consistency across primary and secondary care. Consistent management and safety-netting by healthcare professionals reduces parental anxiety, which in turn reduces urgent care presentations by empowering parents to confidently self-manage minor illnesses. Addressing this avoidable activity would relieve pressure on our currently overstretched urgent care services, improving access and quality of care to those who need it most.