NHS NorthWest London
Integrated Care Board
Action Taken
NHS North West London has implemented a single children’s continuing care team with registered nurses and experienced managers providing a consistent service. A parental agreement has been developed which sets out expectations and responsibilities in regard to parental responsibility. (AI summary)
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Dear Ms Brown,
Re. Response to regulation 28 report to prevent future deaths, following your investigation into the death of Asher William Robert Sinclair.
NHS North West London have reviewed your findings in relation to the sad death of Asher William Robert Sinclair on 8 October 2019. We are committed to ensure that we learn from Asher’s death, to prevent future deaths under these circumstances.
At the time of Asher’s death, the children’s continuing care service was delivered by borough based teams, covering North West London’s eight local authorities. Each team had developed its own local processes for managing children’s continuing care. This led to varying levels of service delivery being in place. Since Asher’s death, the national dissolution of clinical commissioning groups (CCGs) into integrated care boards (ICBs) has resulted in a number of changes being made in the way previous commissioning responsibilities are delivered.
There is now one North West London children’s continuing care team in place that is responsible for providing a consistent, safe, effective and equitable service.
The Team comprises of registered nurses, experienced in the management of children’s continuing care, including assessment and on-going case management. Each case manager has a designated caseload and is overseen by a senior experienced manager. All members of the team receive monthly supervision and regular caseload review.
The Team continue to work within the national children’s continuing care framework (2016). A standard operating procedure has been put in place and a clear process for referral, assessment and delivery of a package of care has been developed.
In accordance with the national framework, reviews are undertaken of all children’s packages of care, initially at three months from a new package of care commencing and then on an annual basis or more frequently where there is a need/change of circumstance identified by the family, care provider or health/social care professional. All reviews are now undertaken with the family and the multidisciplinary team involved in the child’s care. Reviews are now recorded and discussed formally
- 2 - within a multi-disciplinary panel. The responsibility for the performance monitoring of reviews is undertaken by senior managers within the team.
The children’s continuing care case managers now meet at quarterly intervals with the clinical leads for the provider commissioned to provide a children’s care package, within this meeting, the appropriate lead professional for the child is also involved, to identify any clinical concerns and monitor the provision of the package of care, as well as identifying and ensuring that the child’s clinical needs are being safely and appropriately met.
When commencing a package of care, an NHS standard contract is issued to all providers commissioned by NHS North West London which sets out specific key performance indicators, including;
quality checks required the requirement to return monthly reports on provision of care staff competencies assurance required to safely meet the health needs of the child risk assessments, associated with the provision of the care package
Senior Managers responsible for children’s continuing care and our care brokerage officer meet with commissioned care providers on a quarterly basis to monitor the care packages.
In addition, an individual care contract is issued for each separate children’s package of care, setting out individual requirements, for example:
the need for 2:1 support and who provides this what elements of care are delivered as support to the family as opposed to respite periods?
Benchmarking of care is now undertaken to identify hours of support to meet assessed children’s clinical needs. This is also peer reviewed, to ensure safe, fair and consistent packages of care are provided.
A parental agreement has been developed which sets out expectations and responsibilities in regard to parental responsibility. Where parents feel that they are unable to maintain parental responsibility for the care of their child, parents can escalate their concerns initially via their names case manager, continuing healthcare senior manager or via NHS North West London’s complaints team. During the initial continuing care assessment and planning stage, all families are now informed of this process for raising concerns, in addition to further information provided both in a paper based information leaflet, as well as within NHS North West London’s website.
In my new role as the Chief Nursing Officer for NHS North West London, I am currently meeting along with our Director of Nursing, responsible for all age continuing care, with the local Borough Directors of Children’s services. One of the outcomes of these meetings is to ensure that joint care is seamless between the NHS and local authority. NHS North West London acknowledge that this is essential for children with complex health needs, where families have siblings that require support from local authority partners, to facilitate parental responsibility for their child’s health needs.
The NHS procures care packages for children with increasingly challenging complex clinical care needs. Supporting children and families to allow care to be provided outside of the hospital setting, continues to present risks for care providers and the NHS. The ability to reduce these risks will continue to be the responsibility of NHS North West London and I hope that the steps that we have taken since Asha Sinclair’s death will assure you of our commitment to provide children and their families with safe, effective and consistent care.
