Children and Young People Strategy

Transcription

1 Children and Young People Strategy 0-07 Part Children, young people, parents and carers will be treated with respect and given support and information to enable them to understand and cope with illness or injury and treatment needed. They will be encouraged to be active partners in decisions about their healthcare and where possible exercise choice. OUR VISION: To deliver services that meet the health needs of children, young people, parents and carers and provide effective and safe care, through appropriately trained and skilled staff working in a suitable child friendly and safe environment Children and young people will receive care that is integrated and coordinated around their needs and that of their family. (strategy includes neonatal services) Children and young people will receive appropriate high quality evidence based care, developed through clinical governance systems and delivered by staff with the right set of skills and competencies. Care will be delivered in an appropriate location and in an environment that is safe and well suited to the age and stage of development of the child and young person. 5 Children, young people, parents and carers will participate in designing NHS services that are readily accessible, respectful, empowering, follow best practice and provide effective response to their needs.

2 We want our children to... enjoy and achieve achieve economic wellbeing be healthy make a positive contribution stay safe

3 What our children say... give us things to do to take our mind off being poorly keep us safe talk to us as well as our parents we want a playground we want to be in a separate children s area

4 What our children want... cared for in a young people friendly environment access to internet and age appropriate information good food and accommodation staff with right training to care for us

5 What our parents say, we want/need... Enough accommodation so that we don t have to leave our child Consistent information from all staff Enough seats to be able to sit at the cotside with our baby to be actively involved in their care 5

6 Core Values & Strategic Themes Quality of Care & Patient Safety Business Sustainability Be healthy - Stay Safe Achieve Economic Well Being Sta ff s up i t n n u o ous C i Enjoy & Achieve Organisational Capability 6 delivery ice rv l Workforce development l HCA l advanced practitioners l volunteers l nurse consultants l nurse prescribing PGD`s l succession planning l specialist therapy roles l Practice development - CPDT l Support for nurses working outside of children s services l Working groups - programme board l Nurse led discharge l Training strategy for staff caring for children and young people l Medical staff training /development l Family nurse partnership ch e and resp ect valu, t r ea o p e n m t in s ove e pr m Children & young people are central to everything we do l Influence commissioning services for children and young people l Our vision, our health, our north east clinical partnership l Fundraising l Divisional partnership working l Innovation bids l Children and young people programme board and clinical governance structure l Board of Directors - children and young people s story / annual report l Strategic meetings and business planning - children and young people agenda item and section within reports and business cases l CQUINS l Quality accounts l High impact actions l QIPP er oth l Leadership - supporting and developing leaders in children and young people services l NSF & quality standards l You re welcome standards l Care Quality Commission Standards l Patient / parent experience l Patient safety indicators l Mental health and psychological well being l Transition l Bereavement services l Environment for parents l Young people s unit l Privacy and dignity l High dependency care l Separate children s A&E / emergency care centre l children in need of safeguarding l Family centred care l Children and young people forums l Parents forum l Acute / community forums l Youth workers l Volunteers l University l Children s trusts l PCT s / commissioners l Voluntary organisations l Separate children s section of the main hospital site l Project groups l LSCB Making a Positive Contribution Partnerships & Engagement

