Download Generic Specification for Transition INSERT

ANNEXE 1.
PAEDIATRIC MEDICINE- SPECIALISED GENERIC CHILDREN’S SERVICES
SPECIFICATION INSERT
Aims and objectives of generic specification
This is an appendix to all the individual specialised services specifications.
Vision for children with specialist health needs
All children and young people are able to lead lives as free from their illness as possible.
Children, young people and families feel that care is personalised to their needs, organised around them, and
they are active participants in their care
The illness is diagnosed early, accurately and comprehensively, using age-appropriate tools and strategies
Children and young people are supported by their families, early years settings and schools, as well as health
Self- manage their illness, to receive regular structured review and to have rapid access to appropriate
services when control deteriorates
Acute deterioration in their health are treated promptly and appropriately and the child/ young person is
supported to avoid future acute episodes where possible
Premature deaths in children and young people are prevented Variations in the quality of care across the
country are explored, addressed and minimised.
This specification applies to all children’s services and outlines generic standards and outcomes that would
be fundamental to all services. The majority of specialist services are provided in tertiary or quartenary care
centres but some aspects may occur in secondary or even primary care.
1. Population Needs
Descriptions of populations by specific services are included in individual service specifications.
Population covered
This generic specification applies to all children receiving specialised services in England, up to their 19th
birthday. Individual services may transition children to adult services before their 19th birthday. Although it
may be useful to set a target age, there is no ‘right’ time for transition. A flexible approach is called for that
takes developmental readiness into account and links to other social transitions such as leaving school”
(National Service Framework for children, young people and maternity services ( 2003,2004)
(see individual specifications for detail of transition to adult services and the NHS England Specialised
Service Transition service specification) Is this needed or do we refer to the appendix on transition?
The specification applies to all services described in NHS England manual (http://www.england.nhs.uk/wpcontent/uploads/2012/12/pss-manual.pdf) for paediatric services and includes any “all ages” sections within
other specialised services specification where this is relevant to children.
1.1 National/local context and evidence base

The Children’s Outcome forum report is a key document that takes a life course approach from preconception to transition to adult care. It includes a number of key recommendations to improve
children and Young People’s health outcomes.
https://www.gov.uk/government/publications/independent-experts-set-out-recommendations-toimprove-children-and-young-people-s-health-results

The National Service Framework for Children, Young People and Maternity Services Sets national
standards for the first time for children’s health and social care which promote high quality, women
and child-centred services and personalised care that meets the needs of parents, children and their
families.https://www.gov.uk/government/publications/national-service-framework-children-youngpeople-and-maternity-services

Evidence is increasing that implementation of the national Quality Criteria for Young People Friendly
Services “You’re Welcome” (Department of Health, London 2011) have the potential to greatly
improve patient experience, leading to better health outcomes for young people and increasing
socially responsible life-long use of the NHS. Implementation is also expected to contribute to
improvements in health inequalities and public health outcomes e.g. reduced teenage pregnancy and
STIs, and increased smoking cessation. All providers delivering services to young people should be
implementing the good practice guidance which delivers compliance with the quality criteria.

The NHS Constitution
http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution/Documents/2013/the-nhsconstitution-for-england-2013.pdf

Bringing Networks to life RCPCH
http://www.rcpch.ac.uk/system/files/protected/page/Bringing%20Networks%20to%20Life%20for%20w
eb_0.pdf
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Transforming community services – For Children, Young People and their families
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215783/dh_124198.pdf

UN convention “Rights of the child” http://www.unicef.org.uk/UNICEFs-Work/Our-mission/UN-
Convention/

Facing the Future: Standards for Paediatric services RCPCH http://www.rcpch.ac.uk/panelcontent/facing-future-standards-paediatric-services

