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A window of opportunity

She described the NHS as reactive, not proactive and highlighted the “overwhelming” evidence for early intervention; so early that it should start before birth if possible, and even pre-conception.

“We provide treatment services primarily, we fi ght fi res, we put them out, but we don’t prevent them. The only contracted preventative services are the routine screening at 6-8 weeks and the routine immunisations for children. After that, it’s an illness service; it’s not a wellness service.

“We need to start, as GPs, diverting a little bit of attention away from the patient in front of us and thinking about the needs of the community outside. That’s actually quite hard: it’s going to take a great culture shift.”

Dr Vimal Tiwari is a GP, and Clinical Commissioning Champion at the RCGP. She pointed out that despite signifi cant concern about the future of commissioning children’s services, challenges in this area of care had long been evident.

Children represent 25% of the total population, something Dr Tiwari urges commissioners to keep “at the forefront of our minds for planning and delivering any services”.

Despite this sizeable stake in the population, the spend on children and young people is less than 5% of the total NHS budget. She recommended spending the money “much more wisely” to even out this imbalance; just a 1% increase in the budget for children and young people could make a massive difference.

Dr Tiwari said: “There always has been fragmentation and the new arrangements look set to make it worse. That’s one of our fears. But the services for children have never been brilliant, so there are opportunities now, this time, to make it better. There are also opportunities to make things better for adults.”

This could be achieved by decreasing the number of years of ill-health faced by people born into deprivation and addressing inequalities based on geographical location and poverty.

Dr Tiwari described a “very narrow window of opportunity to make a difference to the child’s life”, from around conception to 18 months old, and recommended a much stronger ‘life approach’ to invest in the foetus.

GPs are not being brought into children’s lives early enough, she stated, and this is essential to provide a smooth transition between children’s services and adult care.

“Every contact has to count,” she added. “We absolutely have to start promoting health earlier and at every possible opportunity.”

Katrina Percy, chief executive of the

Southern Health NHS Foundation Trust, gave a healthcare provider’s perspective on the commissioning of children’s services.

A major transformation of the trust’s services has seen a signifi cant change to the skill mix of health visiting teams, “radically altered” models of care, and work to fully understand and price the cost of these services, Percy said.

“We now know that to deliver the healthy child programme, it costs us £96 per child if you’ve implemented all of those different models of care and those skill mixes. We need £31 extra if that child is vulnerable and another £18 if it’s the fi rst child born in the family. We are able to look at the costs of delivering that national

Dr Nicholas Hicks Dr Vimal Tiwari

programme for children.

“We’ve implemented an outcomes metric and performance improvement framework

children’s services. Working with our partners and our commissioners we’re able to be clear what we are delivering through our services.”

Long-term impact

Percy highlighted that the benefi ts achieved through improved services formed part of a long-term return on investment. “One of the challenges is that often you don’t see those outcomes for many years. We have to recognise that the long-term impact on the individual’s health may not emerge for many years; we know the evidence is strong so let’s not make it an excuse that you don’t see the outcomes immediately.”

Focusing on the 5- to 19-year-old group, she stated that “school nursing is just chronically underfunded” and said they should be spending their time making the most of opportunities around family planning, sexual health education and healthy eating, not just measuring and weighing.

She emphasised the need for integration and suggested that with children’s services being drawn in several different directions, creating a commissioning core does not necessarily fi t into the traditional model of the cornerstone of primary care. This will involve thinking carefully about the placement of integrated services.

“Our GPs are desperate to get the health visitor workforce in their practice providing real cradle to grave services,” Percy added, concluding that strong leadership is the way to achieve necessary improvements in care. “We really need to work together to be sure that the increased complexity of the commissioning environment doesn’t hinder our progress.”


Andrew Webb

Katrina Percy TELL US WHAT YOU THINK public sector executive Jul/Aug 12 | 27

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