7 Safeguarding children and young people Ambulatory Care Inpatients Provision of an integrated urgent care service providing one point of access for urgent care on both sites Provision of child centred hospital services that: Provision of child and family friendly care in an age appropriate department Provision of safe and appropriate initial assessment of children Provision of safe and effective care of the sick child Care provided by appropriately trained and competent staff Neonatal Services Provision of services in line with NICE specialist Neonatal standards > consider the whole child, not simply the illness being treated > treat children as children and young people as young people > are concerned with the overall experience for the child and family > treat children, young people and parents as partners in care > integrate and coordinate services around the child and families particular needs > graduate smoothly into adult services at the right time > work in partnership with children, young people and parents to plan and shape services and to develop the workforce Provision of safe and effective care of the sick neonate Hospital stays will be kept to a minimum through the coordinated delivery of care. Effective discharge planning will meet the needs of the child or young person and family. Care provided by appropriately trained and competent staff Care will be provided in a setting which meets the individual needs of the child or young person Achievement of Bliss standards 7 Prevent children suffering harm and to promote their welfare, provide them with the services they require to address their identified needs and safeguard children who are being or who are likely to be harmed Surgery Provision of south of region surgical service for Tees Conurbation based at JCUH. Care provided in all areas in an environment which is physically separated from adults and will be provided by appropriately trained staff with adequate caseload to maintain skills: specialist nursing specialist surgeons specialist support services. Child Therapy Services Children with identified needs will have equitable access to appropriate services. High quality general and specialist services will be delivered in a co-ordinated, planned and timely way, in collaboration with children, young people and their parents/carers to optimise health, functioning and well being. Medicine (including intensive care) Children and young people requiring intensive care will be cared for in line with the Paediatric Intensive Care: National Guidance. Children and Young people requiring inpatient medical care will receive care and support in line with the children s national framework and other national guidance. Outpatients Children`s outpatient services are truly designed around the needs of children, young people and their parents. Provision of child and family friendly care in an appropriate environment Community Services Provision of paediatric community services to meet the needs of children, young people and their families Provision of safe and effective, evidence based care in the community Implementation of the Healthy Child programme Achievement of the national Health Visiting plan & school nursing review recommendations Provision of child and family friendly community care in an age appropriate department Care provided by appropriately trained and competent staff Hospital stays are kept to a minimum and care is transferred to a paediatric community team Achievement of family nurse partnership programme Achievement of Unicef accreditation

8 Children and Young People Strategy Part 8

9 At a strategic level, agencies and professionals work in partnership with each other, service users and members of the local community, in accordance with their agreed ACPC (or its successor, the Local Safeguarding Children Board) annual business plan. Agencies develop, implement and evaluate the effectiveness of policies, procedures and practices for safeguarding and promoting the welfare of children and young people including those concerned with the recruitment and management of staff Where there are concerns about a child's welfare, an assessment is undertaken in accordance with the Framework for the Assessment of Children in Need () and their Families and plans are made, implemented and reviewed which result in each child achieving their optimal outcomes. Children and families are actively involved in these processes unless this would result in harm to the child All staff are alert to the increased likelihood of harm being suffered by disabled children, or by those children who are living in special circumstances, whose needs may not be recognised by staff in statutory agencies and who, therefore, are 'invisible' to the system. A broad range of integrated, evidence-based services are available to prevent children and young people from being harmed, safeguarding those who are likely to suffer significant harm, and address the needs of those children who have suffered harm, at the same time, providing support to their parents/carers. Agencies provide staff working with children, young people and families with supervision and with support to enable them to manage the stresses inherent in this work, implement systems which quality assure the services they provide or commission, and ensure their staff use effective systems to record their work with children and families. Safeguarding Vision 9

10 Staff (at all levels) understand their roles and responsibilities regarding safeguarding and promoting the welfare of children and young people and are appropriately trained to undertake these effectively. All agencies have in place safe recruitment practices for all staff in contact or working with children At the strategic level, all agencies in contact with children and young people, including health, social services, education and housing, should work together, and with service users and members of the local community, to plan comprehensive and co-ordinated children's services which address the needs of all children and families living in their area. At both a strategic and individual agency level, there should be a commitment to safeguarding and promoting the welfare of children which is reflected in local policies and procedures. Local strategic partners identify children and young people's welfare as a priority and each constituent agency includes safeguarding and promoting children's welfare as a key priority area in their strategic partnership plan for children and the Children and Young People's Plan. The processes for developing these plans should also reflect this commitment. All agencies ensure that the Local Safeguarding Children Board (LSCB), is effective in safeguarding and promoting the welfare of children and young people through the provision of adequate financial and human resources, senior management representation and adherence to its policies and procedures. (Working Together to Safeguard Children ()) Agencies work in partnership within the framework of Multi-Agency Public Protection Arrangements (MAPPA) to safeguard and promote the welfare of children and young people. (Criminal Justice Act 00 (5); The MAPPA Guidance (6).) Safeguarding Prioritising Safeguarding and Promoting the Welfare of Children and Young People 0