Academy of Royal colleges/7 day working
http://www.aomrc.org.uk/projects/seven-day-working.html
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National pledge to improve children’s health and improve child deaths
https://www.gov.uk/government/publications/national-pledge-to-improve-children-s-health-andreduce-child-deaths
Children and Young People Atlas of Variation http://www.rightcare.nhs.uk/index.php/atlas/childrenand-young-adults/
Principles for commissioning and Delivering better health outcomes and experiences for Children and
Young People (East of England)
Involving Children and Young People in Health services, RCPCH, NHS Confederation, OPM (And Not
Just a Phase)
http://www.rcpch.ac.uk/system/files/protected/page/Involving%20CAYP%20in%20Health%20Services
.pdf
Our children deserve better
Generic Principles
Information and communication
Children, young people and their families feel listened to and have meaningful information provided to them
in a format that empowers them to make informed choices.
Health information is provided in a format that is easy for them to understand and is age appropriate.
Patient information is shared with informed consent between health, social care and education.
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Information systems and technologies are in place to facilitate the easy and secure sharing of information
and communication.
Good quality information is collected and used to inform service planning
Supporting self- care
Children, young people and their families are appropriately educated and enabled to manage their own
illness as far as possible
Patient Participation and engagement
Children, Young People and their families will be at the heart of decision-making, with the health outcomes
that matter most to them taking priority. (The Outcomes Framework, NHS Mandate and Business plan.)
Children, Young People and their families are asked for their feedback and services include a measure of
patient experience and evidence this feedback has made a difference. (You said.. we did…)
Children, Young people and their families have the opportunity to shape service change and improvement.
(Also Friends and family test for CYP – 2015)
Evidence based and sustainable
Services are commissioned and delivered according to national or locally agreed best practise guidelines and
standards
Planning and development of services takes into account number of staff required to treat number of patients
Healthcare is delivered to the same standard 24/7
Staff are able to access, understand and act on service activity and outcomes
Access to care
The standards outlined in “Facing the Future” should be adhered to including the standard Specialist
Paediatricians are available for immediate advice for acute problems for all specialities and all paediatricians.
Workforce planning and safe and sustainable
All staff caring for children and young people are appropriately trained to look after children and Young
people and have appropriate communication skills. They have on-going continual professional development.
Children’s Community services are vital to deliver care closer to home. Teams need to be of an appropriate
size to allow specialist and generic support in the community and allow an extended hours service.
There should be appropriate planning and training to deliver an appropriate children’s workforce and this will
change as new innovative roles are developed.
Prevention and early intervention
Professionals take every opportunity to “Make every contact count” to advise and sign-post children, young
people and their families to enable them to improve their health and well-being outcomes. E.g smoking
cessation, pregnancy, social support, immunisations.
?Also need something about screening and support services
Governance and variation of care
Good quality information is collected and used to inform service planning.
Staff are able to access and act on information on service activity and outcomes. There is evidence that
minimum data sets are collected and incidents are reported and acted on.
Services should bench mark themselves against each other and variations in care should be explored and
understood. Good practise should be shared and unnecessary variation reduced.
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There should include mechanisms to act on incidents across pathways of care and evidence of audit and reaudits preferably across pathways.
Transformation and Innovation
There is evidence of critical review of current services, considering reconfiguration, integration and networked
care
Commissioners ensure providers have critically appraised and adapted service delivery models to transform
care across the health care system
