Children’s Services

Health and wellbeing in the early years of life influences health in adulthood, so the delivery of high-quality care is crucial from birth to the teenage years. In addition to providing skilled clinical care, nurses working in children’s services act as advocates for their patients. They often become trusted carers for children with long-term conditions, seeing them grow up, learn to take control of their own health and transition to adult services. They also provide care in partnership with families and need to be able to develop trusting relationships with them while acting in their patients’ best interests and supporting their autonomy as appropriate.

Blackpool Teaching Hospitals NHS Foundation Trust
Early parenthood service – supporting families to be the best they can be

Blackpool has the highest rate of Children in Need and Looked After Children in the country, with the rate for those under the age of one being over four times higher than the national average. The Early Parenthood Service (EPS) was designed as a response to this and the decommissioning of Family Nurse Partnership (FNP) in order that the needs of a broader population could be better met, particularly those expecting parents with: Learning difficulties Difficult experiences in their own childhood and may be care experienced. Had children who are no longer in their care. Are experiencing vulnerabilities and whose lifestyle may pose a risk. The aim is to support Parents to be the Best They Can Be, by providing consistent and intensive support utilising a tool kit of evidenced based interventions throughout the antenatal period until the baby is up to three months old. EPS supports parents who may go home with their baby and those born into care. We considered recommendations of research, independent reviews, child safeguarding practice reviews, local information, and data to design a bespoke service integrated into the Blackpool Start for Life offer. A shared goal enabled a smooth and rapid development of a complex service. Putting the baby and their family at the centre enabled challenges to be considered as opportunities for growth and learning. EPS has been commissioned initially until 2027. 59 families have been referred to date, with amongst them 4 babies at significant risk of being removed have gone home with their parents. 4 families have been supported whose babies were born into care. We are currently working with 10 families in pregnancy whose babies are at significant risk of being born into care. Future plans are to evaluate, adapt, expand and integrate further into the Blackpool Partnership offer to families.

Central London Community Healthcare NHS Trust
Kids speak up: an educational animation

The 'voice' of the child being central to their medical and health needs is in multiple documents. There appeared to be a gap, however, in using the voices, imagery, and lived experience of children to teach peers about their health condition using an age-appropriate and child-friendly resource. I aimed to design an animated educational tool that amplifies the voices and experiences of children with health conditions, as well as fostering empathy among their peers. I presented my vision to the Shared Governance team who were fully supportive. Initially, I created an animation on Type 1 Diabetes with 3 children in a primary school with the condition (see evidence 2).The children thought it was amazing and were thrilled to take part. I guided the children in crafting the script for the animation's storyline and empowered them to envision the characters and scenes they wished to see animated. Parents and school staff were extremely accommodating and enjoyed seeing their children being involved. I have since developed a second animation focused on Allergies (see evidence 1). Drawing from lessons learned during the creation of the first animation, I streamlined the process, minimizing classroom disruption for the children and accelerating production. The outcome has been two educational animations with the voice of the child at the forefront. A resource for children of primary school age, to gain an understanding of their peers needs and enhance general knowledge of the conditions. To encourage empathy and understanding by enabling children to gain a greater perspective of the impact it has on people’s daily lives. The goal of this initiative is to maintain the circulation of the animations and gather feedback on their educational effectiveness. Additionally, I aim to create more due to their success, and integrate them into the National Curriculum!

