CHILDREN AND YOUNG PEOPLE’S HEALTH SUPPORT GROUP

MEETING – MONDAY 26 APRIL 2010

CONFERENCE ROOM 3, VICTORIA QUAY, LEITH, EDINBURGH

MINUTES

Present:

Children and Young People’s Health Support Group (CYPHSG)

Malcolm Wright, Chief Executive, NHS Education for Scotland (NES) - Chair

Sharon Adamson, West of Scotland Regional Planning Group

Safaa Baxter, Association of Directors of Social Work

Jim Beattie, Scottish Officer, Royal College of Paediatrics and Child Health

Michael Bisset, Consultant Paediatrician, RoyalAberdeenHospital for Sick Children Mary Boyle, NHS Education for Scotland

Sarah Burton, Policy Development Manager, representing Bronwen Cohen, Chief

Executive, Children in Scotland

Zoë Dunhill, Child Health Consultant

Andrew Eccleston, Consultant Paediatrician, NHS Dumfries and Galloway

Deirdre Evans, Director, National Services Division

Annie Ingram, North of Scotland Planning Group

Ann Kerr, Team Head, Healthy Living, NHS Health Scotland

Kathy Leighton, RoyalCollege of Psychiatrists

Pauline McCartan, Speech and Language Therapy

Neil McKechnie, HM Chief Inspector of Education

Brenda Renz, British Psychological Society

John Wilson, Chair, SEAT Children’s Regional Planning Group

George Youngson, Consultant Paediatric Surgeon, NHS Grampian

Scottish Government

Kay Barton, Health Improvement Strategy

Catherine Calderwood, Senior Medical Officer

Lucy Colquhoun, Child and Maternal Health Division

Val Cox, Deputy Director, Positive Futures, Children, Young People and Social Care, Education Directorate

Christine Duncan, Change Manager, Maternity Services, Child and Maternal Health

Division, Health Directorate

John Froggatt, Deputy Director, Child and Maternal Health Division

Margo Fyfe, CAMHS Nurse Adviser, Mental Health Division, Primary and Community

Care Directorate

Deirdre McCormick, Nursing Officer for Children, Vulnerable Families and Early

Years

Nicola Robinson, Allied Health Professions, Health Promotion and Support in

Schools Team

Mary Sloan, Policy Manager, Child and Maternal Health Division

Apologies:

Lorraine Currie, Chair, Child Health Commissioners’ Group

Linda de Caestecker, Faculty of Public Health

Gavin Fergie, Professional Officer for Scotland, Community Practitioners and Health

Visitors’ Association

Lesley Fraser, Deputy Director for Safer Children, Stronger Families, Scottish Government Education Directorate

Claire Gibson, Community Care Providers

Mo Grant, Allied Health Professionals Scotland

Graham Haddock, Consultant Paediatric Surgeon, RoyalHospital for Sick Children,

Yorkhill

Janice MacKenzie, Strategic Paediatric Educationalists and Nurses in Scotland (SPENS)

Ray Murphy, Association of Directors of Education in Scotland (ADES)

Eleanor Nisbet, Royal College of Nursing

Chris Ridley, Integrated Children’s Services, Health Directorate

Shirley Rogers, Scottish Ambulance Service

Caroline Selkirk, Director of Innovation and Change, NHS Tayside

Jan Warner, Director of Patient Safety and Performance Assessment, NHS Quality

Improvement Scotland (QIS)

ITEM 1WELCOME AND APOLOGIES

1.Malcolm Wright welcomed everyone to the quarterly meeting of the Children and Young People’s Health Support Group, pointing out that there was a very full agenda. There would be presentations in the morning and afternoon with breakout sessions afterwards to allow members to discuss the issues more fully.

ITEM 2CHILDREN AND YOUNG PEOPLE’S HEALTH SUPPORT GROUP (CYPHSG)/QUALITY IMPROVEMENT SCOTLAND (QIS) VISITS

2.A draft model for the visits was circulated prior to the meeting. John Wilson reminded the meeting that since the publication of the Action Framework in 2007 and the National Delivery Plan for Children and Young People’s Specialist Services in Scotland in 2009, a lot of activity and investment had taken place and it was now appropriate to look at the impact they had had on health services. He emphasised the visits would not take the form of another inspection. The aim was for the visits to be productive, cooperative and multi-disciplinary. The Action Framework was a key document and the visits should review progress on its implementation. The visits could also identify opportunities for the Support Group to inform its future workplan. It was hoped they would also provide an opportunity for Boards to identify areas for development and stresses.

3.John went on to say the sub-group had looked at various models and was recommending the visits should be to each region and should be done over a 2 day period – Day 1 would concentrate on regional activity, Day 2 would concentrate on the individual constituent Boards. Boards would be asked to demonstrate progress and could showcase successes and/or challenges in the 7 areas of the Action Framework, plus health improvement. They would be asked to complete a template prior to the visit.

