Evaluating models of care closer to home for children and young people who are ill

Researchers: SPRU: Gillian Parker, Linda Cusworth, Gemma Spiers, Kate Gridley, Jan Heaton, Suzanne Mukherjee
Department of Health Sciences: Karl Atkin, Yvonne Birks
York Health Economics Consortium: Karin Lowson

Funder: NHS Service Delivery and Organisation R&D Programme

Duration: April 2007 – May 2010

Background

Since the 1950s, children, their families and campaigning organisations have argued that care for children and young people who are ill should, whenever possible, be provided outside hospital. There have been various attempts to develop ‘care closer to home’, but progress has been slow. The National Service Framework for Children emphasised again the need to provide care away from hospitals and suggested ways of achieving this.

Aims

This project identified models of health care for children and young people who are ill that involved delivery of ‘care close to home’. It explored how those models responded to different needs, e.g., age, condition, ethnicity, deprivation and explore the benefits, drawbacks and costs of shifting from hospital in-patient care to community-based models of care. The project also established, evidence-based, principles of good practice about creating and running ‘close to home’ models of care.

Methods

There were four stages to the project:

• We updated and extended an earlier systematic review of paediatric home care.
• We also reviewed the descriptive literature on ‘close to home’ models of care in the UK for children and young people who are ill. This stage focussed specifically on service delivery and organisation, including issues for primary care, and child and family views
• We carried out a national postal survey to identify services ‘close to home’ for ill children and young people. The survey gathered information about services’ functions and about how they were organised and delivered. Following this we carried out four case studies that explored the implications for services and service users of providing care closer to home for children and young people.
• We modelled the impact of providing care close to home on hospital paediatric acute activity and health service costs. This stage examined the costs and effectiveness of different models of care close to home, using standard economic impact assessment techniques.

A group containing representatives of parents, voluntary organisations and health and social care services for children and young people advised the project from the start.

Publications and presentations

2012

Systematic review of international evidence on the effectiveness and costs of paediatric home care for children and young people who are ill, (forthcoming)
Parker, G., Spiers, G., Gridley, K., Atkin, K., Birks, Y., Lowson, K. and Light, K., Child: care, health and development, (Available online from 13 February 2012).

2011

Care closer to home for children and young people who are ill: how far can we go? Plenary.
Parker, G., Delivering Better Health Services, Health Services Research Network and Service Delivery and Organisation Network Joint Annual Conference, Liverpool, 7-8 June 2011.

Children's community nursing services: what does the research say?
Parker, G., Inspiring, Achieving Success and Keeping it Going: Launch of the Practical 'How To' Guide for Achieving High Quality in Children and Young People's Emergency and Urgent Care. Learning from the Rapid Improvement Programme, University of Warwick, 25 March 2011.

Children's community nursing services: what does the research say?
Parker, G., NHS Care at Home: Community Children's Nursing Services Conference, London, 24 May 2011.

Care closer to home for children and young people who are ill: developing and testing a model of service delivery and organization, (forthcoming)
Parker, G., Spiers, G., Cusworth, L., Birks, Y., Gridley, K. and Mukherjee, S., Journal of Advanced Nursing, (Available online from 6 December 2011).

Evaluating Models of Care Closer to Home for Children and Young People who are Ill: A systematic review, 2011
Parker, G., Spiers, G., Gridley, K., Atkin, K., Birks, Y., Lowson, K., and Light, K., NIHR Service Delivery and Organisation programme,.

Evaluating models of care closer to home for children and young people who are ill, 2011
Parker, G., Spiers, G., Gridley, K., Atkin, K., Cusworth, L., Mukherjee, S., Birks, Y., Lowson, K., Wright, D., and Light, K., Research Works, 2011-03, Social Policy Research Unit.

Evaluating models of care closer to home for children and young people who are ill: executive summary, 2011
Parker, G., Spiers, G., Gridley, K., Atkin, K., Cusworth, L., Mukherjee, S., Birks, Y., Lowson, K., Wright, D., and Light, K., NIHR Service Delivery and Organisation programme,.

Evaluating Models of Care Closer to Home for Children and Young People who are Ill: Main report, 2011
Parker, G., Spiers, G., Gridley, K., Atkin, K., Cusworth, L., Mukherjee, S., Birks, Y., Lowson, K., Wright, D., and Light, K., NIHR Service Delivery and Organisation programme.

Moving care closer to home for children and young people who are ill. Invited.
Spiers, G., Moving Care Closer to Home for Children and Young People, Service Delivery and Organisation Network Seminar, Birmingham, 19 July 2011.

The psychosocial experience of parents receiving care closer to home for their ill child, 2011
Spiers, G., Parker, G., Gridley, K. and Atkin, K., Health and Social Care in the Community, 19, 6, 653-660.

Understanding models of 'care closer to home' for children and young people who are ill: a mixed methods study, (forthcoming)
Spiers, G., Parker, G., Gridley, K., Cusworth, L., Mukherjee, S., Heaton, J., Atkin, K., Birks, Y., Light, K., Lowson, K. and Wright, D., Nursing Children & Young People.

2010

Care closer to home for children and young people who are ill: how far can we go?
Parker, G., 3rd Congress of the European Academy of Paediatric Societies, Copenhagen, Denmark, 23-26 October 2010.

Evaluating models of care closer to home for children and young people who are ill: findings from research
Parker, G. and Spiers, G., West Sussex Primary Care Trust Meeting, Worthing, 6 October 2010.

The experiences of staff and families managing children's care closer to home: implications for policy and practice
Spiers, G., Transforming Healthcare Through Education and Research, 11th Annual Interdisciplinary Research Conference, Trinity College Dublin, Dublin, Ireland, 4-5 November 2010.

Policy Impact

NHS at Home: Community Children’s Nursing Services, Department of Health, (2011). Championed by the Public Health Minister Anne Milton this report is aimed at helping commissioners and providers improve services. Our report is quoted extensively in chapter 3.

If you require further information about the project, please contact Gillian Parker