Innovation in service delivery and new technologies is encouraged and implementation supported
Role of primary care
Although much of the care for children with specialist conditions occurs in specialist centres primary care
often play an important role in supporting the whole family. The consequences of having a child with a long
term or serious condition can be profound for the parents and siblings. Primary care also have a
responsibility for developmental checks and immunisations. Parents also sometimes use them as a first port
of call. When a Young Person is transitioned to adulthood some conditions may be looked after in primary
care or a GP may be requested to help with the palliative care of a patient. They often prescribe many of the
medications. It is important therefore that the GP is kept fully informed and they are given appropriate
information about the child or young person’s illness and clear guidelines to the expectations from you.
Children with long term conditions should have a named GP.
Poorly planned transition from young people’s to adult-oriented health services can be associated with
increased risk of non adherence to treatment and loss to follow-up, which can have serious consequences.
There are measurable adverse consequences in terms of morbidity and mortality as well as in social and
educational outcomes. When children and young people who use paediatric services are moving to access
adult services (for example, during transition for those with long term conditions. Please refer to paediatric
transition service specification insert.)
Communication
All children and young people who use services must be:
•
Fully informed of their care, treatment and support
•
Able to take part in decision making to the fullest extent that is possible.
Asked if they agree for their parents or guardians to be involved in decisions they need to make.
Age appropriate services
All those involved in the care, treatment and support cooperate with the planning and provision to ensure that
the services provided continue to be appropriate to the age and needs of the person who uses services.
Consideration should be made to Young People.
Research
Paediatric clinical and academic researchers provide NHS patients with access to the latest new diagnostic
tests and treatments (required by the NHS Constitution (2009)) and seek to ensure that patients from every
part of England are made aware of research that is of particular relevance to them (Prof Dame Sally Davies’
CMO statement in National Institute of Health Research Annual Report 2010/11)
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Outcomes
NHS Outcomes Framework Domains & Indicators
Domain 1
Domain 2
Domain 3
Domain 4
Domain 5
Preventing people from dying prematurely
Enhancing quality of life for people with long-term
conditions
Helping people to recover from episodes of illhealth or following injury
Ensuring people have a positive experience of
care
Treating and caring for people in safe environment
and protecting them from avoidable harm
√
√
√
√
√
For children and young people the NHS will work with other agencies to promote health and wellbeing in a
joined-up approach, to give them the best start in life.
Since 2010, the DH has published three outcomes frameworks, one for each part of the health and care
system. The outcomes framework for public health, adult social care and the NHS include the outcomes for
health and care that matter most to all of us, including children, young people and their parents. As one of the
primary mechanisms by which the health and care system is held to account, they will act as a focus for
action and improvement.
Outcomes.
The National Minimum Standards for Providers of Independent Healthcare, (Department of Health, London
2002) require the following minimum standards for children, these can be improved upon within individual
Providers:
i.
A16.1 Children and Young People are seen in a separate out-patient area, or where the hospital does
not have a separate outpatient area for children, they are seen promptly.
ii.
A16.3 Toys and/or books suitable to the child’s age are provided.
iii.
A16.8. There are segregated areas for the reception of children and young people into theatre and for
recovery, to screen the children and adolescents from adult patients; the segregated areas contain all
necessary equipment for the care of children.
iv.
A16.9 A parent is to be actively encouraged to stay at all times, with accommodation made available
for the adult in the child’s room or close by.
v.
A16.10 The child or Young Person’s family is allowed to visit him/her at any time of the day, except
where safeguarding procedures do not allow this
vi.
