Developing a community child health service for the 21st century

Section 6: Existing standards, performance and outcome measures relevant to CCH services

Scottish Government

The Scottish Government has published performance measures since 1997 when the Clinical Resource and Audit Group produced a range of indicators for acute hospitals. Davies (2005) ⁴⁷ produced a report for NHSQIS in which he recommended the development of "comparable clinical indicators" but cautioned regarding the production of robust and interpretable data and highlighted the need to create ( IT) systems that encourage "data usage in programmes of quality improvement at service level".

As noted in CCH services, paper recording systems are widely used which present challenges in monitoring quality. More recently the NHSiS Quality Strategy ⁴⁸ has been published with a range of parameters for improving services.

• HEAT Targets

HEAT ⁴⁹ targets were introduced in the "Better Health, Better Care" report in 2007. Those for 2008-9 covered three areas specifically relating to children: dental registration of 3-5 years; children defined as overweight completing healthy weight intervention programmes and new-born children exclusively breastfed at 6-8 weeks.

These could be used as an indicator of effectiveness of primary care and community services but not specifically for community paediatrics.

The new out-patient Did Not Attend ( DNA) HEAT target sought to achieve a reduction of the DNA rate to 9.2% in the year ending March 2010. Overall, the rate was 10.5% in 2010, making the fact that three health boards are reporting DNA rates for CCH clinics at over 26%, very far from what is deemed acceptable for the whole Scottish population and represents lost opportunity and waste which can be ill afforded.

• 18-week Referral to Treatment ( RTT) Initiative

NHSScotland says that 18-week RTT sets "a whole-journey standard for almost all patient pathways - from GP to hospital". As noted from the HB questionnaire results, 2 large health boards do not apply 18-week RTT to their CCH clinics and do not intend to. It is not clear why CCH clinics (who see some of the most deprived children in Scotland and present the opportunity of mobilising early intervention for such children) should be exempt from 18-week RTT.

RCPCH Standards

RCPCH has published a whole series of standards and College-endorsed guidelines ⁵⁰ relevant to CCH practice on its website.

The "Charter for Paediatricians" (2004) ⁵¹ is a comprehensive document intended to improve working practice and promote best care for children. Helpfully it outlines the facilities a paediatrician should have to enable them to carry out their duties. Requirements particularly pertinent to CCH are marked * on the list.

"All paediatricians should expect to have the following:

• Satisfactory bed allocation in a suitable environment staffed by nurses with appropriate paediatric qualifications
• Access to short stay, day case and emergency beds*
• Dedicated paediatric outpatient departments*
• Children's services should not be disseminated too widely among too many centres*
• Support from appropriate multidisciplinary team*
• Full investigative facilities for children readily available*
• Access to modern information technology in clinical areas*
• Adequate facilities for education of undergraduates and post graduates*
• Appropriate secretarial support with cover arrangements for absence*
• Appropriate additional clerical and administrative support to undertake filing, photocopying, finding medical records, etc.*
• Consultant letters sent out preferably within 5 days and at a maximum within 10 days of dictation*
• Appropriate office facilities must be provided. There must be easily and readily available access to facilities for private work and confidential meetings, conversations and telephone calls, recognising the sensitive nature of much of the work which paediatricians are required to carry out, and the right to confidentiality of children and their families*
• The office must have access to appropriate IT facilities including access to e-mail and the internet for appropriate levels of CME/ CPD commensurate with requirements for revalidation*
• Adequate arrangements to provide continuity of care."*

BACCH Standards

BACCH has published a number of helpful documents regarding monitoring and measurement of quality in CCH.

• Standards for Outpatients ( Annexe 12)

These standards provide a comprehensive framework to enable services to provide a "flexible child friendly service appropriate to needs of the client and profession for all children and young people" relating to structure process and outcome parameters. This document can assist in monitoring quality in local CCH clinics, but it is apparent from the HB questionnaire that some services in Scotland are not meeting some of the parameters (for example appointment waiting times).

It is recommended that local services perform an audit of their CCH clinics to determine whether they are meeting these standards.

• Service specification for Community Paediatrics ( Annexe 9)

Dr Fawzia Rahman and colleagues in Derby City PCT have produced a comprehensive service specification for CCH Medical Services and the author has received much support and help from DR Rahman regarding her methodology and results. Derby City is a small PCT and there is a small local CCH workforce. Further work was deemed necessary to adjust the specification for broader application in the Scottish context and taking account of different terminology and legislation. An informal consultation was carried out with a group of paediatricians working in the community and amendments were made. Further formal consultation may be needed before widespread application of this service specification.

The specification seeks to do the following:

• Define the evidence base
• Describe the service
• Specify the mode of service delivery
• Outline the Access criteria
• Define the discharge criteria
• Specify information and support for parents carers and children
• Lists the quality and performance standards

• Standards for Child Development Services ⁵²

This guide for commissioners and providers was published in 2000. It lays out the requirements for a comprehensive child development service, and why what is needed is needed. In particular it lists the client groups of children.

• Job Planning Guidance for Consultant Community Paediatricians ⁵³

This guide outlines best practice in job planning for CCH consultants.