11 Senior management in all agencies demonstrates leadership, is informed about, and takes responsibility for the actions of their staff in providing services to children, young people and families which safeguard and promote the welfare of children. Agencies have systems in place to safeguard and promote the welfare of children and young people in special circumstances i.e. those children whose needs are often not recognised or addressed by services - universal, targeted or specialist. All agencies promote awareness, within the community and among professionals, of children and young people's rights under the United Nations Convention on the Rights of the Child (7) (in particular Article 9 - the right to be protected from harm) through public education campaigns, and training and supervision for staff at all levels within the organisation. The methods used to communicate with the public are sensitive to the cultures and languages of local community members. All agencies have comprehensive single and multi-agency policies and procedures to safeguard and promote the welfare of children which are easily accessible by staff at all levels within each organisation These policies and procedures are informed by the policies and procedures of the ACPC or its successor, the LSCB, which in turn, are in line with legislation, regulations and government guidance All agencies have in place safe recruitment practices for all staff, including agency staff, students and volunteers, working with children. Where a criminal record review on employment is mandatory, these are undertaken routinely. All agencies have in place comprehensive policies and procedures for addressing allegations against staff which take account of the recommendations from Lost in Care (), the inquiry into the abuse of children in care in North Wales. Safeguarding Promoting the welfare of children

12 All organisations have in place and promote robust complaints and whistle-blowing policies which are extended to all commissioned services. Agencies offer a guarantee to staff and service users that using these procedures appropriately will not prejudice their own position and prospects. Safeguarding Roles and Responsibilities Each NHS Trust is required to designate a named doctor and a named nurse and named midwife who takes a professional lead in the Trust on safeguarding children matters. These named professionals have expertise in children's health and development, the nature of child maltreatment, and local arrangements for safeguarding and promoting children's welfare. A named professional is responsible for conducting the NHS Trust's internal case review as part of a serious case review (except when she/he has had substantial personal involvement in the case and then it is the responsibility of the designated professional for the Primary Care Trust area). Serious case reviews are conducted: When a child dies, and abuse or neglect are known or suspected to be a factor in the death; Where a child sustains a potentially life-threatening injury or serious and permanent impairment of health and development, or has been subjected to serious sexual abuse, and the case gives rise to concerns about interagency working to safeguard children. All services ensure that their staff are competent and confident to contribute to serious case reviews. Agencies implement the findings from serious case reviews to improve services

13 Local authorities, NHS Trusts and Primary Care Trusts ensure that where there are concerns about impairment to a child or young person's health or development, or where abuse or neglect is known or suspected, a timely and thorough multiagency assessment is undertaken, led by social services. (Children Act 989 (9); Working Together to Safeguard Children (); Framework for the Assessment of Children in Need and their Families ()) During the assessment, professionals ensure that the child is seen by social services and communications by all professionals are conducted in a manner which is appropriate for the child's age, developmental stage and method of communication. This assessment brings together information from a number of sources, including from the child and family, which is then analysed and a judgement made about whether the child is in need, if he or she requires protection from harm, and what services are required to meet the child's identified developmental needs and provide support for the family. See Standard Disabled Children Professionals who come into contact or work with disabled children are aware of their increased vulnerability to neglect and abuse, and respond to concerns about their safety and welfare. (Assessing Children in Need and their Children in Special Circumstances All professionals in contact with vulnerable children and young people are aware of the need to identify and support children and young people who are not receiving the services they need, and make particular efforts in working together to support them. All professionals in contact with vulnerable children and young people are: Able to recognise situations, and are competent to respond, when a child or young person might be involved in, or be at risk of becoming involved in, prostitution in line with the Government Guidance Safeguarding Children Involved in Prostitution. Aware of the new offence of commercial sexual exploitation of a child. Safeguarding Recognising a Child or Young Person who requires protecting from harm

14 If there are concerns that a child is being deliberately harmed through fabricating or inducing illness, the Government's Guidance 'Safeguarding Children in whom Illness is Fabricated or Induced'(6) is followed All practitioners working with children and families and with parents who are experiencing personal problems, should ensure that the needs of their children are assessed and that appropriate services are delivered to these children and their families All staff working with women and children are alert to the relationship between domestic violence and the abuse and neglect of children, and that witnessing domestic violence also constitutes harm to a child or young person. (Children Act 989) All practitioners are trained and equipped to include routine questions about domestic violence in all assessments, including ante-natal care. See Standard All staff are aware of and supported by a local multi-agency agreement on the thresholds for referral to social services in cases where there is domestic violence. Local authorities, NHS Trusts and Primary Care Trusts ensure that integrated services are available to respond in a co-ordinated manner to the assessed needs of children and young people and their families where a child has been or is at risk of being abused or neglected. The types of programmes offered are based on best available evidence of what interventions are effective and are subject to regular audit, the findings of which inform future service provision All staff maintain an accurate, clear record of their involvement with a child and family on a routine basis. The record is clear, accessible, comprehensive and contemporaneous with both judgements made and decisions taken carefully recorded. It is dated, signed and the person's name legibly written at the end of the record entry. Safeguarding The impact adult problems can have on children s development Services for Children and Young People who are At Risk of being or have been Abused or Neglected Recording