A16.13 When a child is in hospital for more than five days, play is managed and supervised by a
qualified Hospital Play Specialist.
vii.
A16.14 Children and young people are required to receive education when in hospital for more than
five days; the Local Education Authority has an obligation to meet this need and is contacted if
necessary.
viii.
A18.10 There are written procedures for the assessment of pain in children and young people and the
provision of appropriate control.
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All hospital settings should meet the standards for Children and Young People in emergency settings
http://www.rcpch.ac.uk/emergencycare
All hospital settings should meet the Standards for the Care of Critically Ill Children (Paediatric Intensive Care
Society, London 2010).
There should be age specific arrangements for meeting Regulation 14 of the Health and Social Care Act
2008 (Regulated Activities) Regulations 2010. These require:
i.
A choice of suitable and nutritious food and hydration, in sufficient quantities to meet service users’
needs;
ii.
Food and hydration that meet any reasonable requirements arising from a service user’s religious or
cultural background
iii.
Support, where necessary, for the purposes of enabling service users to eat and drink sufficient
amounts for their needs.
iv.
For the purposes of this regulation, “food and hydration” includes, where applicable, parenteral
nutrition and the administration of dietary supplements where prescribed.
v.
Providers must have access to facilities for infant feeding, including facilities to support breastfeeding
(Outcome 5E, of the Essential Standards of Quality and Safety, Care Quality Commission, London
2010)
vi.
All paediatric patients should have access to appropriately trained paediatric trained dieticians,
physiotherapists, occupational therapists, speech and language therapy, psychology, social work,
pharmacy and CAMHS services within nationally defined access standards. (see relevant service
specification for detail).
vii.
All children and young people should have access to a professional who can undertake an
assessment using the Common Assessment Framework and access support from social care,
housing, education and other agencies as appropriate
All registered providers must ensure safe use and management of medicines, by means of the making of
appropriate arrangements for the obtaining, recording, handling, using, safe keeping, dispensing, safe
administration and disposal of medicines (Outcome 9 Essential Standards of Quality and Safety, Care Quality
Commission, London 2010). For children, these should include specific arrangements that:
i.
Ensures the medicines given are appropriate and person-centred by taking account of their age,
weight, formulation or delivery device references/capabilities and any disabilities/impairments and
cultural issues they may have. Licensed medicines should be used when ever available and clinically
acceptable.
ii.
Ensures that staff prescribing, dispensing and issuing medicines have the competency and skills
needed for children and young people's medicines management and have the appropriate paediatric
dosing reference resources to use.
iii.
Ensures that understandable written information is available for parents and carers and wherever
possible, age specific information is available for the children, about the medicines they are taking,
including the risks and ways to report adverse events. Information should be informative, covering
topics such as the increased length of time it may take to acquire specialist or orphan medicines.
iv.
Ensures that all drug related problems are recorded and acted upon; including demonstration of
continued learning and improved medicines provision.
Many children or Young people with long term illnesses have a learning or physical disability. Providers
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should ensure that:
i.
They are supported to have a health action plan
ii.
Facilities meet the appropriate requirements of the Disability Discrimination Act 1995
iii.
They meet the standards set out in Transition: getting it right for young people. Improving the
transition of young people with long-term conditions from children's to adult health services.
Department of Health Publications, 2006, London and the national NHS England transition service
specification.
iv.
Children with life-limiting/threatening long term conditions to have a comprehensive annual review
which is appropriate to condition.
Research outcomes will be disseminated via local, regional and national Institute of Health reporting
pathways.
Key principles for children
The Care of Children in Hospital (HSC 1998/238) requires that:

Children are admitted to hospital only if the care they require cannot be as well provided at home, in a
day clinic or on a day basis in hospital.

Children requiring admission to hospital are provided with a high standard of medical, nursing and
therapeutic care to facilitate speedy recovery and minimize complications and mortality.

Families with children have easy access to hospital facilities for children without needing to travel
significantly further than to other similar amenities.

Children are discharged from hospital as soon as socially and clinically appropriate and full support
provided for subsequent home or day care.

Good child health care is shared with parents/carers and they are closely involved in the care of their
children at all times unless, exceptionally, this is not in the best interest of the child; Accommodation
is provided for them to remain with their children overnight if they so wish.
Research

Children should be provided with access to relevant National Institute of Health Research (NIHR)
portfolio clinical trials.
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Improvements in child health in the NHS will occur through underpinning research.
Service description/care pathway
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All paediatric specialised services have a component of primary, secondary, tertiary and even
quaternary elements and in many settings are fully integrated with relevant clinical research.
The efficient and effective delivery of services require children to receive their care as close to home
as possible dependent on the phase of their disease
Services should therefore be organised and delivered through “integrated pathways of care” (National
Service Framework for children, young people and maternity services (Department of Health
&Department for Education and Skills, London 2004)
Managed clinical networks are recognised as providing high quality standards of care for children with
specialist conditions
Interdependencies with other services/providers
Co-located and interdependent services
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Specific co-located and interdependent services will be found in the individual specialised service
specification, generic requirements for all areas looking after children are:
Imaging
All services will be supported by a three-tier imaging network (“Delivering quality imaging services for
children”, Department of Health 13732 March, 2010). Within the network;
 It will be clearly defined which imaging test or interventional procedure can be performed and reported
at each site
 Robust procedures will be in place for image transfer for review by a specialist radiologist, these will
be supported by appropriate contractual and information governance arrangements
 Robust arrangements will be in place for patient transfer if more complex imaging or intervention is
required
 Common standards, protocols and governance procedures will exist throughout
 All radiologists, and radiographers will have appropriate training, supervision and access to continuing
professional development
 All equipment will be optimised for paediatric use and use specific paediatric software
Specialist Paediatric Anaesthesia
Wherever and whenever children undergo anaesthesia and surgery, their particular needs must be
recognised and they should be managed in separate facilities, and looked after by staff with appropriate
experience and training.1 All UK anaesthetists undergo training which provides them with the
competencies to care for older babies and children with relatively straightforward surgical conditions and
without major co-morbidity. However those working in specialist centres must have undergone additional
(specialist) training2 and should maintain the competencies so acquired3 *. These competencies include
the care of very young/premature babies, the care of babies and children undergoing complex surgery
and/or those with major/complex co-morbidity (including those already requiring intensive care support).
As well as providing an essential co-dependent service for surgery, specialist anaesthesia and sedation
services may be required to facilitate radiological procedures and interventions (for example magnetic
resonance imaging (MRI) scans and percutaneous nephrostomy) and medical interventions (for example
joint injection and intrathecal chemotherapy), and for assistance with vascular access in babies and
children with complex needs such as intravenous feeding.
Specialist acute pain services for babies and children are organised within existing departments of
paediatric anaesthesia and include the provision of agreed (hospital wide) guidance for acute pain, the
safe administration of complex analgesia regimes including epidural analgesia, and the daily input of
specialist anaesthetists and acute pain nurses with expertise in paediatrics.
Specialised Child and Adolescent Mental Health Services (CAMHS)
The age profile of children and young people admitted to specialised CAMHS day/in-patient settings is
different to the age profile for paediatric units in that it is predominantly adolescents who are admitted to
specialised CAMHS in-patient settings, including over-16s. The average length of stay is longer for
admissions to mental health units. Children and young people in specialised CAMHS day/in- patient
settings generally participate in a structured programme of education and therapeutic activities during
their admission.
Taking account of the differences in patient profiles the principles and standards set out in this
specification apply with modifications to the recommendations regarding the following:
 Facilities and environment – essential Quality Network for In-patient CAMHS (QNIC) standards
should apply (http://www.rcpsych.ac.uk/quality/quality,accreditationaudit/qnic1.aspx)
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Staffing profiles and training - essential QNIC standards should apply.
The child/ young person’s family are allowed to visit at any time of day taking account of the child /
young person’s need to participate in therapeutic activities and education as well as any
safeguarding concerns.
Children and young people are offered appropriate education from the point of admission.
Parents/carers are involved in the child/young person’s care except where this is not in the best
interests of the child / young person and in the case of young people who have the capacity to
make their own decisions is subject to their consent. Parents/carers who wish to stay overnight
are provided with accessible accommodation unless there are safeguarding concerns or this is not
in the best interests of the child/ young person.
Children’s Psychological Medicine
Children and young people who have acute and chronic paediatric conditions experience a range of
stressors, as do their families. These range from dealing with the impact of distressing symptoms,
managing intrusive and painful investigations and treatments and adjusting their lifestyle to accommodate
the condition. Children, young people and their families need easy access to psychological and family
systemic support and intervention to manage these difficult experiences and support healthy adjustment
to the condition. These services are ideally provided as and embedded part of the paediatric team and as
part of a wider Children's Psychological Medicine Service. Clinicians providing psychological and family
systemic services also need easy access to Paediatric Liaison Services to provide mental health
assessments and treatments to children, young people and their families, as needed, and which are
coordinated with psychological and family systemic interventions.
Children and young people with acute and chronic paediatric conditions are also more vulnerable to
mental health problems, ranging from x2-x6 the rate in well children, the highest prevalence being
amongst children and young people with CNS conditions. Children with physical health problems and
mental health problems need prompt and easy access to a paediatric liaison service (child and
adolescent psychiatry, child and adolescent mental health nursing, clinical psychology and other Allied
Health Professions). This service should provide assessment and evidence based treatments, referring
children and families to local CAMH services when appropriate.
These services depend on close and regular contact with a wide range of paediatric services and should
always be co-located with paediatric services in order to ensure good communication and ease of access
for children and their families. Psychological and family systemic universal services can be part of a
wider team including paediatric liaison but they can function as separate services. However in both
circumstances close collaboration, liaison and, where indicated, co-working is essential in order to provide
a seamless service for children and their families.
Safeguarding
Children and young people must only receive a service from a provider who takes steps to prevent abuse
and does not tolerate any abusive practice should it occur (Outcome 7 Essential Standards of Quality and
Safety, Care Quality Commission, London 2010 defines the standards and evidence required from
providers in this regard).
Providers minimise the risk and likelihood of abuse occurring by:
 Ensuring that staff and people who use services understand the aspects of the safeguarding
processes that are relevant to them.
 Ensuring that staff understand the signs of abuse and raise this with the right person when those
signs are noticed.
 Ensuring that people who use services are aware of how to raise concerns of abuse.
 Having effective means to monitor and review incidents, concerns and complaints that have the
potential to become an abuse or safeguarding concern.
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
Having effective means of receiving and acting upon feedback from people who use services and any
other person.
Taking action immediately to ensure that any abuse identified is stopped and suspected abuse is
addressed by:
 Having clear procedures followed in practice, monitored and reviewed that take account of relevant
legislation and guidance for the management of alleged abuse
 Separating the alleged abuser from the person who uses services and others who may be at risk or
managing the risk by removing the opportunity for abuse to occur, where this is within the control of
the provider
 Reporting the alleged abuse to the appropriate authority
 Reviewing the person’s plan of care to ensure that they are properly supported following the alleged
abuse incident.
 Using information from safeguarding concerns to identify non-compliance, or any risk of noncompliance, with the regulations and to decide what will be done to return to compliance.
 Working collaboratively with other services, teams, individuals and agencies in relation to all
safeguarding matters and has safeguarding policies that link with local authority policies.
 Participating in local safeguarding children boards where required and understand their
responsibilities and the responsibilities of others in line with the Children Act 2004.
 Having clear procedures followed in practice, monitored and reviewed in place about the use of
restraint and safeguarding.
 Taking into account relevant guidance set out in the Care Quality Commission’s Schedule of
