Local Context

The Children Young People and Families’ Network and ‘Making it Better’ (www.bestforhealth.nhs.uk)

The public consultation ‘Making It Better’, conducted by the Children, Young People and Families (CYPF) Network for Greater Manchester East Cheshire and High Peak was about changes to healthcare services to optimise care for children, young people, parents and babies. Furthermore, the response to this public consultation was the largest ever received in the NHS.

The clinical model of care emphasised that care should be delivered to children , young people and families out of hospital wherever possible. There would also be a reduction in the number of inpatient units providing overnight paediatric and obstetric services from 13 to 8 units, and an increase from 2 to 3 Level 3 Neonatal Intensive Care Units.

In summary this would mean that:

• 24 hours a day safe sustainable in-patient hospital services would be provided with a reduced risk of closure due to staff shortages;
• Hospitals would continue to provide routine services even if they did not have in-patient facilities;
• There would be more community based nursing and therapy services, in people's homes and in community settings such as clinics, children's centres and schools. This would give more opportunity to integrate health services with other agencies such as Education and Social Care;
• Children, young people and families would be given the opportunity where appropriate to manage their own conditions effectively with support;
• There would be strong links with the North West Ambulance service by working to protocols;
• Staff would be able to keep up their skills and competencies by concentrating overnight care in fewer sites;
• Staff would have opportunities to train in new roles and
• There would be more choice for women in the setting for the birth of their babies; and more choice in deciding whether to have care provided in hospital, in another setting or at home.

The formal written consultation period on the proposals was conducted for 17 weeks, starting on 12 January 2006 and ending on 12 May 2006.

Over 55,000 formal written responses were received together with 15,000 responses at public meetings and over 125,000 signatures on a number of petitions, making it the largest ever response to an health consultation anywhere in the United Kingdom.

The Joint Committee of Primary Care Trusts (JCPCT) for the Network geographical area endorsed the Network’s proposed option for service redesign on the 8th December 2006 Part of the decision making process was the application of a ‘Safety’ criterion’ to all of the proposed options, and within this criterion was how EWTD would be achieved. The workforce Network team provided evidence for the JCPCT , both in the report for the 8th December and in previous presentations to the Committee. (www.bestforhealth) ; ‘Making it Better’, statistics /workforce section and report for JCPCT).

The proposed clinical model and service redesign was endorsed by the Secretary of State for Health on the 24th August 2007.

Greater Manchester has now a clinically agreed, PCT funded, innovative and modern new model of care for children’s and maternity services which meets all of the Royal College good practice standards. These changes will happen over the next five years and beyond.

The PCT and Acute Trust Chief Executives for the Greater Manchester area have also already agreed on a CYPF Network organisational model to implement the clinical model (see accompanying paper). Clearly the key to the success of this change is to ensure that there is a high quality and sustainable workforce.

The EWTD 2009 target is a key workforce challenge facing the Network. The development of a networked approach to the utilisation of medical workforce has the potential to ensure that all doctors working within the Network geographical area are able to work within the EWTD regulations without this having a detrimental affect on their education and the service they deliver.