The Children and Young People Health Partnership (CYPHP) model of care has been co-designed by local clinicians, parents, carers, children and young people, researchers, commissioners and providers. The aim is to bring about change by testing and proving the benefits of a new model of care and new approaches to the way health care is delivered.
Children and young people’s healthcare in England should be better. Child mortality rates are worse than in comparable countries, and children with common long-term conditions receive poorer care.
In south London, Lambeth and Southwark have relatively young, ethnically diverse populations. They are among the most deprived boroughs in the country.
Initial research by the CYPHP revealed significant problems with children and young people’s health services in the boroughs, including high and increasing hospital use, poor management of long-term conditions, and healthcare needs not being met.
Services for young people in Lambeth and Southwark are poorly coordinated and arranged in ways that makes it hard for young people to access health care, particularly vulnerable young people, such as those in care, who have the greatest health needs.
Professor Ingrid Wolfe, professor of paediatrics and child population health at King’s College London, consultant in children's public health medicine at the Evelina London Children’s Hospital, and the ARC’s children and young people research theme lead is leading the implementation and evaluation of the programme.
The current model is struggling to meet the needs of children and young people. Our aim is to create new strong health teams dedicated to children and young people, which will work across traditional barriers between organisations and professions to deliver care in the child’s best interests.
The CYPHP programme aims to ensure that health services are shaped around the needs of children and their families, and this means delivering more of children's health care closer to home and schools. The programme is also working with GP practices and other health care providers to help them make young people feel more welcome.
Professor Wolfe says: 'At the moment, children and young people’s health outcomes are not as good as they could or should be. Too many children and young people (CYP) experience care that is less than optimal, for example, often going to A&E for minor health problems. We are providing nurse-led children’s health clinics within primary care, and comprehensive physical and mental health care for CYPs with long-term conditions, as part of an innovative new package of care. We are already starting to see exciting results.'
The focus of the new model of care is on managing everyday health conditions and long-term conditions, such as asthma and eczema.
Patients registered to GP practices in Lambeth and Southwark are randomised to the CYPHP (intervention) model or given enhanced usual care (control). An innovative feature is to offer preventative and comprehensive healthcare to all children with ‘tracer conditions’, such as constipation, asthma, and eczema. Tracer conditions are common medical conditions that can be routinely diagnosed, treated and prevented, but if untreated can cause significant problems.
Parents of CYP with tracer conditions are asked to complete the CYPHP Health Check, a questionnaire about their child's condition, emotional wellbeing, as well as other day-to-day challenges. Parents and children receive a summary of the results and a pack with information on how to manage the condition and community resources. In the intervention group, high-risk patients are triaged to the CYPHP’s multidisciplinary health team.
In addition, the service provides integrated care for general paediatric conditions, through local Child Health Teams. Each Child Health Team comprises a named paediatrician, a CYP GP lead and a CYPHP nurse. There is one Child Health Team for every group of GP practices in Southwark and Lambeth; each week the team review and triage all paediatric referrals and ensure the most appropriate care is given. The paediatrician holds monthly clinics within primary care, and there is also a monthly multi-disciplinary team meeting to provide education and training for primary care staff in managing paediatric conditions.
More than 4,000 children with ‘tracer’ conditions have been part of the CYPHP approach to care so far. Up to 20 per cent of their families face challenges that make day-to-day life extra difficult. This includes food and housing insecurity, unstable employment, difficulty paying bills and parental mental health problems.
Working in partnership with support services and other agencies, the CYPHP team aims to deliver improved care for local children by responding to their healthcare needs alongside the broader challenges facing their families.
We are fixing the ordinary stuff that takes its toll on children’s health, and blocks up healthcare systems. We know that so many things could be done better. One proven intervention for asthma, for example, is having a written care plan, but this happens all too rarely. We are making it part of routine care, using new technologies to support this
The new clinical model has been tested and implemented, and is now embedded across Lambeth and Southwark, providing more integrated, equitable, and higher quality care.
Early evaluation has shown reductions in acute service use, and improvements in health and healthcare quality. The model is increasing access to care, particularly for children living in the most deprived neighbourhoods:
I can go on school trips because the [CYPHP nurse] makes sure they know how to help me if I have an epilepsy attack
The early access to the mental health service is massive, not having to wait, you know, months on end
Experts from the Centre for Implementation Science are supporting and evaluating the implementation of the new model, including analysing whether or not it is cost efficient. The plan is to build up evidence that can help to improve the way children’s and young people’s services are delivered, both during and after the study.
The partnership is made up of Lambeth and Southwark clinical commissioning groups; Lambeth and Southwark Councils; The Evelina London Children’s Hospital; Guy’s and St Thomas’ NHS Foundation Trust; King’s College Hospital NHS Foundation Trust; King’s College London; South London and Maudsley NHS Foundation Trust; and children, young people and families living in Lambeth and Southwark. The programme is sponsored by the Guy's and St Thomas' Charity.
The trial results are expected later in 2022.
Listen to an interview with Professor Ingrid Wolfe on what drives her work with the CYPHP and how she came to specialise in paediatric public health: Not Mini Adults Podcast, Episode 17, Root Causes
Read a blog on how the CYPHP is integrating mental and physical health care: A new approach to address the health needs of children – a health professional’s perspective
The CYPHP has been highlighted as a case study in good practice in a Health Foundation report: Developing learning health systems in the UK: Priorities for action. A learning health system is a systematic approach to iterative, data-driven improvement.