15 All decisions and disagreements about specific decisions are recorded in children and young peoples' health, social care and/or education records as appropriate. All services routinely audit and evaluate their work. The data collected is made available, in appropriate form, to practitioner, users and commissioners. As a minimum, all services evaluate outcomes from the perspective of users (including, where possible, the referred child or young person themselves as well as key family members or carers) and providers of the service Resources, including administrative and practitioner time and IT equipment, are available so that routine evaluation of outcomes can be carried out in all services. All agencies have in place robust information systems which enable them to monitor practice and the management of work with children and families to ensure their welfare is being effectively safeguarded and promoted. All agencies have in place a programme of internal audit and review which enables them to continuously improve the protection of children and young people from harm or neglect. The information from these audits is included in the agency's report to the ACPC and its successor body, the LSCB. Policies, procedures and practice are refined or changed in the light of this information. Agencies provide appropriate supervision to staff who work directly with children and young people and specifically in relation to cases where there are concerns about harm, self-harm or neglect of a child or young person. This includes the supervisor regularly reading the case files to review and record in the file whether the work undertaken is appropriate to the child's current needs and circumstances, and is in accordance with the agency's responsibilities Safeguarding Measuring Outcomes Quality of Care / Quality Assurance Good Supervision of staff working with Children and Families, including monitoring of individual cases 5

16 All staff who work with or come into contact with children, young people and their families have the common core of skills and competencies outlined in Standard. Staff in all settings are competent to recognise indicators that a child or young person's welfare or development may be being impaired or she/he is, or may be at risk, of suffering harm. This is achieved through ongoing staff training, guidance and supervision. All staff are alert to the messages (verbal and non-verbal) children and young people are giving them about their safety and welfare and know how to respond and communicate with them to establish their wishes and feelings. This includes children who have specific communication needs or for whom English is not their preferred language. All settings should have staff who are competent to: complete a nationally specified common assessment for a child or young person, and working with social services, contribute collaboratively to a child in need assessment of the child or young person's developmental needs, and the capacity of their parents to respond to the child or young person's needs within the wider family and community in which they live. Specialist single agency and multi-agency training is provided for designated and named professionals, child protection specialists, key workers and senior managers, governors and members with special responsibility for children and young people, to enable them to fulfil their responsibilities for safeguarding and promoting the welfare of children. All agencies ensure that they resource their safeguarding and promoting the welfare of children responsibilities e.g. enabling staff to attend multi-agency and other specialised training. Safeguarding Training and continuing staff development 6

17 All front line staff delivering urgent care to children are competent in the basic skills required for safe practice Working with commissioners we will ensure safe urgent care provision for children in the local geographical area Notification of the child`s attendance at any urgent care setting should be made in a timely way to the primary care team Staff will prevent unnecessary hospital admissions by being aware of alternative options and developing care pathways for community and paediatric colleagues Children and young people will be cared for in an environment which is appropriate to their age and development which is separate from adults As well as audio visual separation from adults, consideration will be given to security issues, availability of food and drink, and breast feeding areas, and hygienic, safe play facilities Achievement of You`re Welcome standards Play specialists will provide appropriate support and care at peak times of attendance Comments will be sought from children to improve services and facilities 5 Provision of facilities to meet parent s needs 5 All children will be visibly assessed within minutes of arrival, to identify an unresponsive or critically ill child Ambulatory Care An integrated urgent care system Child and family friendly care in an age appropriate environment Safe and appropriate initial assessment of children 7

18 A brief clinical assessment will occur within 5 mins of arrival A system of prioritisation for full assessment will be in place if the waiting time exceeds 5 mins Initial assessment must include a pain score Registration details must include specific additional information (e.g.: health visitor, school nurses, school attended, accompanying adult) Staff caring for children and young people will have access to an appropriate range of drugs and equipment with the support of the children s pharmacist All staff caring for children and young people will be trained in basic life support. Nurses working in emergency departments will be PILS / PLS or equivalent trained. Consultants in emergency medicine, nurse practitioners and if possible senior trainees dealing with acutely unwell children will be APLS / EPLS trained Support is available for advanced airway management Paediatric anaesthesia is carried out by competent staff The facilities and staff required to establish high dependency care and intensive level care for airway and respiratory support are available Systems are in place to ensure safe discharge of children, including advice to families on when and where to access further care if necessary Ambulatory Care Safe and appropriate initial assessment of children Safe and effective care of the sick child 8

