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Foundations for the Future: Case Studies for Better Child Health and Care
Foundations for the Future: Case Studies for Better Child Health and Care
Case Studies
Case Studies
Learning from the Ground Up: Real Stories, Real Impact
In this section
In this section
Early years models of care & population Health management
Early years models of care & population Health management
Integrated delivery model
Integrated delivery model
Identifying children 0 - 5 as a priority cohort
A population health management approach involves gathering data (health, public health and publicly available) to support stakeholders in making a decision on how to prioritise a cohort and then how to design a care model to address assessed need.
Our Population Health Management (PHM) approach focused on supporting families and children under 5 who are registered with Central GPs in Westminster.
The prioritisation funnel framed our analysis and decision-making around deprivation, inequalities, access and outcomes that matter most to people. It led the Westminster team to select children aged 0 - 5 as the priority cohort.
Further data analysis was used to understand the needs of the cohort, to inform the outcomes we wanted to achieve (including school readiness indicators), and to inform the design of the new model of care, which is presented here.
Strategic Priorities
Strategic Priorities
Clear strategic priorities set at an NWL and Westminster level to work collaboratively to improve health outcomes for children.
Socio-economic Factors
Socio-economic Factors
Children from the 20% most deprived communities have the highest GP and A&E attendances.
People Outcomes
People Outcomes
Children in Westminster have higher levels of obesity and lower levels of immunisation than the rest of London and England
Value for Money
Value for Money
Data suggests that children who are from the most deprived communities are higher utilisers of GP time and A&E attendances.
Service Level Approach
Service Level Approach
Integrated health and wellbeing offer, building on the Family Hubs offering and adopting locally focused outreach
The model illustrates the collaboration and integration that is at the heart of our approach. Services are co-located in the family hubs, which also serve as connectors to a broad range of services in the community.
Through our MDTs, outreach and linking services, we are able to address inequalities, offering targeted and smarter support across a range of health, social and wellbeing needs.
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Data to understand the issues and areas of focus for 0-4yrs
Data to understand the issues and areas of focus for 0-4yrs
Data Insights
Data Insights
18 Households per 1000 with dependent children owed a duty under the homelessness. Reduction (59% higher than the national average(2020/21)
40% of year 6 (10-11 year old) children in Westminster are overweight
20% most deprived are twice as likely to be frequent A&E attenders than the remaining population
A&E attendees under 18 year olds peak between 5pm - 7pm
63% of 5 year olds recorded as having 2 MMR immunisations - lowest rate in NWL (using GP records as at Q3 2021)
Top Issues / Problems that need to be fixed for this cohort
Top Issues / Problems that need to be fixed for this cohort
Access: A central issue is accessibility. Particularly, same day access.
Prevention: Immunisations, oral health and obesity were identified as an issue, along with directing services to those who need them the most.
Complexity of services: Services are complex and fragmented, often families are not sure where to go.
Language and digital exclusion: Continue to be barriers to accessing services.
SLCN: Identified as one of the most common developmental challenges
Top needs that are not being addressed for the most deprived
Top needs that are not being addressed for the most deprived
Reconciling overseas immunisation records: improving protocols for reconciling and translating these records when families are registering with the GP.
Families in this group are often young and isolated: Resulting in these families being less resourceful and not having the ability to navigate a complex system.
Children's experience: Need to understand what's important to children in this group and understand their experience with these services.
Impact of living conditions: Living conditions, for example, overcrowding, can have an impact on utilisation, health inequalities and respiratory conditions.
Case example of a family hub
Case example of a family hub
Features the model: Co-location and Collaboration
Family Hubs
Family Hubs
Family Hubs bring services together to offer a wider range of support for expectant parents and families with children of all ages, so that families and children can get the right help, support and advice at the right time.
Co-location of mental health, wellbeing, nursery and other early years services increased awareness and access for families who attend the hub for one reason or another. Joint functions ensure that providers can seamlessly introduce residents to other services. Those with additional or complex needs will be discussed at the Family Hub MDT to provide a holistic and person-centred approach.
Each hub has its own community network of children's services that includes colleagues from the voluntary sector, education, health, social care and more to be able to take a holistic, place-based and whole-family approach.
Acknowledgements: Thank you to each of the local teams in Harrow , Brent and Ealing have provided case studies for inclusion in this toolkit
Clinical Case Studies
Clinical Case Studies
Under 5 with respiratory symptoms and environmental challenges i.e. mould with multiple episodes of respiratory infection and wheezing
ADHD/Neurodiversity child
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Anxiety and Stress in Children Case Study Example
12 year old presenting with physical symptoms, poor attendance to school which was then diagnosed as anxiety/low mood
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Combining data to support babies, children and young people to thrive in Harrow
Proposal for a live dashboard to identify risks, support families, reduce inequalities, and improve early years outcomes in Harrow, building on Harrow’s early years expertise.
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