Commissioning children’s palliative care

Commissioning children’s palliative care in England: 2017 edition | Together for Short Lives 

This report summarises responses to a Freedom of Information request sent to every CCG and upper-tier local authority in England, asking how they plan care and support for children who need palliative care and their families, and which services they commission for them.

The report found that:

  • Children’s palliative care commissioning in England is patchy and inconsistent
  • The government’s end of life care choice commitment is not being fulfilled in almost half of local areas in England
  • Most CCGs have not implemented the new clinical guidance for children who need palliative care
  • Even though many seriously ill children need care 24 hours a day, seven days a week, commissioners are failing to plan and fund this support
  • Many local authorities are failing to commission short breaks for children who  need palliative care, despite being legally obliged to do so
  • There is a postcode lottery of bereavement care across England for parents whose child has died
  • CCGs and local authorities are failing to fund voluntary sector children’s palliative care organisations – including children’s hospices
  • Too many areas still do not commission age and developmentally appropriate services for young people with life-limiting and life-threatening conditions
  • Despite significant challenges across England, there are still some examples of commissioners reporting a broad range of children’s palliative care commissioning.

The report proposes a number of recommendations in response to these findings.

Full report:  Commissioning children’s palliative care in EnglandTogether for Short Lives’ report on children’s palliative care services commissioned by NHS clinical commissioning groups (CCGs) and local authorities in England.

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Depression in children and young people

NICE has published a guideline on identifying and managing depression in children and young people aged between 5 and 18 years.

This guideline covers identifying and managing depression in children and young people aged between 5 and 18 years. Based on the stepped care model, it aims to improve recognition and assessment and promote effective treatments for mild, moderate and severe depression.

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Image source: www.nice.org.uk

This guideline includes recommendations on:

Full guideline: Depression in children and young people: identification and management

Children and Young People’s Mental Health and Wellbeing Profiling Tool

This tool has been developed to support an intelligence driven approach to understanding and meeting need| PHE

It provides commissioners, service providers, clinicians, services users and their families with the means to benchmark their area against similar populations and gain intelligence about what works.  It collates and analyses a wide range of publically available data on: prevalence, protective factors, primary prevention (adversity and vulnerability) and finance. It provides commissioners, service providers, clinicians, services users and their families with the means to benchmark their area against similar populations and gain intelligence about what works.

Tool structure – indicators are presented in 5 domains:

  • Identification of need
  • Protective factors
  • Primary prevention: Adversity
  • Primary prevention: Vulnerability
  • Finance

Within this domains, indicators are grouped by geography (predominantly county and local authority but also Clinical Commissioning Group) and then ordered by topic (e.g.adversity associated with poverty, abuse and neglect, family difficulties and parental difficulties).

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Burden of child and adolescent obesity on health services in England. 

Viner RM, Kinra S, Nicholls D, et al. Burden of child and adolescent obesity on health services in England. Archives of Disease in Childhood Published Online First: 01 August 2017. doi: 10.1136/archdischild-2017-313009

Abstract

Objective To assess the numbers of obese children and young people (CYP) eligible for assessment and management at each stage of the childhood obesity pathway in England.

Design Pathway modelling study, operationalising the UK National Institute for Health and Care Excellence guidance on childhood obesity management against national survey data.

Setting Data on CYP aged 2–18 years from the Health Survey for England 2006 to 2013.

Main outcome measures Clinical obesity (body mass index (BMI) >98th centile), extreme obesity (BMI ≥99.86th centile); family history of cardiovascular disease or type 2 diabetes; obesity comorbidities defined as primary care detectable (hypertension, orthopaedic or mobility problems, bullying or psychological distress) or secondary care detectable (dyslipidaemia, hyperinsulinaemia, high glycated haemoglobin, abnormal liver function).

Results 11.2% (1.22 million) of CYP in England were eligible for primary care assessment and for community lifestyle modification. 2.6% (n=283 500) CYP were estimated to be likely to attend primary care. 5.1% (n=556 000) were eligible for secondary care referral. Among those aged 13–18 years, 8.2% (n=309 000) were eligible for antiobesity drug therapy and 2.4% (90 500) of English CYP were eligible for bariatric surgery. CYP from the most deprived quintile were 1.5-fold to 3-fold more likely to be eligible for obesity management.

Conclusions There is a mismatch between population burden and available data on service use for obesity in CYP in England, particularly among deprived young people. There is a need for consistent evidence-based commissioning of services across the childhood obesity pathway based on population burden

Reducing antibiotic prescribing for children presenting to primary care with acute respiratory tract infection

Blair, P.S. et al. (2017) BMJ Open. 7:e014506

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Objective: To investigate recruitment and retention, data collection methods and the acceptability of a ‘within-consultation’ complex intervention designed to reduce antibiotic prescribing.

Conclusion: Differential recruitment may explain the paradoxical antibiotic prescribing rates. Future cluster level studies should consider designs which remove the need for individual consent postrandomisation and embed the intervention within electronic primary care records.

Read the full article here

GPs struggle to support patients sent far from home for mental healthcare

GPs warn they are struggling to support young patients with mental illness after BMA research found seven in 10 children and adolescents with severe mental health problems were admitted to hospitals outside their local area | GPonline

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A total of 69% of child and adolescent admissions for severe mental health issues in 2016/17 were classed as ‘out of area’, according to data obtained from hospitals by the BMA.

Figures obtained under the Freedom of Information Act show that the proportion of children admitted to hospital out of their area rose 12 percentage points in 2016/17 compared with the previous year.

The BMA warned that the figures – published to coincide with Mental Health Awareness Week – showed worsening access to specialist beds.

Read the full article here

Commissioning ophthalmology services for children

The approaches to the prevention of vision/eye conditions and promotion of good visual health for children require very different approaches to those used in adult services | The Royal College of Ophthalmologists

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Image source: RCO

This briefing document will help inform commissioners of the key issues to consider when commissioning services for:

  • Children with conditions that cause (or may cause) visual impairment (VI), severe visual impairment (SVI) or blindness (BL) (WHO definition i.e. corrected acuity in better eye of LogMAR 0.5 or worse)
  • Children with common eye conditions that cause (or may cause) unilateral or milder reduction in vision
  • Children with isolated refractive error alone or those with mild/acute/self-limiting conditions (e.g. conjunctivitis)

This briefing document sets out the themes and issues relevant to commissioning of ophthalmic services for children, on behalf of the Paediatric Sub-committee of The Royal College of Ophthalmologists.

Read the full overview here

Read the full briefing here