Applicable Publications
 Ensuring that those working with children must wait for a full CRB disclosure before starting work.
 Training and supervising staff in safeguarding to ensure they can demonstrate the competences listed
in Outcome 7E of the Essential Standards of Quality and Safety, Care Quality Commission, London
2010
Applicable Service Standards
Applicable national standards
Children and young people must receive care, treatment and support by staff registered by the Nursing
and Midwifery Council on the parts of their register that permit a nurse to work with children (Outcome
14h Essential Standards of Quality and Safety, Care Quality Commission, London 2010)
 There must be at least two Registered Children’s Nurses (RCNs) on duty 24 hours a day in all
hospital children’s departments and wards.
 There must be an Registered Children’s Nurse available 24 hours a day to advise on the nursing
of children in other departments (this post is included in the staff establishment of two RCNs in
total).
Accommodation, facilities and staffing must be appropriate to the needs of children and separate from
those provided for adults. All facilities for children and young people must comply with the Hospital Build
Notes HBN 23 Hospital Accommodation for Children and Young People NHS Estates (The Stationary
Office 2004.)
All staff who work with children and young people must be appropriately trained to provide care, treatment
and support for children, including Children’s Workforce Development Council Induction standards
(Outcome 14b Essential Standards of Quality and Safety, Care Quality Commission, London 2010).
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Each hospital who admits inpatients must have appropriate medical cover at all times taking account of
guidance from relevant expert or professional bodies (National Minimum Standards for Providers of
Independent Healthcare, Department of Health, and London 2002).”Facing the Future” Standards, Royal
College of Paediatrics and Child Health.
Staff must carry out sufficient levels of activity to maintain their competence in caring for children and
young people, including in relation to specific anaesthetic and surgical procedures for children, taking
account of guidance from relevant expert or professional bodies (Outcome 14g Essential Standards of
Quality and Safety, Care Quality Commission, London 2010).
Applicable quality requirements
Providers must have systems in place to gain and review consent from people who use services, and act on
them (Outcome 2a Essential Standards of Quality and Safety, Care Quality Commission, London 2010).
These must include specific arrangements for seeking valid consent from children while respecting their
human rights and confidentiality and ensure that where the person using the service lacks capacity, best
interest meetings are held with people who know and understand the person using the service. Staff should
be able to show that they know how to take appropriate consent from children, young people and those with
learning disabilities (Outcome 2b) (Seeking Consent: working with children Department of Health, London
2001).
Guidelines for providing anaesthetic services (GPAS) Paediatric anaesthetic services. (Royal College of
Anaesthetists (RCoA) 2010 www.rcoa.ac.uk)
Certificate of completion of training (CCT) in Anaesthesia 2010
Continuous professional development (CPD) matrix level 3
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Quality standards specific to specialised children’s services
Quality
Requirement
Threshold
Method of Measurement
Consequence of
breach
Domain 1: Preventing people dying prematurely
Time from
Operating
Number of children presenting to
presentation at
standard of
service and time to diagnosis and
NHS setting to
90%
treatment. (admission/days to
i) definitive
diagnosis/days to treatment
diagnosis ii)
commencing)
initiation of
Review of monthly Service Quality
treatment
Performance Report
Referral to
treatment within
18weeks
Domain 2: Enhancing the quality of life of people with long-term conditions
As set out in
Service Condition
21 and Schedule 4
Part G
Reduction in
Reduction in
Number of unplanned admissions to
Audit of outcomes
unplanned
unplanned
the service
and set rate for
hospitalisation for
readmissions
improvement
children and young
people due to poor
chronic disease
control
Domain 3: Helping people to recover from episodes of ill-health or following injury
Reduction in
Reduction in
Number of discharges/number of
readmission rate
readmissions
readmissions where possibility has
where possibility
not been planned with parents/child
has not been
as part of early ambulation /homecare
planned with
plan
parents/child as
part of early
ambulation
/homecare plan
Domain 4: Ensuring that people have a positive experience of care
Audit of outcomes
and set rate for
improvement
% teenagers/young Feedback
Experience survey feedback. Sample
Audit and set rate
people who have
received from
of feedback
for improvement
completed a
questionnaire
transition specific
questionnaire
having used the
service
Domain 5: Treating and caring for people in a safe environment and protecting them from
avoidable harm
Incidence of
medication errors
for children and
young people that
reach the patient
Incidence of harm
to children due to
‘failure to monitor
0%
Monthly report number of medication
errors and as a percentage of
admissions
As set out in
Service Condition
21 and Schedule 4
Part G
% Improvement
based on
baseline
assessment
Number of incidents of harm due to
failure to monitor – reported quarterly
Audit of outcomes
and set rate for
improvement
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