Sarah Jane Marsh: Prioritising children as a city-wide issue through the sustainability and transformation partnership

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  • Posted:Wednesday 29 November 2017

Speaking at The King's Fund Annual Conference on 29 November 2017, Sarah-Jane Marsh, Chief Executive, Birmingham Women’s and Children’s Hospitals NHS Foundation Trust shares lessons on securing priority for children through the sustainability and transformation partnership.


Here we are thinking about the role of children and young people within our STP in Birmingham and Solihull.  Now 29% of our population are under 20 and we’ve also got an incredibly diverse population too, 68% of children in Birmingham are from a BME background so we’ve got huge variations in childhood obesity, asthma admissions, ED attendances.  I think we have to be in children’s services much better at not only stating our case of what the issues are but really being a lot more proactive in leading some of the solutions.  We’ve got to be embedded in the STP otherwise we’re not an STP and we’re there, we’re very fortunate in Birmingham, we’ve got a women’s and children’s hospital.  if we don’t lead STP work, then who’s going to do that?  

Data has been a really key part of that.  Not just the data that says we’ve got massive problems with inequalities, which we clearly have, but we’re also spending a fortune on systems that are really inefficient and ineffective as well and if we take the resources that’s currently spending on children’s care and think about  how we can do that better, we know that we can make the same sorts of contributions often as our colleagues in the  adult sector can do and that always makes people sit up and listen when you say, not only can we actually start to reduce some these inequalities but we can also start to target some of those issues around finances and inefficiencies as well. 

Probably the key though, to some of the momentum that we’ve got so far, is the relationships that we have across all of the different organisations.  All of the constituent parts of the STP have said, we’ve got Birmingham Women’s and Children’s Hospital, could you lead this work for us on behalf of the STP.  The three big projects that we’ve got, the first is the one I’m most proud of, that’s out bump project, so that’s Birmingham and Solihull’s united maternity partnership, Bump and this is how we can all work together across Birmingham and Solihull to ensure that we’ve got a consistent standard of care for every woman that’s in our maternity system.  It’s not about which hospital you choose to go to that depends how many scans you’re going to get, what sort of information, whether you might have an induction or not, that everybody is going to receive the same standard of care. 

We’ve also got CHIP, again it’s about our, all the people working in paediatrics and child health coming together to think about paediatrics as a single system.  So for a GP, they phone a number, they speak to a senior professional, they describe the help they need and that person says this is how we can help you today or this is how we can help you tomorrow, please send your patient to X location. 

And then our third one is forward thinking Birmingham, this is our child young person and young adult mental health services.  This is an open access service which you yourself can refer yourself into, seven days a week 24/7.  There’s an access centre and out of hours there’s a crisis care line.  We’ve also got a pause hub in our city centre, next to Selfridges.  Anybody can walk in, off the street, 0-25 with any sort of mental health condition and talk to a trained practitioner about their mental health.  So we’ve taken away the gateway.  You don’t need a GP referral to access into the service and again that’s very similar to Bump and CHIP in that there’s lots of different services that sit behind there, they’re not all run by Birmingham women’s and children’s.  In fact 60% of them are voluntary sector.  

In all three points, this idea of a single point of access is really important, that we take away the young person or the family or the general practitioner needing to understand the complexities of our system.  So all of these things are about a system way of working and not an organisational way of working and we need to be realistic that big sways of money are not coming to us.  We’re lucky if we can get pots of funding for small projects and things.  Therefore the monies we’ve got is the money that we’ve got and we’ve got to put it all together into one big pot and say how do we spend it better.  Change occurs when clinical teams on the ground get together and work together and we need to be focussing on bringing clinical teams together.  If clinical teams in different organisations are doing things differently, let’s thrash it out.  I know we all like to say evidence based medicine but quite frankly, when you really go down the path, there’s not much of it about.  

People tend to be able to tussle out a lot what the right evidence is and we have to understand, in the maternity example why a woman with exactly the same presentation might get six scans in one trust and four scans in another, and really come to a decision about the most efficient and effective way to be able to do that.  I don’t think it’s good enough for anybody in this country to think that children are not a fundamental part of anything that goes on in society.  They’re 25% of the population, but they’re 100% of the future and if we get things right for them, lots of the problems that we’re now experiencing down the line in adult services, we could actually nip in the bud, at the beginning if we could get it right for children and young people.  

So I guess that’s our challenge for us.  We can do this, we have to have the mindset that we are the leaders.  If we get out there we can make it better for children and young people. 

Thank you. 

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