4.The arrangements for the Special Health Board visits would be different. There would be a one day meeting with all the Special Boards – the morning session would be with all the Boards, the afternoon session with individual Boards. They would be asked to give examples of national initiatives. Links would be made with patient/carers’ groups, drawing on existing work.

5.John then invited feedback from the Group on the proposed approach before consulting with the Service.

6.During discussion, the following points were raised:

  • Pleased that the Special Boards, and health improvement, were to be included
  • The Early Years Framework and health inequalities should be included
  • The earlier CYPHSG visits were perceived as inspections – are these visits to be for advocacy, remediation? Will Boards highlight their best and worst practice?
  • Feedback to the Boards, framed against standards, would be very important Feedback would be given on the day and followed-up regionally and nationally
  • It would be helpful to find out what isn’t going well where the Support Group could help
  • The visits should be a balance between challenge/support, and sharing good practice
  • the model is too vague, it needs to be robust
  • Will the submitted work be published with comments? Will the work be high enough quality to publish?
  • The National Delivery Plan Implementation Group (NDPIG) are concerned at the timing of the visits. They are being perceived as an inspection
  • The NDPIG is concerned about the visits replicating their work
  • The purpose and timing will be dictated by the Support Group
  • Secondary paediatrics are at risk. General paediatrics, and how they link in to services, should be included. In at least one area consultants will soon have to cover middle grade work
  • Jim Beattie could perhaps provide a briefing on secondary paediatrics before the model goes out for consultation
  • The North of Scotland Regional Planning Group is looking at District General Hospital (DGH) services
  • SEAT – in Fife, the children’s ward is moving into the maternity site
  • There is an estimated 20-70% gap in workforce. A lot of work is ongoing re workforce.

Action: John Wilson/Jan Warner to discuss issues to include with Kay Barton/Val Cox.

John Wilson to speak with Lucy Colquhoun/Caroline Selkirk re the concerns of the NDPIG.

The Sub-Group to consider including DGH paediatrics at its next meeting.

John Wilson/Jan Warner to take on board the comments and consider at next meeting – consider the purpose and timing of the visits.

ITEM 3MATERNITY SERVICES ACTION GROUP

7.Malcolm reminded the Group that it had agreed to work closely with the Maternity Services Action Group. Christine Duncan, the Change and Delivery Manager for Maternity Services had agreed to present to the Group.

8.Christine began by explaining that she was on secondment to the Scottish Government from the NHS and she had a public health/inequalities background. She went on to say the Maternity Services Action Group (MSAG) had been around since early 2000 – it was an overarching group providing guidance and advice. It had a large membership with wide representation. Christine then presented the attached slides.

9.During discussion, the following points were raised:

CAMHS have good examples of joint working

  • Lessons from the Family Nurse Partnership should be spread widely, showing examples of how to bring vulnerable groups on board
  • Neonatal services are a major issue but the Scottish Government is funding 3regional MCNs. An expert group, chaired by Stewart Forsyth, is to be set up to pull together the work of these MCNs
  • The Framework may feel right but the services may or may not agree the level of care, eg rurally there may be practical issues around deliverability. Service configuration is a challenge – remote and rural areas need local maternity services
  • The Framework stakeholder day in October will think about how to implement the Framework
  • Caesarian rates and workforce are part of MSAG’s workplan
  • The quality strategy is helping to focus on how maternity services can improve outcomes
  • Fathers should be involved – work is ongoing with young fathers. The Framework encourages a “significant person” to be with mothers through the process. Who the person is should take account of the women’s wishes
  • Key areas for action include: workforce issues, sustainability in remote and rural areas; mortality; morbidity

ITEM 4MIDWIFERY 20/20

10.Malcolm summarised the Midwifery 20/20 project – which is looking at demographic changes, including asylum seekers and older/younger mothers. It is also looking at the training/education etc for midwives. The final report will be drafted in May in advance of the UK Programme Board in June, where all key stakeholders will have an opportunity to comment further. It will be for the 4countries to benchmark against the key recommendations and prepare an implementation plan. It will include the interface between midwives, GPs etc. Encouraging young people to access maternity services should be covered in school.

11.Noreen Kent, Midwifery 20/20 UK Programme Director, gave a brief presentation explaining that the project was about the future of the midwifery profession in the 4 countries, with the work having been commissioned by the 4Chief Nursing Officers. The aim is to improve outcomes and experiences for women, babies and families. The 5 workstreams were tasked with identifying the changes needed to the ways in which midwives work, their role, responsibilities and the training/professional development needed to achieve this, in order that midwives can lead and deliver care in a rapidly changing health and social environment. The 5 workstreams have now submitted their final reports.

