INTRODUCTION 
The needs of disabled children, and of those with life-limiting or life-threatening conditions, have been specifically addressed in Aiming High for Disabled Children (the transformation programme for disabled children’s services) and in Better Care: Better Lives (the vision for improving paediatric palliative care services).  Working with the Children’s Trust we are committed to improving the outcomes for Children and Young People through the provision of accessible and responsive services.  As part of this commitment we are working collaboratively to develop a joint delivery plan to rationalise, coordinate and further develop the provision of services for children with disabilities in North East Lincolnshire.  

Accessible and Responsive Services: Community children’s nursing services are currently provided 7 days per week from 8.30am – 7pm Monday to Friday and 8.30am – 2pm weekends and bank holidays, this is supported for exceptional cases by the hospital nursing team. Additional provision is commissioned on an individual ‘spot purchase’ basis. 

Access to Aids and Equipment: Aids and Equipment, including powered and non-powered wheelchairs, are provided as part of the Children’s therapy services based at the acute trust. Provision is based on assessment via the Occupational Therapy Department. 

Short Break provision: Short break provision is provided within the home environment for children with continuing health care needs. There is open access to the children’s ward 24 hours a day for some children with complex health needs and their carers. The local Hospice provides short break provision for children and their families with palliative care needs and Community nursing services provide training and support to short break providers. 

Key worker Arrangements: There are named / key-work outreach nurses where children require medical intervention and the school nursing services operate on a key worker basis. The jointly commissioned service provided by Barnardo’s provides a key worker model of support to children 0-13yrs and their families. Through the Early Support Programme a non-designated key worker role is adopted e.g. By Health Visitors.   

Delayed transfers of Care: The hospital team work closely with the community nursing team to ensure that discharge planning starts at the point of admission and therefore there are no significant delays.  However, there are some delays noted by the district general hospital in the discharge notification planning from the tertiary centres.  

Access to Equipment in more than one setting: This service is provided by the Occupational Therapy Department. The Occupational Therapist undertakes an assessment of the range of, and volume of, equipment needed at home and in other settings if appropriate. Where this requires additional funding individual cases are discussed and commissioned on a case by case basis 

Workforce and Health skills Training: As part of the children's trust the workforce development programme is currently being reviewed, specifically looking at what is needed, what is available, where the gaps are and ultimately decisions made by each service area about the training that teams need to undertake.  Short Break provision forms part of the programme to ensure that we have a flexible workforce able to provide health care for children with very complex health needs.  Supporting the needs of disabled children is part of the common induction for all children’s services staff, this includes Health visitors and School Nurses and as part of the Community Paediatric service, the specialist community nursing team provide free training to partner agencies, families and carers. 

Planned developments: There is an evident need to further enhance and develop the service models and pathways to ensure that there is a coordinated and formalised model of care across the partnership to meet local needs; therefore following two stakeholder workshops the draft delivery plan has identified priority statements and key areas for action; these will then be further developed as part of a wider consultation workshop to be held with families and carers. The Local Delivery Plan will be monitored through the Aiming High Strategic group which reports to the Children’s Trust Board.     

Michelle BarnardAssistant Director – Collaborative Commissioning