Developing a community child health service for the 21st century

Section 7: The Health Board ( HB) Questionnaire Methodology

A questionnaire ⁵⁴ was devised to elicit a range of information about how local Health Boards organise their community child health services. The questionnaire was approved by the Steering Committee. It was formatted in Questback (proprietary questionnaire software) to enable online completion with the help of colleagues from the Scottish Government Analysis and Statistics Division and in the hope that analysis of the information gathered would be easier.

Health boards were also sent a Word version of the document to enable data gathering before final completion of the questionnaire. It was expected that the Child Health Commissioner in each Board area would lead the task with input from key colleagues such as clinical and nurse directors from within clinical services. In some cases it proved difficult for data to be entered online and some Boards made paper returns which then required to be entered manually by members of the Child and Maternal Health Division administration. In a few cases, it was difficult to find an individual to gather the data, and the whole process from issuing the questionnaire to receipt of the final data took in excess of 3 months, far longer than was originally envisaged. Clarification of some responses was sought if they seemed unlikely or contradictory.

Questionnaire Response Handling

The data was received as a large Excel spreadsheet which was then subject to further analysis by the project consultant. A number of key themes emerged which related to structures, processes and outcomes in local CCH systems. Limited workforce data was also gathered but it was agreed that ISD and RCPCH census data would provide more detailed and robust information.

Summary of Health Board Questionnaire Findings

(For full report on findings see Annexe 4)

Management Configuration and CCH Clinic Arrangements

• More than half of HBs report they have a combined CCH and Acute Paediatrics Service which may be managed either in a directly managed unit or a CHP. However, 45% of CAMHS services are managed separately from either CCH or acute children's services.
• The number of senior managers responsible for CCH services varies widely and does not correlate with the HB population.
• The number of staffed office bases for CCH varies from 4-10 and does not correlate with the HB population.
• All HBs report they have local CCH clinics available for 0-16 year olds.
• 71% of HBs deliver general paediatric care in CCH clinics.
• Most CCH services across Scotland use a variety of premises in the community but a minority use child and family centres, forensic medical facilities and respite venues.
• In 5 HBs less than a quarter of clinics have reception and booking staff on site.
• 4 HBs report <50% of CCH clinics have adequate space to enable appropriate supervision of trainee paediatricians.

IT and Process Issues

• More than half of HBs use paper-based patient administration systems ( PAS) for CCH clinics.
• 11 of 14 HBs use the national Support Needs System to monitor children with additional support needs.
• Half of HBs have online referral guidelines for CCH; 14% have paper guidelines only. One-third have none.
• One-third of HBs do not have shared patient pathways between CCH and CAMHS services for overlap conditions.
• However, more than two-thirds of HBs have clinical consultation sessions between CCH and CAMHS for problematic cases.
• In a few HBs CCH clinicians do not have any access to comprehensive clinical investigations or to online results.

Specialty CCH Provision

• All HBs except 2 island HBs have a lead (Tier 3) consultant in paediatric neurodisability.
• All HBs bar one have a senior community paediatrician leading for children with visual impairment.
• All HBs except two have a lead senior community paediatrician for children with hearing impairment.
• All HBs have a lead paediatrician for child protection.
• All HBs save 2 island boards have a one-door entry system for child protection referrals.
• In all HBs save 2 island boards CCH doctors participate in interagency initial referral discussions ( IRDs).
• In the majority of HBs CCH clinicians have access to child protection peer review sessions.

Performance and Outcome Measures for CCH

• All HBs bar two large HBs operate 18-week referral to treatment ( RTT) for CCH clinics.
• These two HBs do not intend to introduce 18-week RTT for CCH clinics.
• Waiting times for a CCH clinic appointment vary from a maximum of 4 weeks to 6 months.
• 3 HBs have more than 26% did not attend ( DNA) rates in CCH clinics. Not all these HBs had a high proportion of deprived wards.
• 3 HBs did not know their DNA rates in CCH clinics.
• In terms of new to return patient ratios in CCH clinics, 7 HBs did not know their ratios for CCH clinics.
• Where known CCH N/R ratios varied from 1:1.5 to 1:9.
• 4 HBs did not consult parents/carers about their CCH clinics.

Participation in Networks and Planning Processes

• 8/14 HBs reported involvement in both national and regional networks by CCH clinicians.
• Only 4 HBs reported CCH involvement in local networks.
• However, the majority of HBs (71%) state there is CCH involvement in planning of children's health services at HB regional and national level.