Children s Services in Medway NHS FT. Children s Directorate 23 March 2011

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1 Children s Services in Medway NHS FT Children s Directorate 23 March

2 Intensive Care High Dependency Special Care Transitional Care Neonatal Transport Service Retinopathy Neurodevelopment Safeguarding Children & Young Adults Respiratory Gastroenterology Haemato & Oncology Endocrinology Allergy Adolescent Unit COaST Neurodevelopmental Disability Looked After Children Learning Disabilities & School Nursing Therapists Health Visitors Maternity Services Neonatal Medicine General Paediatrics Community Paediatrics Neonatal Networks L1 & L2 units Sidcup/Maidstone reconfiguration Paediatric Surgery Kent neonatal surgical review Laparoscopic surgery Anaesthetics, Theatre, Radiology, HDU Education & Training 2

3 Neonatal Paediatrics Aung Soe Lead Clinician 3

4 Oliver Fisher Neonatal Unit Lead Level 3 Neonatal unit in Kent 1. Intensive care Cooling, Prematurity 2. High dependency 3. Special care 4. Transitional care Neonatal Outreach service Neonatal Transport Service Risk, Education, Research, Audit Staffing - Medical (22), Nursing (79), Admin (9) Oliver Fisher Special Care Baby Trust 4

5 Data - Activity Live births Admissions Inborn 557 (82%) 718 (86%) 734 (87%) Activity days Intensive care days

6 Outcome Within network 95% Survival rate in extremely preterm infants Other outcomes Brain, Lungs, Heart, Bowels, Hearing, Vision, Development Parental involvement Gestation in weeks (number) Survival % 2009/10 23 (9) (9) (36) (49) 96 6

7 Paediatric Surgery To provide the BEST specialist service LOCALLY With King s College Hospital Paediatric Surgeons in Medway Support for Neonatal unit and Paediatric ward Outpatients and Day case surgery Laparoscopic Surgery Tongue Tie clinic Working with Maidstone, Darenth Valley Hospitals 7

8 General Paediatrics Paul Williams Lead Clinician 8

9 General Paediatrics Emergency work Penguin assessment unit Dolphin/Panda wards Outpatients New referrals Follow up attendances Speciality services 9

10 Emergency workload ~ 7000 referrals seen on Penguin per year (19 per day) ~ 20% admitted overnight COW system Twice daily Consultant ward round including weekends Very high turnover with average LOS < 2 days Child protection 10

11 Out patients 2750 new referrals per year 8800 follow ups seen Consultant lead service Mixture of general and speciality clinics held Current waiting time 6-8 weeks 11

12 Speciality clinics Diabetes Growth Gastroenterology Haematology / Oncology Respiratory Cystic Fibrosis Enuresis UTI 12

13 COaST Clinical specialist nursing team Diabetes Respiratory and CF Oncology Dermatology Generic Social worker 13

14 Potential developments Allergy especially food allergy Adolescent inpatient unit Development of networks Diabetes Epilepsy Consultant expansion to waiting times 14

15 Threats to services Shortage of junior doctors Funding for short stay attendances Funding for specialist nurses 15

16 Community Paediatrics Folake Durowoju Lead Clinician 16

17 Neurodevelopmental and Behavioural Paediatrics Multidisciplinary assessments for Neurodevelopmental disorders (ADHD, Autism, PDD) Joint clinics with therapists Specified pathways Close work with schools Treatment and parent/carer training Neurodisability ;Developmental delay, cerebral palsy Management of children with complex disability. 17

18 2077 New Referrals 5620 Follow up Majority of referrals from GP (40%) Over a third of our patients will need follow up to adulthood. 18

19 Looked after Children Service Providing health assessments for LAC children Training of Foster Carers Health input for the care plan of LAC 724assessments in the last year. 19

20 Learning Disability Special needs Nursery Post diagnostic support Direct behavioural work Transition 20

21 School Nursing Public Health agenda Specialised clinics audiology, enuresis Special School Nursing Special school clinics with Paediatricians 21

22 Safeguarding Everyone s responsibility Assessments 54 NAI; 7 CSA last year. Input to CAF and Case conferences Training 22

23 CHALLENGES More collaborative work Flexibility and Capacity Staffing Respite provision Psychology and Psychiatry support 23

24 Intensive Care High Dependency Special Care Transitional Care Neonatal Transport Service Retinopathy Neurodevelopment Safeguarding Children & Young Adults Respiratory Gastroenterology Haemato & Oncology Endocrinology Allergy Adolescent Unit COaST Neurodevelopmental Disability Looked After Children Learning Disabilities & School Nursing Therapists Health Visitors Maternity Services Neonatal Medicine General Paediatrics Community Paediatrics Neonatal Networks L1 & L2 units Sidcup/Maidstone reconfiguration Paediatric Surgery Kent neonatal surgical review Laparoscopic surgery Anaesthetics, Theatre, Radiology, HDU Education & Training 24

25 Response to Members Questions Raised at the Members Event on Children s Services 24 th March 2011 The evening was opened by Medway Public Governor, Margaret Ratcliffe. She welcomed those present and introduced Dr Aung Soe, Clinical Director for children s services and Lead Clinician for neonatal paediatrics, Dr Paul Williams, Lead Clinician for general paediatrics and Dr Folake Durowoju, Lead Clinician for community paediatrics. Dr Soe and his team gave a presentation on children s services run by the Trust, which included neonatal medicine, general paediatrics, paediatric surgery, and community paediatrics. A discussion followed with and questions and answers summarised below. How can people help a vulnerable child? Anyone can report a case to social services if they are concerned about a child. Are the any plans to employ a child psychologist? Not at the present time. Is the lack of junior doctors a nationwide problem? Yes it is. The government changed the visa regulations which make it more difficult for overseas junior doctors to see employment. There are no national solutions at present. The services provided by the paediatric teams are very impressive. Is it possible to promote the good practice to other services within the Trust? The success of the paediatric services compared to other departments is largely due to the volume of patients that are dealt with. In comparison, the paediatric service treats considerably less patients than services covering adult medicine. Does the Trust have its own screening equipment? No. All screening is carried out by one clinic at Guy s hospital. Could the Trust provide screening services and thus generate an income? It could be possible in the future. Many aspects would have to be considered first to ensure it was financially viable. Notes from the Members Event around children s services 23 March 2011 Page 1 of 2

26 What is the waiting time for patients referred to the community paediatric service? This can range between 8 and 13 weeks. The presentations have outlined how well the service is running but are there any areas where the services could be improved? It was noted that only a small number of younger people had become members of the Trust. A number of suggestions were passed to the Governor and Membership Lead to help raise awareness of membership to the younger generation. These included: Local schools Local organisation called Kasbah Local youth centres Medway Youth Parliament School s Councils A children s psychologist to support the community paediatric service would be beneficial. The service did already work with educational psychologists but this did not cover the wider need. Had the Trust considered having an adolescent ward to cover the transition between childhood and adulthood? It was noted that a charity called Peter s Place was lobbying for a hospice to be created for children in their late teens. Details were provided of the charity s next meeting taking place on 1 st April. MR closed the meeting and thanked everyone for their time and input in the event. Event closed at 8.20pm. Notes from the Members Event around children s services 23 March 2011 Page 2 of 2

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