Tackling culture change to transform mental health services

Mandip Kaur for the King’s Fund Blog | 16th March 2017


Traditionally, mental health services are delivered by Children and Adolescent Mental Health Services (CAMHS) up until the age of 16 or 18 – or when a young person leaves school or college – at which point they’re expected to transition to adult mental health services. It’s long been recognised that this is a poor boundary for service transition, often having a further detrimental effect on mental health.

Forward Thinking Birmingham delivers mental health services for children and young people aged up to 25, combining the expertise of Birmingham Children’s Hospital, Worcester Health and Care Trust, Beacon UK, The Children’s Society and The Priory Group. The partnership’s vision is that Birmingham should be the first city where mental health problems are not a barrier to young people achieving their dreams. The transformational changes to the service were driven by the need to address disjointed and fragmented care provision, complicated service models, long waiting lists and rising demand. The service operates a ‘no wrong door’ policy and aims to provide joined-up care, focusing on individual needs, with improved access and choice for young people.

Read the full blog post here


Improving outcomes for children and families

The Local Government Association has published Improving outcomes for children and families in the early years: a key role for health visiting services

Image source: http://www.local.gov.uk

This guide highlights the importance of health visitors and commissioners to work together to monitor and evaluate the impact of the health visiting service.

The report includes case studies demonstrating examples of innovation.

Effectiveness of an improvement programme to prevent interruptions during medication administration

Dall’Oglio, I. et al. (2017) BMJ Open. 7:e013285


Objective: To assess the effectiveness of an improvement programme to reduce the number of interruptions during the medication administration process in a paediatric hospital.

Intervention: The interventions included a yellow sash worn by nurses during medication cycles, a yellow-taped floor area indicating the ‘No interruption area’, visual notices in the medication areas, education sessions for healthcare providers and families, patient and parent information material.

Conclusions: This bundle of interventions proved to be an effective improvement programme to prevent interruptions during medication administration in a paediatric context.

Read the full abstract and article here 

Improving oral health


This toolkit is for commissioners and providers of supervised tooth brushing programmes in England.

In 2014, both NICE and PHE published documents that reviewed the evidence of effectiveness of oral health improvement programmes. They both recommended commissioning targeted supervised toothbrushing in early years’ settings. Read Improving oral health: an evidence-informed toolkit for local authorities.

Many local authorities in England already commission such programmes. This toolkit will help commissioners, public health teams and providers make sure their programmes are evidence-based and safe, and have clear accountability and reporting arrangements.

Access the full toolkit: Improving oral health: A toolkit to support commissioning of supervised toothbrushing programmes in early years and school settings

Improving the mental health of children and young people

Reports to support commissioners in improving the mental health and wellbeing of children and young people. | Public Health England

These reports describe the importance of mental health and wellbeing among children and young people and the case for investment in mental health. They also summarise the evidence of what works to improve mental health among children and young people in order to inform local transformation of services.

The mental health of children and young people in England

The mental health of children and young people in London

Image source: http://www.gov.uk

Quality improvement in pediatrics: past, present, and future

Schwartz, S.P. & Rehder, K.J. Pediatric Research. Published online: 26 October 2016


Almost two decades ago, the landmark report “To Err is Human” compelled healthcare to address the large numbers of hospitalized patients experiencing preventable harm. Concurrently, it became clear that the rapidly rising cost of healthcare would be unsustainable in the long-term. As a result, quality improvement methodologies initially rooted in other high-reliability industries have become a primary focus of healthcare.

Multiple pediatric studies demonstrate remarkable quality and safety improvements in several domains including handoffs, catheter-associated blood stream infections, and other serious safety events. While both quality improvement and research are data-driven processes, significant differences exist between the two. Research utilizes a hypothesis driven approach to obtain new knowledge while quality improvement often incorporates a cyclic approach to translate existing knowledge into clinical practice. Recent publications have provided guidelines and methods for effectively reporting quality and safety work and improvement implementations.

This review examines not only how quality improvement in pediatrics has led to improved outcomes, but also looks to the future of quality improvement in healthcare with focus on education and collaboration to ensure best practice approaches to caring for children.

Read the abstract here

RCPCH to launch first ever quality improvement measures for children

The Royal College of Paediatrics and Child Health (RCPCH) have  launched a programme of work to develop a set of quality improvement measures specifically for children and young people.


Service Level Quality Improvement Measures for Acute General Paediatric Services, is the first step in a process that will see the development of a set of measures designed to support acute paediatric services following last year’s RCPCH publications of two sets of acute service standards, Facing the Future Together for Child Health and Facing the Future: Standards for Acute General Paediatric Services.

The measures will help to evaluate the impact on service using these standards and assess the impact of locally driven quality improvement initiatives. They can also be used for regular monitoring.

In a consultation that makes up part of the report, there was clear backing from paediatricians to develop outcome standards in this area. The consultation also helped to highlight the key quality improvement measures needed for further development. These include:

  • Management of acute illness by inpatient general paediatric services
  • Patient safety
  • Activity and patient flow
  • Patient and parent/carer experience
  • Staff experience

In addition to the standards, the project will also work to identify research gaps, and work towards a framework to compare the quality of care between units in the future.

Read more on the report:  Service Level Quality Improvement Measures page.

Download the full report here