Common use of TO SERVICE SPECIFICATION Clause in Contracts

TO SERVICE SPECIFICATION. PROVISION OF SERVICES TO CHILDREN Aims and objectives of service This specification annex applies to all children’s services and outlines generic standards and outcomes that would fundamental to all services. The generic aspects of care: The Care of Children in Hospital (Health Service Circular (HSC) 1998/238) requires that: • children are admitted to hospital only if the care they require cannot be as well provided at home, in a day clinic or on a day basis in hospital. • children requiring admission to hospital are provided with a high standard of medical, nursing and therapeutic care to facilitate speedy recovery and minimise complications and mortality. • families with children have easy access to hospital facilities for children without needing to travel significantly further than to other similar amenities. • children are discharged from hospital as soon as socially and clinically appropriate and full support provided for subsequent home or day care. • good child health care is shared with parents/carers and they are • closely involved in the care of their children at all times unless, exceptionally, this is not in the best interest of the child; accommodation is provided for them to remain with their children overnight if they so wish. Service description/care pathway All paediatric specialised services have a component of primary, secondary, tertiary and even quaternary elements. The efficient and effective delivery of services requires children to receive their care as close to home as possible dependent on the phase of their disease. Services should therefore be organised and delivered through ‘integrated pathways of care’ (National Service Framework for Children, Young People and Maternity Services (Department of Health & Department for Education and Skills, London, 2004) Interdependencies with other services All services will comply with Commissioning Safe and Sustainable Specialised Paediatric Services: A Framework of Critical Inter-Dependencies – Department of Health Imaging All services will be supported by a three tier imaging network (Delivering quality imaging services for children’ Department of Health 13732 March2010). Within the network: • it will be clearly defined which imaging test or interventional procedure can be performed and reported at each site • robust procedures will be in place for image transfer for review by a specialist radiologist, these will be supported by appropriate contractual and information governance arrangements • robust arrangements will be in place for patient transfer if more complex imaging or intervention is required • common standards, protocols and governance procedures will exist throughout the network. • all radiologists, and radiographers will have appropriate training, supervision and access to continuous professional development (CPD) • all equipment will be optimised for paediatric use and use specific paediatric software Specialist Paediatric Anaesthesia Wherever and whenever children undergo anaesthesia and surgery, their particular needs must be recognised and they should be managed in separate facilities, and looked after by staff with appropriate experience and training.1 All UK anaesthetists undergo training which provides them with the competencies to care for older babies and children with relatively straightforward surgical conditions and without major co- morbidity. However those working in specialist centres must have undergone additional (specialist) training (2) and should maintain the competencies so acquired (3) *. These competencies include the care of very young/premature babies, the care of babies and children undergoing complex surgery and/or those with major/complex co-morbidity (including those already requiring intensive care support). As well as providing an essential co-dependent service for surgery, specialist anaesthesia and sedation services may be required to facilitate radiological procedures and interventions (for example magnetic resonance screening (MRI) scans and percutaneous nephrostomy) and medical interventions (for example joint injection and intrathecal chemotherapy), and for assistance with vascular access in babies and children with complex needs such as intravenous feeding. Specialist acute pain services for babies and children are organised within existing departments of paediatric anaesthesia and include the provision of agreed (hospital- wide) guidance for acute pain, the safe administration of complex analgesia regimes including epidural analgesia, and the daily input of specialist anaesthetists and acute pain nurses with expertise in paediatrics. *The Safe and Sustainable reviews of paediatric cardiac and neuro- sciences in England have noted the need for additional training and maintenance of competencies by specialist anaesthetists in both fields of practice. References 1. Guidance for Providing Anaesthetic Services (GPAS) Paediatric anaesthetic services. Royal College of Anaesthetists (RCoA) 2010 (xxx.xxxx.xx.xx) 2. Certificate for Completion in Training (CCT) in Anaesthesia 2010 3. CPD matrix level 3 Specialised Child and Adolescent Mental Health Services (CAMHS) The age profile of children and young people admitted to specialised CAMHS day/inpatient settings is different to the age profile for paediatric units in that it is predominantly adolescents who are admitted to specialised CAMHS inpatient settings, including over-16s. The average length of stay is longer for admissions to mental health units. Children and young people in specialised CAMHS day/inpatient settings generally participate in a structured programme of education and therapeutic activities during their admission. Taking account of the differences in patient profiles the principles and standards set out in this specification apply with modifications to the recommendations regarding the following: • Facilities and environment – essential Quality Network for In-patient CAMHS (QNIC) standards should apply

