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Ambulatory Care Experience (ACE) for Children and Young people

Community is where the real action is! It's a great place to be right now if you want to think big and brave!

We are currently running a pilot in Bradford called 'ACE'-the 'Ambulatory Care Experience', a  name chosen by our community nurses who have a passion for this work.   ACE provides an alternative to a hospital referral or admission for children and young people (CYP) with common acute illnesses like asthma, gastroenteritis, croup, bronchiolitis and neonatal jaundice. CYP are referred to the service from Primary Care, A&E and from the CYP assessment unit at the Bradford Royal Infirmary. CYP who meet pathway criteria are looked after at home under the care of a nurse and on-call Consultant Paediatrician in a ‘virtual ward’. For more details see https://www.bradfordhospitals.nhs.uk/the-ace-service/ 

This is the link to the recently launched RCPCH QI site for those interested in the detail:

https://www.qicentral.org.uk/systems-care/efficiency-and-access/%E2%80%98keeping-sick-children-out-hospital%E2%80%99-ambulatory-care-experience

Our multidisciplinary team (MDT) have developed a bespoke training package for our community children's nurses (CCNs) and we developed the service  according to the Calderdale Framework stages https://www.calderdaleframework.com/ Our CCNs feel very much part of the acute care team and have regular clinical support from senior hospital decision makers. They really feel they are making a difference. They are involved in service development and receive MDT appraisal. There is a real spring in their step and we are attracting nurses from outside our Trust and even our region.

At present CCNs have a really diverse remit across the country and their role in the NHS can be misunderstood. This can be good thing providing flexibility but it can also make it a difficult area for change. 

What can be done to encourage more staff to want to work in community settings?

Over the past 10 years there has been a significant increase in demand on paediatric secondary care services. We know this is unsustainable. Changing the perception of community services is going to be key. And those working in acute hospitals like me really need to see community teams as part of our acute service. We need to be brave when it comes to workforce development and to move away from the traditional doctor and nurse paradigm. We need to have the ability to experiment with new technologies and be supported to do so and not hampered by unnecessary bureaucracy or fears (while making sure data is kept safe). I really believe the NHS is ripe for innovation and transformation.  In Bradford there is system level buy-in for improving quality and value with the shared vision that ‘the key to delivering effective and urgent care is ensuring that the whole system is designed to support self-care and community care at home, thereby reducing avoidable hospital admissions and facilitating timely early discharges’ (Institute for Innovation and Improvement). The future I believe can be bright but there needs to be a well communicated vision that is not politically driven and which needs buy in across the system. This is only going to be sustainable through better networks and collaboration and sites like this where ideas can be shared and blue sky thinking is allowed!

What would improve your day-to-day life working in the community?

It all comes down to a few things

1) a vision that is developed by the majority and shared and owned by all. It needs to be driven by patients and families. This is probably the hardest task

2) strong leadership and followership and team building skills being  modelled -and resources to do this in the NHS  

3) to be driven from the grassroots not a top down approach

4) to provide time for development -not just for enthusiasts in their own time

5) to work out how we can nurture and develop our staff and have the right number of people on the ground (and fund it appropriately) to make it fit for purpose and also with time for personal and service development

Navid DHSC 6 months ago

Thank you for your very helpful response, Mat.

Children’s Community Nurses play an important role in the system but more can be done to improve awareness and knowledge of them.

Thank you for sharing the work you are doing in Bradford to provide children with common acute illnesses like asthma, gastroenteritis, croup, bronchiolitis and neonatal jaundice, with an alternative to a hospital referral or admission . It highlights the impact community health services can have on the wider system and the benefits of working across teams, to deliver integrated care which is wrapped around the patient.

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