- 3 -
Re. Response to regulation 28 report to prevent future deaths, following your investigation into the death of Asher William Robert Sinclair.
NHS North West London have reviewed your findings in relation to the sad death of Asher William Robert Sinclair on 8 October 2019. We are committed to ensure that we learn from Asher’s death, to prevent future deaths under these circumstances.
At the time of Asher’s death, the children’s continuing care service was delivered by borough based teams, covering North West London’s eight local authorities. Each team had developed its own local processes for managing children’s continuing care. This led to varying levels of service delivery being in place. Since Asher’s death, the national dissolution of clinical commissioning groups (CCGs) into integrated care boards (ICBs) has resulted in a number of changes being made in the way previous commissioning responsibilities are delivered.
There is now one North West London children’s continuing care team in place that is responsible for providing a consistent, safe, effective and equitable service.
The Team comprises of registered nurses, experienced in the management of children’s continuing care, including assessment and on-going case management. Each case manager has a designated caseload and is overseen by a senior experienced manager. All members of the team receive monthly supervision and regular caseload review.
The Team continue to work within the national children’s continuing care framework (2016). A standard operating procedure has been put in place and a clear process for referral, assessment and delivery of a package of care has been developed.
In accordance with the national framework, reviews are undertaken of all children’s packages of care, initially at three months from a new package of care commencing and then on an annual basis or more frequently where there is a need/change of circumstance identified by the family, care provider or health/social care professional. All reviews are now undertaken with the family and the multidisciplinary team involved in the child’s care. Reviews are now recorded and discussed formally
- 2 - within a multi-disciplinary panel. The responsibility for the performance monitoring of reviews is undertaken by senior managers within the team.
The children’s continuing care case managers now meet at quarterly intervals with the clinical leads for the provider commissioned to provide a children’s care package, within this meeting, the appropriate lead professional for the child is also involved, to identify any clinical concerns and monitor the provision of the package of care, as well as identifying and ensuring that the child’s clinical needs are being safely and appropriately met.
When commencing a package of care, an NHS standard contract is issued to all providers commissioned by NHS North West London which sets out specific key performance indicators, including;
quality checks required the requirement to return monthly reports on provision of care staff competencies assurance required to safely meet the health needs of the child risk assessments, associated with the provision of the care package
Senior Managers responsible for children’s continuing care and our care brokerage officer meet with commissioned care providers on a quarterly basis to monitor the care packages.
In addition, an individual care contract is issued for each separate children’s package of care, setting out individual requirements, for example:
the need for 2:1 support and who provides this what elements of care are delivered as support to the family as opposed to respite periods?
Benchmarking of care is now undertaken to identify hours of support to meet assessed children’s clinical needs. This is also peer reviewed, to ensure safe, fair and consistent packages of care are provided.
A parental agreement has been developed which sets out expectations and responsibilities in regard to parental responsibility. Where parents feel that they are unable to maintain parental responsibility for the care of their child, parents can escalate their concerns initially via their names case manager, continuing healthcare senior manager or via NHS North West London’s complaints team. During the initial continuing care assessment and planning stage, all families are now informed of this process for raising concerns, in addition to further information provided both in a paper based information leaflet, as well as within NHS North West London’s website.
In my new role as the Chief Nursing Officer for NHS North West London, I am currently meeting along with our Director of Nursing, responsible for all age continuing care, with the local Borough Directors of Children’s services. One of the outcomes of these meetings is to ensure that joint care is seamless between the NHS and local authority. NHS North West London acknowledge that this is essential for children with complex health needs, where families have siblings that require support from local authority partners, to facilitate parental responsibility for their child’s health needs.
The NHS procures care packages for children with increasingly challenging complex clinical care needs. Supporting children and families to allow care to be provided outside of the hospital setting, continues to present risks for care providers and the NHS. The ability to reduce these risks will continue to be the responsibility of NHS North West London and I hope that the steps that we have taken since Asha Sinclair’s death will assure you of our commitment to provide children and their families with safe, effective and consistent care.
- 3 -