TO SERVICE SPECIFICATION. PROVISION OF SERVICES TO CHILDREN Aims and objectives of service This specification annex applies to all children’s services and outlines generic standards and outcomes that would fundamental to all services. The generic aspects of care: The Care of Children in Hospital (Health Service Circular (HSC) HSC 1998/238) requires that: • children Children are admitted to hospital only if the care they require cannot be as well provided at home, in a day clinic or on a day basis in hospital. • children Children requiring admission to hospital are provided with a high standard of medical, nursing and therapeutic care to facilitate speedy recovery and minimise minimize complications and mortality. • families Families with children have easy access to hospital facilities for children without needing to travel significantly further than to other similar amenities. • children Children are discharged from hospital as soon as socially and clinically appropriate and full support provided for subsequent home or day care. • good Good child health care is shared with parents/carers and they are • closely involved in the care of their children at all times unless, exceptionally, this is not in the best interest of the child; accommodation Accommodation is provided for them to remain with their children overnight if they so wish. Service description/care pathway All paediatric specialised services have a component of primary, secondary, tertiary and even quaternary elements. The efficient and effective delivery of services requires children to receive their care as close to home as possible dependent on the phase of their disease. Services should therefore be organised and delivered through ‘“integrated pathways of care’ ” (National Service Framework for Childrenchildren, Young People young people and Maternity Services maternity services (Department of Health & &Department for Education and Skills, London, London 2004) Interdependencies with other services All services will comply with Commissioning Safe and Sustainable Specialised Paediatric Services: A Framework of Critical Inter-Dependencies – Department of Health Imaging All services will be supported by a three 3 tier imaging network („Delivering quality imaging services for children’ children‟ Department of Health 13732 March2010March 2010). Within the network: • it It will be clearly defined which imaging test or interventional procedure can be performed and reported at each site • robust Robust procedures will be in place for image transfer for review by a specialist radiologist, these will be supported by appropriate contractual and information governance arrangements • robust Robust arrangements will be in place for patient transfer if more complex imaging or intervention is required • common Common standards, protocols and governance procedures will exist throughout the network. • all All radiologists, and radiographers will have appropriate training, supervision and access to continuous continuing professional development (CPD) • all All equipment will be optimised for paediatric use and use specific paediatric software Specialist Paediatric Anaesthesia Wherever and whenever children undergo anaesthesia and surgery, their particular needs must be recognised and they should be managed in separate facilities, and looked after by staff with appropriate experience and training.1 All UK anaesthetists undergo training which provides them with the competencies to care for older babies and children with relatively straightforward surgical conditions and without major co- morbidity. However those working in specialist centres must have undergone additional (specialist) training (2) training2 and should maintain the competencies so acquired (3) acquired3 *. These competencies include the care of very young/premature babies, the care of babies and children undergoing complex surgery and/or those with major/complex co-morbidity (including those already requiring intensive care support). As well as providing an essential co-dependent service for surgery, specialist anaesthesia and sedation services may be required to facilitate radiological procedures and interventions (for example magnetic resonance screening (MRI) MRI scans and percutaneous nephrostomy) and medical interventions (for example joint injection and intrathecal chemotherapy), and for assistance with vascular access in babies and children with complex needs such as intravenous feeding. Specialist acute pain services for babies and children are organised within existing departments of paediatric anaesthesia and include the provision of agreed (hospital- hospital wide) guidance for acute pain, the safe administration of complex analgesia regimes including epidural analgesia, and the daily input of specialist anaesthetists and acute pain nurses with expertise in paediatrics. *The Safe and Sustainable reviews of paediatric cardiac and neuro- sciences in England have noted the need for additional training and maintenance of competencies by specialist anaesthetists in both fields of practice. References 1. Guidance for Providing Anaesthetic Services (GPAS) GPAS Paediatric anaesthetic services. Royal College of Anaesthetists (RCoA) RCoA 2010 (xxx.xxxx.xx.xx) xxx.xxxx.xx.xx 2. Certificate for Completion in Training (CCT) CCT in Anaesthesia 2010 3. CPD matrix level 3 Specialised Child and Adolescent Mental Health Services (CAMHS) The age profile of children and young people admitted to specialised CAMHS day/inpatient in-patient settings is different to the age profile for paediatric units in that it is predominantly adolescents who are admitted to specialised CAMHS inpatient in-patient settings, including over-16s. The average length of stay is longer for admissions to mental health units. Children and young people in specialised CAMHS day/inpatient in- patient settings generally participate in a structured programme of education and therapeutic activities during their admission. Taking account of the differences in patient profiles the principles and standards set out in this specification apply with modifications to the recommendations regarding the following: • Facilities and environment – essential Quality Network for In-patient CAMHS (QNIC) standards should apply (xxxx://xxx.xxxxxxx.xx.xx/quality/quality,accreditationaudit/qnic1.aspx) • Staffing profiles and training - essential QNIC standards should apply. • The child/ young person‟s family are allowed to visit at any time of day taking account of the child / young persons need to participate in therapeutic activities and education as well as any safeguarding concerns. • Children and young people are offered appropriate education from the point of admission. • Parents/carers are involved in the child/young persons care except where this is not in the best interests of the child / young person and in the case of young people who have the capacity to make their own decisions is subject to their consent. • Parents/carers who wish to stay overnight are provided with accessible accommodation unless there are safeguarding concerns or this is not in the best interests of the child/ young person