Great Ormond Street Hospital for Children NHS Foundation Trust
Joint specialist nursing posts between children's hospices and The Louis Dundas Centre for paediatric palliative care

Issues to resolve • The number of babies, children and young people (BCYP) with palliative care needs is growing, necessitating effective collaboration and joined up working across inter disciplinary and multidisciplinary teams. • To support families to make meaningful decisions about preferred place of care and death, high quality 24/7 care needs to be provided in all locations – hospital, home and hospice – without compromise • At end of life, BCYP and their families often struggle with a move from hospital to home or hospice, particularly if this means their care is transferred to unfamiliar teams • Challenges with funding, recruitment, staffing rotas, education and training pose difficulties for any one service to provide expert 24/7 care in all locations, 365 days a year • Recruitment, training and retention of hospice staff Steps of the project: • Open communication between tertiary centre and hospice, with the aim of improving patient care, and a new model of working together was established . Explored ways to develop a novel way of joint working, breaking down barriers between organisations, creating a ‘one team’ approach, improving access to 24/7 care in all locations and facilitating the transition for families moving between locations, without compromising care • Business case and then first joint specialist nurse introduced to facilitate this process • Service Evaluation undertaken to better understand the impact of the posts on staff and families Challenges • On boarding process across three sites, gaining access to IT systems • Ensuring effective joined-up support and supervision for the post holders to manage demands working across two teams. Outcomes • Specialist nurses appointed,. improved access to training • Improved teamwork, communication, information sharing and continuity of care • Referral processes more efficient and fewer barriers to accessing hospice Future to roll out to third hospice.

Humber Teaching NHS Foundation Trust
Breastfeeding Hull

Humber Teaching NHS Foundation Trust’s project was an initiative that aimed to tackle the low breastfeeding rates in Hull. We wanted to raise awareness around the benefits of breastfeeding, as well as creating a mobile hub (Breastfeeding Tent) that could be used as both an information point, and a comfortable place to sit and breastfeed at public events in the city. We started by writing to 11 schools in areas of the city with lower breastfeeding rates. Two schools signed up to take part and we visited the schools giving a short presentation on breastfeeding and its benefits to school children aged 7 years. The children were asked to spend time in class drawing a picture depicting breastfeeding, as well as writing a fact that they had learnt about breastfeeding on the back of the picture. Hull City Council commissioned the purchase of two large tents, and we used the pictures drawn by the children to decorate them. The funding also enabled us to buy chairs, a table, and a display board to be used in each tent. The tents enable families to breastfeed in a private and comfortable environment as well as providing public health information. Another vital function of the tents is to serve as a visual reminder to the general public that breastfeeding is both encouraged and supported in Hull. The tents are available for all agencies in Hull to borrow for events, for example at play days, or family days. We will also be attending large scale events in Hull and will have staff available within the tents to provide breastfeeding support if needed.

King's College Hospital NHS Foundation Trust
Educating adolescents about vaping risk

The graduate pandemic of adolescent vaping in UK and other countries is concerning . This is now a considerable health issue that also many schools need to tackle safely. In our paediatric respiratory service, as part of smoking cessation service, we found more adolescents sharing the habit of their vaping but it became evident how unaware they are of the damage to their body, especially lungs and developing brain by vaping. With the message that came in 2018 from the Public Health England that e-cigarettes are 95% safer than smoking, many adolescents interpret this message as vaping is 100% safe. Very often adolescents that are our patients, are unaware of ingredients in the vape and use disposable vapes in increased quantity at home, community and also in school premises. In order to deliver evidence based latest information about the risk in adolescent vaping to adolescents themselves in the community, I have developed talks that are delivered in secondary schools and include school nurses and teachers as part of their PSHCE curriculum. Since the start of the project December 2022 I have reached over six thousands pupils in 26 schools in London and outside. I was invited to European Respiratory Symposium to present my poster that created a following and my presentation has been sought after by other NHS Trusts, Asthma Nurse Network, Community Dentistry and many more services. The useful value of these talks represented in a highly positive feedback and testimonials from schools with brilliant pupils engagement. I had a patient in our service that recognised me from one of these talks in his school and informed me that one of his friends stopped vaping after hearing my talk. I know this may be one in thousands but I am hoping not.

