London Acute Care Standards For Children And Young People
London acutecare standardsfor children andyoung peopleDriving consistency inoutcomes across the capitalRevised August 2016
About this documentThese standards bring together a number of children’s standards into one document. In the firstinstance, it was developed by the London Children and Young People’s Strategic Clinical Network.It has been revised by the Healthy London Partnership’s Children and Young People’s Programme(August 2016). We would like to acknowledge the work of the numerous organisations referencedthroughout.2 London acute care standards for children and young people
ContentsIntroduction.4A. Institutional commitment.7B. Governance and accountability.9C. Patient and family experience.10D. Integration and care co-ordination.11E. Clinical services.13F. Clinical support services .21G. Children and adolescent mental health services within acute paediatric care.22H. Outpatients.22I. Long term conditions.22J. Children with complex needs.23K. Safeguarding children and young people.23L. General services for children and young people.24M. Workforce planning.24N. Education and training.25Appendix.27Revisions to the London Acute Care Standards for Children and Young People (April Additional reading.37London acute care standards for children and young people 3
IntroductionPurposeThe Healthy London Partnership (HLP) is a collaborationbetween London’s 32 clinical commissioning groupsand NHS England London region to support the deliveryof better health in London.The Healthy London Partnership’s transformationprogramme for children and young people aims torebuild healthcare around London’s children and youngpeople with five key areas of focus: develop population-based networks to promotehealth and co-ordinate care reduce variation in quality of services integrate care across public health and primary andsecondary healthcare services develop commissioning of children andyoung people services to enable the effectivecommissioning of pathways of care develop innovative access models of care.Acute care standards for children andyoung peopleIn seeking to reduce the variation in quality ofservices, the Children and Young People’s Programmeacknowledges the work done by the London Childrenand Young People’s Strategic Clinical Network toidentify and bring together standards already inexistence relating to the acute care of children andyoung people (CYP).Standards were located in publications from a largenumber of organisations and more than 800 standardsrelated to acute care alone. Extensive work wasundertaken to collate these into one document whichset out the minimum standards which should bedelivered in acute, secondary and tertiary services forchildren and young people in London.As there was extensive similarity and overlap acrossmany of the standards, the standards have beenworded to capture the essential meaning of themultiple sources. However, the original sources havebeen included and cross referenced. Commissioners andproviders are encouraged to read the original sources aswell as this document.4 London acute care standards for children and young peopleThe original document was published in April 2015.However, it was always recognised that over time newstandards of acute care would be agreed and that anysuch standards would need to be incorporated intothe London Acute Care Standards for Childrenand Young People, as appropriate. In the succeeding12 months, a number of key documents have beenpublished that relate to acute care services for childrenand young people.For the most part, the changes that have beenincorporated reflect: Royal College of Surgeons: Standards for nonspecialist emergency surgical care of children;(November 2015). Healthy London Partnership, Urgent and EmergencyCare programme: Urgent and Emergency CareFacilities and System Specifications; (November2015). NICE guidelines [NG43]: Transition from children’sto adults’ services for young people using health orsocial care services (February 2016).Where changes have been made to the originaldocument, these are listed in the appendix.AudienceThis document is aimed at commissioners and providersof acute care services for children and young people. Ithas brought together information and standards of careinto one place to enable the effective commissioning ofservices which meet these required minimum standards.Providers can use these to undertake a self assessmentof their ability to deliver the required quality of acutecare for children and young people. They can be usedto validate, challenge and to quality assure services.Utilisation and implementation of these standards willhelp to reduce the variation in the care delivered tochildren and young people across the capital. They willalso help to reduce the enormous variation in outcomesexperienced.InclusionsThe standards outlined in this document relate to acutecare services provided in hospitals where there is an inpatient facility for children and young people.