TO SERVICE SPECIFICATION. PROVISION OF SERVICES TO CHILDREN Aims and objectives of service This specification annex applies to all children’s services and outlines generic standards and outcomes that would fundamental to all services. The generic aspects of care: The Care of Children in Hospital (Health Service Circular (HSC) HSC 1998/238) requires that: • children Children are admitted to hospital only if the care they require cannot be as well provided at home, in a day clinic or on a day basis in hospital. • children Children requiring admission to hospital are provided with a high standard of medical, nursing and therapeutic care to facilitate speedy recovery and minimise minimize complications and mortality. • families Families with children have easy access to hospital facilities for children without needing to travel significantly further than to other similar amenities. • children Children are discharged from hospital as soon as socially and clinically appropriate and full support provided for subsequent home or day care. • good Good child health care is shared with parents/carers and they are • closely involved in the care of their children at all times unless, exceptionally, this is not in the best interest of the child; accommodation Accommodation is provided for them to remain with their children overnight if they so wish. Service description/care pathway • All paediatric specialised services have a component of primary, secondary, tertiary and even quaternary elements. • The efficient and effective delivery of services requires children to receive their care as close to home as possible dependent on the phase of their disease. • Services should therefore be organised and delivered through ‘“integrated pathways of care’ ” (National Service Framework for Childrenchildren, Young People young people and Maternity Services (maternity services Department of Health & and Department for Education and Skills, London, London 2004) Interdependencies with other services All services will comply with Commissioning Safe and Sustainable Specialised Paediatric Services: A Framework of Critical Inter-Dependencies – Department of Health Imaging All services will be supported by a three tier imaging network (‘Delivering quality imaging services for children’ Department of Health DOH 13732 March2010). Within the network: ; • it It will be clearly defined which imaging test or interventional procedure can be performed and reported at each site site. • robust Robust procedures will be in place for image transfer for review by a specialist radiologist, these will be supported by appropriate contractual and information governance arrangements arrangements. • robust Robust arrangements will be in place for patient transfer if more complex imaging or intervention is required required. • common Common standards, protocols and governance procedures will exist throughout the network. • all All radiologists, and radiographers will have appropriate training, supervision and access to continuous continuing professional development (CPD) development. • all All equipment will be optimised for paediatric use and use specific paediatric software software. Specialist Paediatric Anaesthesia paediatric anaesthesia Wherever and whenever children undergo anaesthesia and surgery, their particular needs must be recognised and they should be managed in separate facilities, and looked after by staff with appropriate experience and training.1 All UK anaesthetists undergo training which provides them with the competencies to care for older babies and children with relatively straightforward surgical conditions and without major co- co-morbidity. However those working in specialist centres must have undergone additional (specialist) training (2) training2 and should maintain the competencies so acquired (3) acquired3 *. These competencies include the care of very young/premature babies, the care of babies and children undergoing complex surgery and/or those with major/complex co-morbidity (including those already requiring intensive care support). As well as providing an essential co-dependent service for surgery, specialist anaesthesia and sedation services may be required to facilitate radiological procedures and interventions (for example magnetic resonance screening (MRI) MRI scans and percutaneous nephrostomy) and medical interventions (for example joint injection and intrathecal chemotherapy), and for assistance with vascular access in babies and children with complex needs such as intravenous feeding. Specialist acute pain services for babies and children are organised within existing departments of paediatric anaesthesia and include the provision of agreed (hospital- hospital wide) guidance for acute pain, the safe administration of complex analgesia regimes including epidural analgesia, and the daily input of specialist anaesthetists and acute pain nurses with expertise in paediatrics. *The Safe and Sustainable reviews of paediatric cardiac and neuro- sciences in England have noted the need for additional training and maintenance of competencies by specialist anaesthetists in both fields of practice. References 1. Guidance for Providing Anaesthetic Services (GPAS) Paediatric anaesthetic services. Royal College of Anaesthetists (RCoA) 2010 (xxx.xxxx.xx.xx) 2. Certificate for Completion in Training (CCT) in Anaesthesia 2010 3. CPD matrix level 3 Specialised Child and Adolescent Mental Health Services (CAMHS) The age profile of children and young people admitted to specialised CAMHS day/inpatient settings is different to the age profile for paediatric units in that it is predominantly adolescents who are admitted to specialised CAMHS inpatient settings, including over-16s. The average length of stay is longer for admissions to mental health units. Children and young people in specialised CAMHS day/inpatient settings generally participate in a structured programme of education and therapeutic activities during their admission. Taking account of the differences in patient profiles the principles and standards set out in this specification apply with modifications to the recommendations regarding the following: • Facilities and environment – essential Quality Network for In-patient CAMHS (QNIC) standards should apply.