19 Nursing staff will have as a minimum basic competence in both emergency nursing skills and in care of children There will be at least one RN (child) or RSCN per shift to care for children and young people Additional training in paediatric skills will be facilitated for all staff in the ambulatory care setting and there will be a long term strategy for recruitment and retention of paediatric-skilled nurses Safeguarding of children and young people Achievement of National Safeguarding Standards under the leadership of the children and young people safeguarding governance group Major Incidents involving children Specific care of children and young people are included in the Trust`s major incident plan Bereavement support The recommendations of the Kennedy Report are adopted Parents witnessing resuscitation are supported by a member of staff Following the death of a child early information is shared with the lead paediatrician for child death Following the death of a child the family will receive an effective bereavement support service which meets their needs Recommendations from CDOP panels will be implemented within the organisation Ambulatory Care Appropriately trained and competent staff 9

20 Subscription to the Trauma Audit and Research Network (TARN) takes place Staff will participate in and plan audit and research projects specifically in relation to care of children and young people Staff will link with regional and national working parties in relation to care of children and young people in the urgent care setting Patient experience Deliver year on year improvement in patient and carer experience Service development Partnership working to ensure children and young people and their parents / carers are involved in service developments 5 Workforce Recruitment and training of nursing staff to provide paediatric nurse practitioner role over 7s day per week Severely injured child Appropriate separate audio visually separate facilities are available to receive severely injured children Ambulatory Children s area The ambulatory children s area will have appropriate facilities to ensure children and adults are separated for diagnostic procedures Ambulatory Care Networking, Information system and data analysis 0

21 Service provision Services are well coordinated, particularly for those with complex conditions who may benefit from having someone available who can act as a key worker Nutrition A nutritional diet is provided with choices that are appropriate to age, cultural needs and health needs and meet children`s individual preferences and development needs Transition to adult services Transisiton of children with long term conditions to adult services will be appropriate to age, cultural needs and health needs and meet individual children`s needs A Trust wide lead for Transition is appointed to lead this programme of work For children with long term conditions transition to adult services will be at the 8th birthday There is a focus on working together, negotiation and information sharing with children, young people and their families to plan deliver and evaluate care. Year on year improvement for patient and carer experience is achieved through an agreed strategy specifically for children young people and parents which will be measured and monitored annually Children and young people are encouraged to be active partners in decisions about their health and care and where possible to exercise choice Children, young people and families are routinely involved In the planning and improvement of services. Methods of seeking children and young people`s views are consistent with the DOH You`re Welcome standards 5 Children and young people will be used during the recruitment process 5 Inpatients Participation and Partnerships / User Consultation and Involvement

22 Children and young people will be able to make choices about the care they receive, providing they are of an appropriate age and have the competence to understand. Young people of 6 years and over will be offered a choice of where they are cared for. Children and young people`s needs are specifically addressed as part of the Patient Advice and Liaison Service, ensuring that children and young people have access to an advocate, and can make a compliant if they should wish Children and young people receive appropriate high quality evidence based hospital care, developed through clinical governance and delivered by staff that have the right set of skills Staff caring for children have up to date training and knowledge to meet the specific needs of children and young people Each service providing care to children and young people ensures that care of children is integral to the plans of each service and are reflected in governance arrangements. This will focus on child protection training, resuscitation / life support, pain assessment and management and communication. Achievement of patient safety thermometer specific to paediatric services. Care is provided in an appropriate location and in an environment that is safe and well suited to the age and stage of development of the child or young person. Babies and children up to and including 6 years of age are admitted to children`s wards. Parents are able to sleep and rest near their child All wards should provide appropriate facilities for resident parents Inpatients Participation and Partnerships / User Consultation and Involvement Clinical Governance Systems Environment