For the sake of clarity, the standards do not apply tourgent care centres; either in-house or standalone.Where acute care services are provided in hospitalswhere there is an in-patient facility for children andyoung people, the standards apply to seven dayservices. There is no difference in the provision ofservices during the week compared to those at theweekend.All services must meet the Care Quality Commission’sfundamental standards of care and Section 11 of theChildren Act (2004) as well as the 2013 document oninteragency Working Together to Safeguard Children.ExclusionsAll specialised services, including neonatal, that areadditionally commissioned against the appropriatenational specialised service specification. However,these standards are an adjunct to the requirementof the service specifications, and should be usedin conjunction with them. Standards relating togeneral hospital requirements are not included (e.g.staff appraisal policies, medical devices standards,moving and handling competencies, service-specificcompetency frameworks and professional bodyguidance on professional standards).NotesIn this document the term children or child should betaken as meaning children and young people underthe age of eighteen years. They also take into accountyoung people aged 16 – 25 who are undertakingtransition to adult services, including those with morecomplex needs.The term multidisciplinary team is used throughoutthis document. The composition of an acute caremultidisciplinary team will vary according to need. Therealso needs to be close collaboration with communityteams, local authorities, social care, local education,school nursing, GPs, continuing healthcare nursing,child and adolescent mental health services (CAMHS),psychology, occupational therapy (OT), physiotherapy(PT), speech and language therapy (SLT), communitypaediatric and district nursing teams.Further standard developmentThe Healthy London Partnership is aware that thesestandards do not describe all areas of care for childrenand young people.Readers are asked to note that two further setsstandards will be published shortly: Healthy London Partnership, Children and YoungPeople Programme: Children’s Surgical Networks:Emergency Surgery, Framework and Standards. Healthy London Partnership, updated PaediatricAssessment Units Standards.The Children and Young People’s Programme willcontinue to develop additional standards across avariety of care settings. Community standards and outof hospital care will be the next areas of work for theprogramme.Commissioners and providers would be expected toincorporate these into planning once published.Both in developing and implementing standardsrelating to service provision for CYP, care must considerthe needs of the child including culture, beliefs andethnicity and should be based on the United NationConvention on the rights of a child that says that everychild has the right to: A childhood, including protection from harm. Education, including completion of primary schoolfor all girls and boys. Health and health services, including clean water,nutritious food and medical care. Fair treatment, including changing laws andpractices that are unfair on children. Be heard, including consideration of children’sviews.London acute care standards for children and young people 5
London’s ambitions for children andyoung people’s networksSome of the issues in delivering effective healthcareto children and young people arise because of thefragmentation of services and commissioning structuresand the lack of integration of providers. This applies toservices in primary, secondary, tertiary and communitycare.Analysis of serious incidents has shown that childrenand young people are often subject to a failure ofcare when moving across care settings. More effectivelinkages between providers and commissioners wouldhelp to reduce these issues.6 London acute care standards for children and young peopleTherefore, a model of population-based networksbased on such linkages across all settings is proposedto address these issues. This is strongly alignedwith NHS England’s Five Year Forward View, whichacknowledges that traditional divides between differentparts of the health system act as a barrier to coordination and personalisation of care. It recommendsdissolving these boundaries to ensure more effectiveco-ordination of care. New models will emerge overtime and the Healthy London Partnership is keen thatcare for children and young people is central to thesedevelopments.
EVIDENCEA. INSTITUTIONAL COMMITMENTREFThe following statements identify the requirement for CYP services to have commitment from the board and the appropriate governance structures in place to ensure a safe,consistent level of quality is provided to all children and young people, parents and carers.InfrastructureInvolvement of trust board1It is recommended that each trust with services for CYP has a named executive board member withboard level responsibility, covering all aspects of care for CYP aged 0-18 years and for the care of youngpeople up to the age of 25 with more complex needs. This should include responsibility for quality, safetyand safeguarding of these children and young people.In addition it is recommended that there is a non-executive director or designated representative whoalso holds responsibility for quality, safety and safeguarding of children and young people.The executive board members chair an appropriately constituted governance committee for CYP,reporting directly into the board with the following clinicians responsible for children’s services asminimum membership: Lead clinician for CYP services Consultant paediatrician Senior children’s nurse and other relevant health professionals Consultant anaesthetist Consultant in emergency medicine Consultant surgeons (general and specialty) Consultant radiologist or senior radiographer Senior children’s manager CYP and parent representative Designated / named nurse and doctor for safeguarding CAMHS representativeThe governance committee is responsible for regional audit, standards and care pathways. The committeeundertakes self assessment of the trust (and each individual hospital site, if applicable) against the HLPacute care quality standards The safeguarding governance committee reports into the governancecommittee for CYP.2The trust has operational policies in place agreed by the trust board for the following:Paediatric service Management of the acutely