Children and Families

Project

Paediatric Physiotherapy

Leads: Carmel Kelly, Service Clinical Manager for Physiotherapy and Occupational Therapy; Christel Corbett, Paediatric Physiotherapy Team Leader; Claudette Keay, Service Manager for Therapies

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.

Project

Early years check-in calls

Lead: Deborah Berzins, Speech and Language Therapist and Early Years Co-ordinator.

 

What was the problem?

Book-ins are a huge output for the team with approximately 80 appointments offered during a week (across the city) in term time. Current base line is 27%, with an initial target to increase by 50% by March 2025. Waiting times were increasing due to the high volume of appointments being received.

 

Aim

To ensure each of the community clinics where sedation is to increase the number of families who access further targeted support following attendance at book-ins by 50% by March 2025.

 

What did we do?

Various improvement change ideas were looked at and the ‘check in call, change idea was selected to be trailed and implemented. At the book-in, families are offered the option to receive a ‘check-in’ call, 4 weeks later.
Locum staff make these calls:

• To check that families have received their report.
• To check that they understand the strategies given.
• To gather some feedback about whether it is helping.
• To problem solve any issues.
• Explain how to re-access.

 

The project also included running Early Years Online Workshops for families:

• Online group workshops hosted on MS Teams;
• On 5 different themes;
• Offered 1 to 1 with an interpreter where needed;
• Started in October 2023 to November 2024;
• Designed to enhance the f2f offer;
• Run by SLT locums making use of remote staff.

 

Early Years online workshops were run by 3 remote locum staff on MS Teams. They sent a link to each invited family and ran a pre-prepared group session on the following topics:

• Attention and Listening.
• Play and Interaction.
• Understanding of Language.
• Expressive Language.
• Higher Level Expressive Language (2 word level +).

If a family needed an interpreter, the session was run 1 to1.

 

What are the benefits for patients and staff)?

What families told us:

• Able to comment on how they will do things differently, for example, remove distractions, commenting rather than asking questions, using object cues, expanding their child’s phrases.
• Able to generate play activities or daily activities in which they will practise the strategies (which shows they have understood the content).
• Bilingualism advice helpful, especially in the interpreter sessions.
• Parents have generally been very appreciative and fed back that the advice was very clear.

 

Key Learning Points:

• Data analysis has been crucial.
• A clear starting point was needed as it wasn’t possible to test on a smaller scale before launching.
• Positive side-effects: increased access to tailored support and lots more impact data collected.
• Negative side-effect: increase on re-access demand.
• All the positives of the online workshops were adapted into the new more flexible and accessible format.

 

The check-in calls project has been a success in that we achieved our aim to increase access to follow up support from the baseline of 27% to 79%.

Measures used

• Waiting lists: data analysis.
• Staff feedback.
• Patient feedback

 

Qi tools used

• Plan, Do, Study, Act (PDSA) Cycle.
• Fishbone diagram.
• Process mapping.
• Demand and capacity modelling.