Are we getting it right? A paediatric AHP’s perspective of coproduction
by Gillian Ferguson Team Lead Paediatric Physio, NHS Greater Glasgow and Clyde.
Our National Delivery Plan [NDP] challenges AHP leadership to ensure an equitable and sustainable service model for a planned and coordinated service across Scotland. As the TV Meercat says “Simples”.
As an AHP (physio) working in children’s health for 20 years I have been involved, or more likely not involved, in so many change programmes. All of these have been with the best of intentions but their benefit and effect on the service given to our patients has been reduced due to the lack of national focus that encourages co-production between health care, social care and the third sector. The NPD clearly tells us the days of working in silos are over.
GIRFEC, Getting it Right for Every Child, has been a term used for some time but until now it has made little impact on how I work with families and children. I have seen many acronyms over my time which I have required to learn about and adjust to e.g. CSP (co-ordinated support plans), IAF (Integrated assessment framework), IEPs (individual educational programme) to name but a few and I have duly inputted my part when necessary. I would recommend the GIRFEC web site as a valuable resource.
When a round robin e-mail came in a few weeks ago – you know the ones – everybody and anybody on the mailing list – asking if a rep from the paediatric physio service could attend a meeting to discuss GIRFEC I was very interested to see health, education AND socialwork had to bring reps too.
A fairly unique moment and an opportunity to embrace GIRFEC and the NPD all in one go. The meeting was the first of its kind in Inverclyde CHCP (Community Health and Care Partnership) to discuss the Child’s Plan.
I went, became very enthused, and put myself forward for the sub-group – to devise the actual plan. We had our first sub-group meeting yesterday with just 5 of us but all 3 agencies represented – a daunting task but we all had one common goal – to improve outcomes whether it be in educational attainment or improved health or well-being for the family at risk. I now firmly believe the concept of GIRFEC will fundamentally change how we all interface with our families.
The paperwork we currently use is at best, useful to help us all set out our own goals and come up with a shared plan, at worst an unwieldy paper exercise which does not appear to improve or change the circumstances of the child and family; this can be disheartening when an awful lot of time has been invested in completing it.
We used what knowledge we had of current practice and looked at other councils’ practice – no we are not the first to implement the single assessment and it would be very interesting to hear from my other AHP colleagues that are using it.
We worked through a couple of cases we currently had and it helped us to clarify why we needed to change things.
The World Triangle and the well-being indicators use language that cuts across all our professions and can be understood by parents and carers, and in a lot of cases the child too. I had to move away from my physiotherapy head and think in the national practice model terminology – is the child safe, healthy, achieving, nurtured, active, respected, responsible and included? These all have to apply no matter what assessment or how complex or straightforward the case may seem – the families that see us do so because the universal services are not going to meet their needs and the targeted specialist service is their next port of call for help and assistance. Our children growing up in Scotland deserve to have a tick at all 8 indicators, and if they don’t we need to ask why – we may be the first point of contact for some families and for a lot of our families the AHP can be the one person regularly seeing the child at home. This give the AHP a better understanding of their world and how it impacts on them. Yes of course we have to apply all specific ‘tool box’ knowledge – something that we have trained long and hard for – but if we haven’t thought about the 8 well-being indicators then we are doing our families and the child a disservice.
So here is to the development of the Child’s Plan – a single shared assessment with cohesive information that we can all contribute to and understand, with the child right bang at the centre. If we do this then we will be much closer to getting it right.
To become effective agents of change in children’s services AHPs must adopt the GIRFEC approach – it will improve outcomes through shared understanding of well-being, and a common approach – no more working in isolation. It will create consistent high standards of co-operation, joint working and communication between the agencies. (Download ‘A guide to Getting it Right for Every Child 2012 Scottish Government’)
[Acknowledgement : All images from GIRFEC web site]