Mid Cheshire Hospitals NHS Foundation Trust
The vulnerable child and young person wellbeing specialist nurse role

Initially as ward manager of a Children's Unit in a rural DGH, there were lots of admissions to the unit that required a lot of intervention in relation to behavioural issues on the ward, Mental Health patients were increasing significantly, and safeguarding concerns. As ward manager there was a lot of input needed to to the acuity and capacity on the ward. Time to attend meetings, complete referrals and spend the time with both the patients, parents and staff on the unit. The presentation of these patents was not what nurses on a Children's unit were used to dealing with. There was a lot of frustration due to long stay admissions which appeared that were in the "wrong "place, as this was a unit for sick children. Communication was difficult between professionals due to the complexity of the situations. I recognised that there was need for a role that could pull all of this together, by building relationships with the local CAMHs team, Social Care agencies, Eating Disorder Teams, work closely with the Security team within the hospital, in order to improve experiences from the patients. This role clearly needed to be separate from the Ward Manager role. Funding needed to be allocated, which initially allowed the trial to move forward and agreement for the hospital recognise that the role was required. Incident forms completed and budget issues highlighted form external services. Challenges were funding and the trust recognising the need for the role. Barriers once the role was commenced altered on a daily basis with the patients admitted. Future plans are to allocate funding in order to increase the team to provide a more available service and have the time to move the team forward strategically. We are currently advertising a support worker post in order to support.

My School Health
Service level school nursing service

We are a team of Children’s Nurses who have chosen to break away from the statutory School Nursing Services and reinvent how these are delivered and funded. We have become an integral part of the school team so that issues can be identified and addressed much earlier than they are currently. This prevents things from escalating and in turn increases the attendance, engagement and wellbeing of the child and family. Our team are now working in over forty local schools and are building a reputation as a service that can build resilience and capacity through targeted support and a ‘can do’ attitude. This year is our fifth year in existence, in that time, we have supported so many schools to manage behaviours and health and continue to focus on making a difference. We are a team of Children’s Nurses who have chosen to break away from the statutory School Nursing Services and reinvent how these are delivered and funded. We aim to become an integral part of the school team so that issues can be identified and addressed much earlier than they are currently. This prevents things from escalating and in turn increases the attendance, engagement and wellbeing of the child and family. Our team are working in over forty local schools and are building a reputation as a service that can build resilience and capacity through targeted support and a ‘can do’ attitude. This year is our fifth year in existence, in that time, we have supported so many schools to manage behaviours and health and continue to focus on making a difference. Our goal is to provide schools in areas with high inequality with increased School Nurse time, thereby maximizing our impact. To achieve this, we must adapt our approach and gain additional funding via Charity status.

Oxleas NHS Foundation Trust, Charlton Athletic Community Trust and METRO Charity
The Young Greenwich Partnership

The Young Greenwich partnership is a collaborative initiative aimed at supporting young people in the Greenwich area of London. The partnership is commissioned by the Royal Borough of Greenwich local authority. The partnership is aimed at creating a positive experience for young people by integrating youth and health-focused services seamlessly, implementing a centralized referral process, and adopting a social prescription approach.

Rotherham, Doncaster and South Humber NHS Foundation Trust
Children's neurodevelopment transformation

Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH) is the main provider of Neurodevelopmental Assessments, specifically the differential diagnosis of Autism and Attention Deficit Hyperactivity Disorder in Rotherham, Doncaster and North Lincolnshire for Children and Young People (CYP). Over the past 3 to 4 years, there has been a significant growth in demand for the assessment and diagnosis of Neurodevelopmental conditions which has resulted in a significant waiting list that exceed 2093 children (1072 CYP waiting for screening and 1021 waiting for assessment as of August 2022). RDaSH Children's service and Clinical Commissioning Groups worked closely to understand the demand and capacity issues across the system. Stakeholders from education, early help and social care and health and the voluntary and community sector have all been involved with this work. Successful business cases and funding bids led by service managers (nurses) supported some increased capacity which helped jump start a massive re-design of the pathway to support a streamline offer across three geographical areas, implementing digital support, improve quality and governance, reduce waiting times for CYP, develop resources to support CYP and families (CYPF) whilst waiting for assessment. This was fully supported by a skill mixed team of nurses, AHP's, support workers, administrators and external stakeholders. Challenges: - Recruitment - Knowledge, education and training - Change fatigue for staff and stakeholders (education) - Impact on stakeholders and how health support this - On-going high referral rates - Waiting lists and high wait times (often seen before innovation unfortunately) Outcomes -Implemented a seamless standardised Neurodevelopment offer for CYPF -Implementation of a school based referral process -Reduce referrals rates by one third -Reduced screening waits from 12 months to 4 weeks -Reduced waiting times for CYPF waiting for assessment Future Plans: -Continue to reduce CYP's wait for assessment -Staff Wellbeing -Share learning.