23 All services will comply with environmental standards required to meet the needs of the child with disabilities Aspirational vision: All young people under age of 8 will be admitted to a young people s unit and will be followed up by the paediatric team in outpatients department. Until then children without long term conditions above the age of 6 will be admitted to adult areas and referred to adult practitioners as outpatient attendees. There is access to age appropriate play and recreational equipment All children staying in hospital have daily access to staff skilled in delivery of play services Play and recreational facilities are available for children and young people, staying in and / or visiting the hospital sites The ongoing educational needs of children and young people staying in hospital are met Where admission to hospital is planned, children are prepared through pre admission and information. A visit to the ward / department is always offered Staff caring for children and young people as a core element of their role (all neonatal areas, children`s wards and departments, accident and emergency units and anaesthetics and surgery) undertake specific training (at a level appropriate to their roles) in the following areas: Safeguarding children, Pain assessment and management, Paediatric life support, Communication Nursing staff will develop skills in nurse prescribing to meet the needs of children and young people. Use of Patient Group Directives will increase thought paediatric care areas Inpatients Environment Play and education Training

24 Named paediatrician When children and young people are admitted to hospital under the care of a consultant, other than a paediatrician, there is always a consultant paediatrician available for advice throughout the hour period Pain management, symptom relief and sedation Children`s needs in relation to pain relief and management are met Safeguarding of children and young people Achievement of National Safeguarding Standards under the leadership of the children and young people safeguarding governance group Discharge and transition arrangements Effective discharge planning meets the needs of children young people and their families. The needs of children and young people are properly catered for and there is a seamless transition to adult services Shared records and information Accurate and timely information is provided to meet the needs of all children and young people. A single documentation record for each patient is used across the Trust for all staff involved in the care of each individual child or young person. Copies of child s attendance to A&E will be included in notes for all children admitted to inpatient areas Inpatients

25 A Trust wide agreed pain assessment tool is used for children and young people and staff have attended training in relation to this tool. Where procedures are planned a pain assessment is completed using the approved Trust wide pain assessment tool Staff have received training in paediatric pain assessment and administration Nursing staff within the paediatric surgical ward will be able to prescribe paediatric pain relief Staff have access to paediatric pain management guidelines Staff have access to sedation protocols Where procedures are planned and pain can be predicted the opportunity should be taken to prepare the child through play and education and pain relief is given through the procedure Service providers ensure that staff receive the appropriate training to develop relevant competencies in dosage calculation, prescribing, dispensing and administration of medicines for children All children / young people are cared for requiring daycare within a separate paediatric day case facility with paediatric trained staff Children planned to come into hospital are prepared through a pre admission visit and information All children / young people are cared for within a separate paediatric recovery area with paediatric trained staff Surgery Pain, symptom relief and sedation Safe and child friendly environment 5

26 All staff are familiar with the concept of competence in gaining consent All staff have access to a Trust wide consent policy which makes particular reference to consent in children and young people Patients and their parents are given informed choices over aspects of treatment and care e.g.: where to be admitted, treatment options Children, young people and parents are given valid, relevant, accurate and up to date easily accessible information that is appropriate to their level of understanding before they can decide whether to consent to or refuse treatment Adolescents are cared for in a specific adolescent area, ideally in an adolescent unit by staff trained to meet their specific needs A fully integrated system of safe standards of cleaning, decontamination and sterilization of equipment with all staff engaged in risk assessment, investigation of events, audit and updating knowledge to minimise the risk of untoward events Children and young people identified with chronic pain problems are referred to the paediatric chronic pain service The use of play techniques is used across the multi disciplinary team caring for children, with appropriate numbers of play specialists taking a lead in techniques that other staff can adopt, including preparation of children for surgery Children undergoing surgery will be fasted in line with agreed guidelines to maintain their safety Achievement of You`re Welcome in all areas Surgery Safe and child friendly environment 6

27 Safe and child friendly environment Development of an admissions area within ward Safeguarding of children and young people Achievement of National Safeguarding Standards under the leadership of the children and young people safeguarding governance group Paediatric specific training All children are recovered by children`s trained staff (preferably with specific theatre recovery competencies) Communication All staff who work with children and families, and those who have access to children s records, receive child protection awareness training and appropriate CRB checks Staff working with children and young people should have training in the necessary communication skills to enable them to work effectively with children, young people and parents At every level in the organisation where children access services, staff are trained to provide paediatric basic life support Consent policy available for all staff Procedure specific and age specific information is available for parents, children and young people All equipment used for children is safe and effective and appropriate for use in children Equipment is of the correct size for the child and is tailored to the needs of children of different ages and stages of development Staff using equipment with children and young people are trained to do so Surgery Children and parents are partners in care including choice and consent Child focused clinical governance 7

