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A national model of care for children: Integrated implementation- the opportunities and the challenges

Authors:

Grace Turner ,

Health Service Executive, IE
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Alf Nicholson,

Health Service Executive, IE
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John Murphy

Health Service Executive, IE
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Abstract

Children in Ireland: Children in Ireland make up 25% of the population.  The number of births is approximately 65,000 per annum, giving Ireland one of the highest birth rates in Europe.  Over a quarter of Irish 9-year-olds are overweight or obese.  Almost 6% of the child population in Ireland have a disability. Immunisation uptake has reached 95% for 2 year olds for the primary immunisation schedule.  The number of children on an inpatient/day case waiting list awaiting treatment increased by 44.4% between 2011 and 2015. In 2014, 18.6% of children were considered to be at risk of poverty. 

A model of care for children: The National Clinical Programme for Paediatrics and Neonatology, a joint clinical initiative between the Faculty of Paediatrics and the Health Service Executive in Ireland, has developed a national model of care for paediatric and neonatal healthcare services.   Extensive consultation took place with healthcare professionals and management working in the child health sector when developing the model of care. It was recognised from the outset that in order to ensure success and widespread acceptance of the model, there would need to be a ‘ground up’ approach, where staff were heard, acknowledged and encouraged to contribute to the shared national vision for child health. In addition, the importance of engaging with parents, children and young people, was recognised and this took place throughout the development of the model of care to ensure that their views were incorporated.

The model of care addresses the changing healthcare needs in Ireland and describes a vision for high quality, accessible healthcare services for children in Ireland, from birth to adulthood.  It spans a range of care settings from community services to tertiary hospital care.  It sets out requirements for infrastructure, staffing and processes, and the expected outcomes for children accessing each service. 

Integrated implementation: The model of care has been approved by the relevant authorities and it must now be implemented. It cannot, however, be implemented in the traditional service delivery ‘silos’.  It must be implemented in an integrated way to ensure that care follows the journey of a child from home to community and if necessary to the acute hospital, and back again.  A seamless provision of care is required. 

An implementation plan is being developed which will outline how the model of care should be implemented across community and hospital networks.  This requires stakeholders to work together in an innovative integrated way, which has not previously happened in Ireland for children’s services on a national scale.  There are challenges around the scale of the project and the differing levels of ‘readiness’ for implementation. Workforce planning is more straightforward in some disciplines and service areas than others.  Lack of good information technology hinders efficient progress.  Breaking down of traditional barriers is required.  Enablers for integrated care are being considered; ICT, workforce, finance and communication.  A framework is being used as a focus for integrated implementation on a national and local level.

How to Cite: Turner G, Nicholson A, Murphy J. A national model of care for children: Integrated implementation- the opportunities and the challenges. International Journal of Integrated Care. 2018;18(s2):253. DOI: http://doi.org/10.5334/ijic.s2253
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Published on 23 Oct 2018.

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