Children and Families

Project

Paediatric Physiotherapy

Leads: Carmel Kelly, Operational Manager; Christel Corbett, Paediatric Physiotherapy Team Leader; Claudette Keay, Interim Operational Manager/Team Leader

What was the problem?

• Rising demand and case complexity: the service was currently managing an open caseload of approximately 3,024 patients, driven by a sustained increase in referral rates and the complexity of cases.
• Capacity constraints: limited staffing and resources had created a mismatch between demand and capacity, resulting in delays to both assessments and interventions.
• Significant backlog: there was a backlog of over 682 children awaiting initial assessment, many of whom presented with urgent needs requiring timely support.
• Extended waiting times: in addition to initial assessments, there were further delays for clinical reviews and treatment. Those long waiting times predate the COVID-19 pandemic and have been exacerbated by it.
• Urgent need for transformation: radical changes were required to ensure that children with the greatest need received timely and effective intervention, safeguarding their health and developmental outcomes.

Aim

To reduce the number of routine new referrals accepted to the Paediatric Physiotherapy Service by 20% by 1st December 2023

 

What did we do?

To better meet the needs of children and manage increasing demand, a new tiered service model was developed to stream patients into three levels of support:

• Specialist level: for children with identified long-term physical disabilities that significantly impact daily function and participation.  Intervention delivered primarily through 1:1 assessments, individualised treatment, and access to specialist clinical pathways.
• Targeted level: for children with specific developmental conditions, such as Down Syndrome, who require focused support.
• Universal level: suitable for all children and available pre-referral, whilst waiting or after discharge. A clinical advice line for parents and professionals. Signposting to a dedicated website with appropriate resources. Training for the wider workforce to support early intervention and consistent messaging and development of accurate, accessible information resources to empower families and carers.

 

What are the benefits for patients and staff?

• Reduced waiting times for initial assessments: families are being seen more quickly for initial assessments, resulting in a noticeable decrease in complaints about long waiting times.
• Improved access to information: parents have responded positively to being directly signposted to relevant information on the website, appreciating the ease of access rather than having to search for it themselves.
• Improved first appointment experience: families are arriving at their first appointments less frustrated due to shorter waiting times, allowing clinicians to build rapport more quickly and effectively.
• Positive feedback from physiotherapists - a physiotherapist shared:

I have found it really helpful having the webpages to refer families to when providing them with advice.

• Efficient use of online resources: clinicians have noted that having all the latest information consolidated on the website saves time. One commented:

It really saves time having all the latest information in one place on the website rather than having to spend time searching. The links are easy to use and signpost families to after seeing them in clinic. I’ve also used the specific website links while triaging, especially when waiting for the Universal Offer letters to be produced.

 

Measures used

• Measure and analyse data from waiting lists.
• Measure and analyse data from referrals.
• Measure and analyse demand, capacity, activity and backlog.
• Feedback from staff.

 

Qi tools used

• Plan, Do, Study, Act (PDSA) cycle.
• Statistical Process Control (SPC) Charts.
• Fishbone Diagram.
• Driver Diagram.
• Process Mapping.

 

Project

To refer or not to refer? Improving the quality and timing of referrals to Children's Speech and Language Therapy (SLT) Eating and Drinking Team.

Lead: Kay Jones, Clinical Expert Speech and Language Therapist – Paediatric Dysphagia

 

What was the problem?

The Children and Families (C&F) Speech and Language Therapy (SLT) Dysphagia Service had experienced steadily increasing waiting times:

• Routine need patients: waiting up to 68 weeks (target: 18 weeks)
• High need patients: waiting up to 24 weeks (target: 4–6 weeks)

A key contributing factor was the misclassification of referrals, with a high number being incorrectly prioritised as high need based on the information provided by referrers. This mis-prioritisation placed additional pressure on the service and contributed to delays for both high and routine need patients.

 

Aim

To reduce waiting time from 40 weeks to 18 weeks for routine need patients and from 17 weeks to 4 weeks for high need patients and increase appropriacy of referrals, by the  end of September 2023, by providing universal strategies and guidance for referrals.

 

What did we do?

To address the increasing waiting times and mis-prioritisation of referrals in the C&F SLT Dysphagia Service, the team implemented a series of targeted interventions:

• Pre-Referral Checklist and Universal Advice Leaflet.
• A pre-referral checklist was introduced to guide referrers in accurately identifying high need versus routine cases.
• An accompanying universal (first line) advice leaflet was developed to support families and professionals with initial management strategies.
• Both resources were made available on the service’s webpages, alongside the referral form.
• Training and Communication:
  • A training package was created to explain the purpose and use of the new resources.
  • The team actively attended referrer team meetings and forums (for example Health Visitors, Paediatricians, Children’s Nursing Teams) to launch the documents.
  • Resources were also distributed via email through the Integrated Care Board (ICB) GP circulation list.
• Consistent Triage Criteria:
  • At the point of triage, the same criteria outlined in the checklist was applied to all new referrals.
  • Referrals that met the criteria for universal support were provided with first-line advice and not added to the waiting list, helping to manage demand more effectively.

 

What are the benefits for patients and staff)?

• Average waiting times for routine need referrals reduced to the 18-week target by project end. High need referrals: waiting times reduced to 9 weeks.
• Improved referral quality led to a reduction in high-risk list additions during the project period.
• 30% reduction in referrals added to waiting lists, mainly for routine needs. This equates to approximately 200 fewer referrals per year 2023 to 2024 and 2024 to 2025 compared to previous years.
• The pre-referral checklist and top ten tips resource are now embedded in the clinical pathway, supporting consistent and effective triage.
• Families now receive appropriate advice earlier, avoiding unnecessary delays of up to a year for guidance that could be provided at the point of referral.
• SLT staff and colleagues across services (Early Years, School Age, Special Schools, Health Visiting, Community Nursing, Paediatrics) feel confident and supported to offer early advice as a first-line intervention.
• More appropriate and targeted referrals are being made, reducing pressure on waiting lists and ensuring children receive the right support sooner.
• Staff in schools and early years settings are better informed about when and how to refer and feel enabled to provide early advice or signpost families to relevant services.

Measures used

• Waiting list data highlighted the problem initially.
• Statistical Process Control (SPC) charts were used to show longest waits and numbers added to the waiting list and to monitor impact of project on these over time.
• Children and Families SLT patient tracker tool was also used to monitor average wait times.

 

Qi tools used

• 5W’s and 2H’s.
• Process mapping.
• Fishbone analysis.
• Driver diagram.