28 There is a dedicated children`s theatre list within a children`s theatre Children planned to come into hospital are pre assessed prior to admission All parents are allowed in the recovery room as soon as it is deemed safe and provided there is no other emergency in the recovery area All parents stay until induction of anaesthesia and are supported after leaving the anaesthetic room Clear workforce planning will take place to ensure future service provision for children Recruitment of a paediatric orthopaedic surgeon within st year Increase in nurse prescribers and use of PGD`s Workforce Junior doctor role established in paediatric surgery ward Commissioning / marketing Joint work with commissioners to ensure provision of high quality sub regional paediatric surgery for Tees Conurbation based at JCUH 5 Patient experience Deliver year on year improvement in patient and carer experience Service development Partnership working to ensure children and young people and their parents / carers are involved in service developments 5 Surgery OPD and elective surgery child only lists Workforce 8

29 Care provided for children and young people whose care is delivered across the AHP pathway will be provided in a child friendly age appropriate environment Review of current footprint of space for paediatric service delivery to take into account the environmental needs for therapies to deliver their services effectively Equipment All equipment used for children and young people is accessible, safe and effective and appropriate for their use Care planning All members of the AHP team are involved in comprehensive care planning for individual children and young people across the pathway of care Appointments Appointment system which is flexible and takes account of the needs of children and their families is offered Discharge Effective admission/discharge planning commences on admission and is negotiated to meet the needs of the child and family, which are continually assessed. Effective discharge planning takes place for children with complex needs to ensure that a safe and quality discharge is achieved with appropriate liaison between acute and community services. Transition Every lead health professional has adequate arrangements for transfer of young people to adult services, preferably via specific transition clinics involving staff from both paediatric and adult services Information Age appropriate information is available about specific conditions, medicines, procedures, services and support groups in a variety of formats and media Hospital pharmacy provide information that is easily understandable about medicines being used to treat children Specialist Care Environment 9

30 Safeguarding of children and young people Achievement of National Safeguarding Standards under the leadership of the children and young people safeguarding governance group Service developments Increase in psychology services for children and young people accessing hospital and specialist services to ensure that their psychological needs are met Implementation of the recommendations from the recent review of paediatric therapy services, coordinating this with the ongoing process of integration into Clinical Support Services Integration of speech and language service with inpatient settings to meet needs of inpatient paediatric and neonatal patients All future service developments will identify the impact of the development on AHP services and their needs will be reflected within any new developments Model of Integrated working for children with complex needs Experienced AHP staff are members of relevant peer, clinical interest, development groups The Trust is compliant with the NSF medicines management standard Workforce Clear workforce plans will be developed to ensure safe and effective ongoing provision of care to children, young people and their parents Training Therapy staff working with children are trained to provide general and specialist interventions and receive supervision appropriate to their role Specialist Care Networking / benchmarking 0

31 All trust staff are trained, updated and supported in safeguarding children and attend level safeguarding children training All staff working regularly with children are trained, updated and supported in safeguarding children and attend level safeguarding children training Training and supervision opportunities are available Year on year patient experience will be measured and feedback given to children and young people in relation to changes as a result of feedback via the You Said We Did method Specialist Care Training Patient experience

32 A Trust wide agreed pain assessment tool is used for children and young people and staff have attended training in relation to this tool. Where procedures are planned a pain assessment is completed using the approved Trust wide pain assessment tool Staff have received training in paediatric pain assessment and administration There is one nurse per shift in all areas trained to prescribe paediatric pain relief Staff have access to paediatric pain management guidelines Staff have access to sedation protocols Where procedures are planned and pain can be predicted the opportunity should be taken to prepare the child through play and education and pain relief is given through the procedure Service providers ensure that staff receive the appropriate training to develop relevant competencies in dosage calculation, prescribing, dispensing and administration of medicines for children Safeguarding of children and young people Achievement of National Safeguarding Standards under the leadership of the children and young people safeguarding governance group Safe and child friendly environment Areas are accessible for all children with facilities for wheelchairs and buggies, accessible car parking, clear sign posting Provision of Intensive Care for children and Young people in line with National Guidance Framework Medicine (including intensive care) Pain, symptom relief and sedation