Royal Wolverhampton NHS Trust
Paediatric virtual ward

After reviewing the admissions of children and young people in hospital, we recognised that many of them could be cared/treated for at home hence the implementation of a dedicated service. A team of experienced paediatric nurses were employed to launch this new service. Together with their matron, they designed pathways and guidelines to ensure safe and effective care could be carried out. The well-designed pathways and robust escalation plans enable the service to be nurse-led with consultant oversight. The Paediatric Virtual Ward is a technology enabled service which enbables patients to receive high level nursing care whilst recovering from their illness in the comfort of their own homes. Virtual wards are a new concept within the NHS especially within Paediatrics, so therefore, challenges regarding service expectation amongst a lot of other areas were all new to us and as there wasn't much learning to go off, it was ours to shape. Our future is to continue to expedite discharge and we aim to avoid admission where possible and safe to do so. This will be done by taking directly from primary care services and self-referrals (via parents/carers).

Sandwell and West Birmingham Hospitals NHS Trust
Paediatric virtual ward

Within our hospital trust there are two inpatient areas with 32 beds and two assessment areas. NHS England identified that with the introduction of virtual wards patients requiring acute nursing care could be looked after at home with the support of digital monitoring supporting flow of patients in hospitals. Paediatric virtual ward was launched in October 2022 through submission of a business plan to obtain funding to launch with 8-10 beds. It is now open 8am-8pm 365 days a year supported by 2 band 7 clinical nurse specialists and 5 full time equivalent band 6s. All of the staff have completed additional trianing to ensure quality of care and the team have worked alonside other acute and community teams to create 8 pathways to support early discharge and admission avoidance. The challenges have been to build confidence in a group of new nurses that they are able to recognise a deteriorating child and escalate appropriately, safely building pathways which enable total admission avoidance, and how we evidence the work we are doing whilst being compared to adult data sets. In the future we would like to start supporting discharges and readmissions from the emergency department, and look at taking referrals directly from UCCs and GPs to improve the patient's journey.

South Tees Hospitals NHS Foundation Trust
We Can Talk training – implementation of wellbeing passport and distraction packs for children and young people

Lack of knowledge and understanding of how to respond to children and young people when experiencing a mental health crisis. Limited resources to support children and young people while in hospital. • How did you go about it? The Trust joined the We Can Talk (WCT) national training in mental health, funded by NHS England. This training uses the experiences of young people, hospital staff and mental health professionals to improve the knowledge, skills and confidence of all hospital staff to support young people in a mental health crisis. Adopting a whole Trust approach, our Paediatric Nurse Educator Katie, who led the project, targeted areas where staff might encounter young people in crisis and communicated with staff how the training could help. Liaison took place with the local Child and adolescent mental health team (CAMHS) and ideas were sourced for quality improvement projects from staff and young people. The development of a wellbeing passport and a distraction toolkit took place working in partnership with young mental health advisors who had lived experience. • What challenges did you face and what outcomes did you achieve? - Time - The online training took six hours to complete. - Motivating staff to keep going with all modules. - Securing funding for quality improvement resources. - Identifying areas of need outside of the paediatric departments.