12.The Education and Career Progression workstream –led by England - looked at clinical and academic careers, mobility and flexibility, newly qualified midwives, levels of practice, research, midwife managers and teachers, and the image of midwifery as a career choice. Consideration was given to current pre-registration education and it was acknowledged that midwives are increasingly seeing women with more complex problems from existing co-morbidity, older mothers, obesity issues etc, and their training needs to adequately prepare them to care for these women. The issue of attrition from midwifery training has also been explored as have existing AP(E)L arrangements. A career pathway which enables both clinical and academic careers to be followed more flexibly and effectively was also considered.

13.The Measuring Quality workstream - also led by England – had the remit of looking at metrics work, clinical quality and outcome indicators and valuing midwifery care. Although there were many quality measurement tools identified, most of them related to maternity care overall rather than being midwifery specific. The workstream considered that it was important to develop metrics which indicated the added value that midwives contribute specifically and a few potential areas for developing these have been suggested including women being seen by a midwife by week 12 of pregnancy. However it was acknowledged that the content of the consultation was just as important and that this is what should be measured i.e. assessing the women’s health and social needs holistically and not just that the contact took place. The woman’s experience of maternity care also importantly needs to be included in assessment of the quality of care.

14.The public health workstream had the remit of considering the midwives role in relation to inequalities, parenting education, early years work and multiagency working. Scotland, in partnership with Northern Ireland, led this work. They looked at ways in which the midwife could maximise her impact on outcomes for the woman and her baby. Mapping of the current care pathway was undertaken, identifying when midwives currently see mothers, and consideration was then given for further intervention opportunities. The midwife cannot be expected to be an expert in all aspects of public health, however she should be able to engage with mothers and signpost to other professionals. Addressing the underpinning issues of inequality, attachment and early intervention are very important if future generational impact is to be achieved. Multi-agency working has been strengthened within Sure Start teams for example where health and social care services are co-located within one building. Noreen suggested this was a good way to plan services as it improves ease of access for women and encourages information sharing between agencies and health professionals.

15.The Workforce and Workload workstream was led by Scotland. The group had the remit of looking at demographics, education commissioning, attrition and workforce planning. Among the key emerging issues are acknowledging the complexity of future workforce planning in particular in relation to demand, with variances in projected and actual birth numbers in some areas in the UK being up to 18% more than those projected. Additionally the increased time midwives require to spend providing care for women needing more complex care due to existing co-morbidity, older women giving births and increasing multiple pregnancies resulting from assisted fertility treatments is also a factor. There are also a significant number of midwives registered with the NMC who are not currently practising as midwives. Data analysis demonstrates that 40-45% of the midwifery workforce are due to retire by 2020 – this is based on the current average retirement age of 57 (midwives can retire from age 55). There is also a significant trend towards part-time working and job-sharing, this can mean that 2 people need to be trained for one post, not just one. According to student numbers versus retirement projections however currently Scotland for example may be currently training more than required.

16.The final workstream is the Core Role of the Midwife and this was led by Wales in partnership with Northern Ireland. This group were tasked with looking at all aspects of care, including models of care, service delivery, elements of skill mix and social enterprise. It had been challenging getting consensus on the core role of a midwife as there were many divergent opinions within the group. There was a big focus on "normality" however acknowledging that for all women no matter what their risk status, the aim should be to maximise the physiological birth process where possible. Midwives are experts in normal birth but increasingly also need to be highly skilled in caring for complex cases There is currently no advanced practice level qualification for midwives, however the group recognised that many midwives have developed in a post with a special interest e.g. in substance misuse and therefore these issues require further consideration. The models of care and service delivery discussions acknowledged that these should depend on local need but key principles should be applied when planning future models and services. Midwives work as part of a multi-disciplinary team and therefore changes impacting on other professions require to be considered. Maternity care assistants are now educated to a higher level and are now working under the delegation of a midwife, undertaking aspects of care to support the midwife and enhance the care of the mother and baby.

17.Noreen concluded by saying the final workstream reports had been received at the end of March. An overall programme report is currently being drafted and will be submitted to the UK Programme Board in June. Consultation has taken place throughout the programme of work, with key stakeholders involved in all the workstreams and the UK Programme Board, therefore a further consultation will not take place. However engagement sessions will take place during the summer, with the report being launched in September. The project's web address is

ITEM 5FEEDBACK FROM BREAKOUT SESSION 1

GROUP 1

  • Health services concentrate on acute planning – need to be more holistic
  • Look at services in a more multi-disciplinary way – need access to the right services
  • Protocols and pathways need to be reviewed as should assessments
  • GIRFEC highlights good practice
  • Skills/competencies – eg on asking about social situation and to ask the right questions.

GROUP 2