Using the

to improve services for children,

young people and their families

BACCH/BACAPH

September 2014

FAMILY FRIENDLY FRAMEWORK

Structure

• Introduction• Where are we?• Systems - theory• Family Friendly Framework• Application - commissioning• Application - provision• Application – regulation• Benefits

Introduction

Why is the FFF needed?

• System reform - free market

• Austerity – public service cuts

• Unnecessary variations

• Waste

• Resource allocation

Biological systems

• Genetic coding in DNA• Basic proteins plus encoded fractal formulae• Iterative designs• Control systems based on feedback loops

• Interaction with environment• Innovation• Communication• ‘Survival of the fittest’

Learning“Simple rules”

Innovation plus learning = survivalCommunication

Service

Lifestyles

Determinants

InputInput Output

Evidence

Competence

Settings

Timing

Initial

Review

Transition

Life course

Prevention

Recognition

Assessment

Interventions

Purpose

Values

Leadership

Learning

Basics

Systems

Pathways

Networks

FFF 4x4 overview

Where are we?

Recent Reports• UK

– Berwick Report A Promise to Learn

• England – Kennedy Report, Atlas of Variations– Children + Young People’s Health Outcome Forum

• Scotland – GIRFEC (getting it right for every child) – Early Years Collaborative

• Wales – Rights of Children and Young people Measure 2011,– ‘Flying Start’, ‘Families First’

• Northern Ireland

– ‘Transforming Your Care’

Key themes

• Whole system approaches - culture

• Clear outcomes

• “Integrated care” = “pathway-based”

• Relentless focus on prevention

• Patient participation in the system

• Measurement – information - feedback

• Learning through innovation/improvement

Don Berwick

“You are stewards of a globally important treasure: the NHS.

In its form and mission, guided by the unwavering charter of universal care,

accessible to all, and free at the point of service, the NHS is a unique example for

all to learn from and emulate”.

Commonwealth Fund

For PCTs in England, the emergency admission rate for children with asthma ranged from 38.7 to 732.6 per 100,000 population aged 0–17 years (19-fold variation).

When the five PCTs with the highest rates and the five PCTs with the lowest rates are excluded, the variation is 5-fold.

Action to reduce emergency admissions requires a whole pathway approach, including public health, and primary and secondary care. Parental education and school medication management are vital to good care.

Variations

Theory - systems

CATWOE

Types of systems

Measures

Change

Environment

InputInput Output

A simple system

Environment

Trans

formation

Environment

positive

InputInput Output

Customer

Worldview

Actors

Owner

CATWOE

Soft systems methodology

Environment

negative

Peter Checkland

Service

Environment

positive

InputInput Output

Clients

Worldview

Actors

Owner

Services for CYP + Families

Patients

Commissioners

Providers

Politicians

Environment

negative

Service

Lifestyles

Determinants

InputInput Output

Children

Families

Communities

Health

Education

Social care

Providers

Regulators

Commissioners

Government

Private sector

Voluntary sectors

Users

Policymakers

Teams

Managers

Stakeholders-Partnerships

Systems

• Simple systems

• Complicated systems

• Complex (adaptive) systems

• Chaotic systems

Complex adaptive systems

• They are complex in that they are dynamic networks of interactions, not aggregations of the individual static components.

• They are adaptive, in that the individual and collective behaviour mutate and self-organise depending on the internal environment or adapt to the changing external environment.

• Complex adaptive systems are systems that have a large numbers of components that interact and adapt or learn"