33 Areas are appropriately equipped, baby and child friendly treatment rooms, have suitable play and recreational equipment Mothers have access to breast feeding facilities and also baby changing facilities Health promotion messages are promoted in the departments; Reduce smoking, health eating, prevention of accidents, promoting breast feeding, alcohol reduction All settings that deliver services to children and young people have drinking water readily available in an appropriate place and at no charge All staff are familiar with the concept of competence in gaining consent All staff have access to a Trust wide consent policy which makes particular reference to consent in children and young people Patients and their parents are given informed choices over aspects of treatment and care e.g.: where to be admitted, treatment options Children, young people and parents are given valid, relevant, accurate and up to date easily accessible information that is appropriate to their level of understanding before they can decide whether to consent to or refuse treatment Adolescents are cared for in a specific adolescent unit by staff trained to meet their specific needs The use of play techniques is used across the multi disciplinary team caring for children, with appropriate numbers of play specialists taking a lead in techniques that other staff can adopt, including preparation of children for surgery All children have access to a play therapist Medicine (including intensive care) Safe and child friendly environment

34 Children are weighed and heighted on admission and measurements are plotted in growth charts Nutritional screening assessment is performed and a feeding plan is written, implemented and evaluated if required. Scales are approved and calibrated annually The environment / equipment is conducive to eating There is a breast feeding policy that is disseminated to all staff, is universally implemented and is evaluated. Mothers are supported with breastfeeding and have private facilities to do so Food meets the standards set out in the better Hospital Food Catering Services for Children and Young Adults Food is presented to patients in a way that takes into account what appeals to them Patients have sufficient information to enable them to access food Patients have set meal times but are offered a replacement if they miss a meal and can access snacks at any time Menus are appropriate to religious, cultural and ethnic background Protected mealtimes are in place Medicine (including intensive care) Safe and child friendly environment

35 Menus are developed with children and young people and their feedback is used to inform any changes to menu development 5 The Trust has an appointed LSMS (Local Security Manager Specialist) There are Trust security and fire policies. Staff have security ID badges. Inpatient wards have restricted access (Aspirational) depending if future commissioning arrangements for inpatient pediatric units - A wing on the ground floor of the hospital at JCUH will be dedicated to children`s services Improved parents facilities are provided to meet the needs of parents and carers during their child`s stay in hospital The environment meets the needs of children and young people and meet health and safety and disability regulations Environment meets the needs of siblings visiting the hospital Written child focused information for ongoing care is available for patients and their families Discharge planning commences on admission and is negotiated to meet the needs of the child and family, which are continually assessed Inpatient documentation includes discharge plan negotiated/ agreed with child and family Discharge information is available for children and their families which is age appropriate and in different languages Where child protection / safeguarding concerns exist the hospital procedure for discharge in such situations is followed Medicine (including intensive care) Safe and child friendly environment Discharge and ongoing care 5

36 Hospital stays are kept to a minimum with ongoing care transferred to a paediatric community team Parents / children / carers are provided with education and training and have documented competency packs completed prior to discharge for complex discharge patients Every lead health professional has adequate arrangements for transfer of young people to adult services, preferably via specific transition clinics involving staff from both paediatric and adult services Transitional care policies are in place and audited regularly Achievement of You`re Welcome in all areas Ongoing audit of transition process takes place Good practice would be: All + year olds are offered air time with doctor or nurse on their own when they attend outpatient areas Good practice would be: All competent + year olds are offered copies of letters written about them Accurate and timely information on services is provided to meet the needs of all children and young people in every section of the community. The information is written with the participation of children, young people and their families using a variety of formats, media and languages Service providers ensure that families receive information, explanation and support concerning benefits they are entitled to, particularly when there are children with complex needs in the family Medicine (including intensive care) Shared records and information 6

37 Age appropriate information is available about specific conditions, medicines, procedures, services and support groups in a variety of formats and media A range of communication methods are used and information is available about specific conditions, medicines, health promotion information A single documentation record (single case notes) for each patient is used across the Trust for all staff involved in the care of each individual child or young person Any prior records are available at all times whenever and wherever children are seen and assessed Clinicians letters are copied to the patient and or parents (as appropriate / competence level) All care is given by paediatric trained staff Provision of play therapy / recreational support meets the needs of all children and young people The nurse practitioner role will be developed and implemented in the department Expansion of specialist nursing services Exploration and implementation of Nurse Consultant role At every level in the organisation where children access services, staff are trained to provide paediatric basic life support The paediatric emergency team members are all competent to undertake any role required of them in the clinical emergency situation Medicine (including intensive care) Shared records and information Paediatric specific Training / workforce 7