unwell child, including transfers and management of life savinginterventions Surgery and anaesthesia in children and young people, including management of life savingintervention in these circumstances Imaging and pathology services Mental health services within paediatric acute care Emergency Department Pain assessment and management of pain in children Transition to adult services Safeguarding Demonstrated in published plans, reports and inmanagement structure to support the serviceGovernance structureTerms of reference, membership and accountabilityof the group (Note: This group may have otherfunctions as long as the standard is met in relation toterms of reference, membership and accountability.)Evidence in minutes of regular discussion at boardlevelRole identified in the job plan with evidence ofreview at appraisalEvidence of audit and compliance against standardsSelf assessment against HLP acute care standards forCYP and action planEvidence of safeguarding structuresEvidence that operational policies regarding provisionof CYP services are reviewed regularly by governancecommittee1, 4, 5,6a, 6b, 7,8, 9, 23,57, 58Current operational policiesRole identified in job plan and reviewed at appraisalDiscussion of data in minutes of governancecommittee and escalation to trust board whenrequired6a, 6b, 8,23, 57, 58London asthma standards for children and young people 7
A. INSTITUTIONAL COMMITMENTInfrastructureEVIDENCEREF1, 4, 5, 6a,6b, Submission of data to national audit programmes»» TARN»» CEM audits relating to children»» National Paediatric Diabetes Audit»» Oncology (if applicable)»» Epilepsy 12»» CQC»» Other relevant national audits»» PROMs and PREMsData is benchmarked against national outcomes whereavailableEvidence of SHMI data reviewed regularlyMortality and morbidity and outcomes reviewsParticipation in CDOP panelsQuality and safety dashboards and action plansEffective investigation and action plans following SIsGovernance and audit3There is a programme of audit across all elements of the service. All services that manage children areaware of, submitting data to and participating in appropriate national, regional and local clinical auditprogrammes. 10, 11,22,23, 574Each trust has a comprehensive directory of services, contacts details and referral guidelines,completed separately for each hospital site. Current updated directory of services5The service meets the current staffing data recommendations and the board receives data on staffingcapacity and capability quarterly. Staffing records and rotasDiscussion of staffing in board papers7, 51 The unit produces a CYP annual report summarising activity, compliance with quality standards, andclinical outcomes. This report is shared with all referring hospitals, primary care clinicians, communitycare and all commissioners. Annual report5, 23Trusts delivering care to CYP demonstrate commitment to participation in a population based CYPnetwork which links with providers, commissioners, public health, local authorities and involves CYPand their families. Shared pathways and protocols and workforce planning are developed across thenetwork. There is evidence of collaboration between all sectors including local children’s safeguarding boards. Network terms of reference and hosting arrangements 4, 5, 6a,6b,Trust participation in network meetings7, 9Shared network protocols and guidelinesRegular assessment of performance in placeWorkforce planningExamples of measures to improve service delivery acrossthe networkEvidence of collaborative working with LSCBs6Involvement in local networks7 8 London asthma standards for children and young people
A. INSTITUTIONAL COMMITMENTEVIDENCEREFInvolvement in local networks8There is a directory of all surgical specialties and age ranges available within the surgical network asindicated with surgical network standards. Networks have clear protocols describing how services at othersites will be provided elsewhere through network arrangements (e.g. diagnostics, surgery, interventionalradiology, endoscopy, all tertiary services). Directory of servicesOperational policyEvidence of regular audit of London-widestandards for CYP surgical networks on childrenincluding number and timeliness of transfers andoutcomes6a, 6b,11, 12B. GOVERNANCE AND ACCOUNTABILITYQuality and safetyThere is evidence of continuous assessment and ongoing service improvement which includes patient and family feedback and involvement in service development.Audit and data (minimum dataset, dashboard)9The Urgent and Emergency Care Clinical Audit toolkit is used to review individual clinician consultationssystematically wherever children with urgent care needs are assessed, including on the telephone, face toface, in hospital or in the community. 10There is use of national minimum dataset that incorporates the specific needs of children and participationin regular required audits, such as safeguarding.Evidence of use of national datasets such as: 11Evidence of audit of consultations using toolkitMaternity and Children’s Data Set whichincorporates : Children and Young People’s HealthServices Data SetMental Health Services Data Set (MHSDS)Evidence of safeguarding audit programme6a, 6b, 51ProposedbyCHIMAT Regular audit, outcomes discussed at board levelwith evidence of feedback to improve services6a, 6b, 11Multidisciplinary audit and morbidity and mortality meetings are held regularly. When a death occurs within30 days of surgery a multidisciplinary meeting is convened and a note made in the clinical record. Thereare regular morbidity/mortality multidisciplinary team (MDT) reviews of individual cases to identify areas ofgood practice. Evidence of morbidity and mortality meetingsEvidence of SI reports, action plans and learni
London acute care standards for children and young people 5 For the sake of clarity, the standards do not apply to urgent care centres; either in-house or standalone. Where acute care services are provided in hospitals where there is an in-patient facility for children and young people, th
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3 Principles and Values of Acute Mental Health Care 8-9 4 Key Service Areas of the Acute Care Pathway 10-11 5 Acute Mental Health Care Pathway Standards 12 . Through the development and implementation of this Pathway we are confident that it will help to promote a genuine partnership approach in mental health services.
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