JH Holland

Family Friendly Framework

Service pathwaysLife course pathways

NetworksWhole systems

Service

Lifestyles

Determinants

InputInput Output

Evidence

Competence

Settings

Timing

Initial

Review

Transition

Life course

Prevention

Recognition

Assessment

Interventions

Purpose

Values

Leadership

Learning

Basics

Systems

Pathways

Networks

4x4 Approach

Service pathways

Service

Lifestyles

Determinants

InputInput Output

Simple system

Better healthIll health

Prevention Recognition Assessment Interventions

NeedsOutcome

Lifestyles

Determinants

Complicated pathway

Service

Lifestyles

Determinants

InputInput Output

QuantitativeQualitativeEconometric

ProfessionalCulturalImprovement

PlaceSpaceSupport

AccessExperienceOutcome

Evidence

Timing

Competence

Setting

Basics

Serous otitis media

Needs Outcomes

HealthEquitySustainable

Protection

Promotion

Concern

Screening

Family

Child

Social

Psychiatric

ChildFamilyCommunity

Condition

Community Educational

Medical

Behavioural

Surgical

HealthEquitySustainable

27

Needs Outcomes

Initialpathway

Transitionpathway

Reviewpathway

Lifestyles

Determinants

Long term condition

Life course pathways

Life course pathways

B 1 5 1510 Adult

QAL Ygap

Quality of life

Ag e

QoL gap

Years gapSocial capital

Empl oyment

LifestylesPeer group

Marketi ng

EducationParenting

Safety

Nutrition

Genetics

Neil Halfon Transforming Early Childhood Community Systems

Services

DeterminantsLifestyles

Pathogenesis Salutogenesis

Specific programmes

PromotionProtection

AssetsHazards

Needs

Infant

Child

Young person

Life course pathway

Hazards Assets

Lifestyles Determinants

Infant

Child

Young person

Promotion Protection

Lifestyle hazards

Substance misuse

Lack of exercise

Smoking

Poor diet

Determinant hazards

Poverty

Poor housing

High crime areas

Inaccessible services

Lifestyle assets

Stable family

Good diet

Creative play

Friendships

Determinant assets

Stable communities

Sustainable economy

Affordable homes

Small inequalities

Lifestyles Determinants Services

Child

Preschool Parental smokingSmoking in media

Asthma services

School Health education in schools

Young person Health educationSmoking enquiry

in clinical consultations

Access to cigarettes near

schools

Smoke stop services

Family

Parents Tackling smoking in pregnancy

Nicotine replacement

Siblings Access to cigarettes

Extendedfamily

Smoking cessation

advertising

Tobacco taxation Nicotine replacement

Community

Home Smoke-free homes

Quality of housing

SUDIinformation

Neighborhood Smoke-free cars No advertising Smoke free shops

+ leisure

Society Smoke-free public places

Legislation increasing age of

accessControl of illegal

imports

Health services

Smoking cessation

interventions

Networks

Integrated care

34

Initialpathway

Reviewpathway

Life coursepathway

Transitionpathway

Networks

Systems

Valuesparticipationpromotionprotectionprovision

Purposehealthequitysafesustainable

Learningmeasuresfeedbackinnovationimprovement

Leadershipintegrityaccountabilitytransparencyinclusivity

Lifestyles Determinants

Values Purpose

LearningLeadershi

p

ProtectionPromotion

11

2

3

4

5

6

Hazards Assets

System Culture

Application planning and commissioning

Serous otitis media

Needs Outcomes

HealthEquitySustainable

Protection

Promotion

Concern

Screening

Family

Child

Social

Psychiatric

ChildFamilyCommunity

Condition

Community Educational

Medical

Behavioural

Surgical

HealthEquitySustainable

Planning otitis media services

Recognition InterventionsAssessmentCommissioner Prevention Outcomes

Rates of smoking in pregnancy.HCP uptake

Healthy ChildProgramme

Smoking cessationPH

Language devEducational achievement

Teachers for the deafHearing loops

   LA

AccessTimeliness

Hearing aidsSaLTParent support

Paediatricaudiology assessment

 CCG

Br feeding rates @6/52  

Recognition of hearing impairment in primary care

Breast feeding promotion in primary care

NHS England

  

 

 

 

 

Application - provision

Providers Prevention Recognition Assessment Interventions

Child

Specialist services

General services

Local Authority

Public Health

Third sector

Private

Providers Prevention Recognition Assessment Interventions

Family

Specialist services

General services

Local Authority

Public Health

Third sector

Private

Generic framework for providers

Transition pathway

Review pathway

Initial pathway

NeedsChild

FamilyCommunity

OutcomesEffectiveness

EfficiencyEquity

Initial Review Transition

Needs Outcomes

Child

Family

Community

Applicationregulation

Inspectors for Safeguarding

• Chief Inspector of Social Services • Director for Health Improvement,• Care Quality Commission • Her Majesty's Chief Inspector of Constabulary • Her Majesty's Chief Inspector of the Crown Prosecution

Service• Her Majesty's Chief Inspector of the Magistrates' Courts

Service• Her Majesty's Chief Inspector of Schools• Her Majesty's Chief Inspector of Prisons • Her Majesty's Chief Inspector of Probation

Informatics for improvement

46

A myriad of measures!!!

needs outcomes

Child

Community

Family

Determinants

Harm Exposure

Effectiveness

EquityEfficiency

AccessibilityAffordability

Acceptability

Outputs

Components

ProcessStructure

Environment

Measures

• Matter

• Meaningful

• Motivating

• Monitor change

Service measures simplified

needs outputs outcomes impacts

benefit valueeffectexpectations

Lifestyles +

Determinants

Life course and service pathway measures

Service outcomesmeasures

Life course outcomesmeasures

Healthimpact

measures

Health measures

Service impact

measures

Health service

measures

Public health

service measures

Needs

Benefits

Benefits - Families

• Improved experience and outcomes with • more timely care, closer to home.

• Better coordination and continuity of services.

• Greater participation at every level.

Benefits - Professionals

• Enables evidence into practice, through the use of agreed guidelines, algorithms and protocols across the network.

• Investment in inter-professional training and better support by improved learning through improvement.

• Increased skill mix within multidisciplinary teams, coupled with staff rotations within the network.

• Greater involvement in decision-making and the allocation of resources across the network.

Benefits - Managers

• Reduced costs achieved through greater integration – less duplication.

• A shift from a short-term focus on efficiency, to a longer-term (whole-life) focus on effectiveness and equity (the added value agenda).

• A framework for learning through continuous service improvement.

• Greater participation of clinicians and families in decision-making, delivery and improvement.

Benefits - Planners

• Brings multiple planners and commissioners together with shared thinking/values/models and a culture of collaboration rather than competition.

• Less fragmentation, duplication or omission and therefore better value for money across the network.

• Clearer lines of responsibility and accountability.• A framework for leadership and partnership

working.

Key messages

• Think “whole systems”

• Family focus

• Pathway based – all parts in place

• Evidenced based, competent teams

• Networked, allocation and improvement

• Alignment and synergy

• Weakest link – start for improvement