TO SERVICE SPECIFICATION. PROVISION OF SERVICES TO CHILDREN Aims and objectives of service This specification annex applies to all children’s services and outlines generic standards and outcomes that would fundamental to all services. The generic aspects of care: The Care of Children in Hospital (Health Service Circular (HSC) 1998/238) requires that: • children are admitted to hospital only if the care they require cannot be as well aswell provided at home, in a day clinic or on a day basis in hospital. • children requiring admission to hospital are provided with a high standard of medical, nursing and therapeutic care to facilitate speedy recovery and minimise complications and mortality. • families with children have easy access to hospital facilities for children without needing to travel significantly further than to other similar amenities. • children are discharged from hospital as soon as socially and clinically appropriate and full support provided for subsequent home or day caredaycare. • good child health care is shared with parents/carers and they are • closely involved in the care of their children at all times unless, exceptionally, this is not in the best interest of the child; accommodation is provided for them to remain with their children overnight if they so wish. Service description/care pathway All paediatric specialised services have a component of primary, secondary, tertiary and even quaternary elements. The efficient and effective delivery of services requires children to receive their care as close to home as possible dependent on the phase of their disease. Services should therefore be organised and delivered through ‘integrated pathways of care’ (National Service Framework for Children, Young People and Maternity Services (Department of Health & Department for Education and Skills, London, 2004) Interdependencies with other services All services will comply with Commissioning Safe and Sustainable Specialised Paediatric Services: A Framework of Critical Inter-Dependencies – Department of Health Imaging All services will be supported by a three tier imaging network (Delivering quality imaging services for children’ Department of Health 13732 March2010). Within the network: • it will be clearly defined which imaging test or interventional procedure can be performed and reported at each site • robust procedures will be in place for image transfer for review by a specialist radiologist, these will be supported by appropriate contractual and information governance arrangements • robust arrangements will be in place for patient transfer if more complex imaging or intervention is required • common standards, protocols and governance procedures will exist throughout the network. • all radiologists, and radiographers will have appropriate training, supervision and access to continuous professional development (CPD) • all equipment will be optimised for paediatric use and use specific paediatric software Specialist Paediatric Anaesthesia Wherever and whenever children undergo anaesthesia and surgery, their particular needs must be recognised and they should be managed in separate facilities, and looked after by staff with appropriate experience and training.1 All UK anaesthetists undergo training which provides them with the competencies to care for older babies and children with relatively straightforward surgical conditions and without major co- morbidity. However those working in specialist centres must have undergone additional (specialist) training (2) and should maintain the competencies so acquired (3) )*. These competencies include the care of very young/premature babies, the care of babies and children undergoing complex surgery and/or those with major/complex co-morbidity (including those already requiring intensive care support). As well as providing an essential co-dependent service for surgery, specialist anaesthesia and sedation services may be required to facilitate radiological procedures and interventions (for example magnetic resonance screening (MRI) scans and percutaneous nephrostomy) and medical interventions (for example joint injection and intrathecal chemotherapy), and for assistance with vascular access in babies and children with complex needs such as intravenous feeding. Specialist acute pain services for babies and children are organised within existing departments of paediatric anaesthesia and include the provision of agreed (hospital- wide) guidance for acute pain, the safe administration of complex analgesia regimes including epidural analgesia, and the daily input of specialist anaesthetists and acute pain nurses with expertise in paediatrics. *The Safe and Sustainable reviews of paediatric cardiac and neuro- sciences in England have noted the need for additional training and maintenance of competencies by specialist anaesthetists in both fields of practice. References 1. Guidance for Providing Anaesthetic Services (GPAS) Paediatric anaesthetic services. Royal College of Anaesthetists (RCoA) 2010 (xxx.xxxx.xx.xx) 2. Certificate for Completion in Training (CCT) in Anaesthesia 2010 3. CPD matrix level 3 Specialised Child and Adolescent Mental Health Services (CAMHS) The age profile of children and young people admitted to specialised CAMHS day/inpatient settings is different to the age profile for paediatric units in that it is predominantly adolescents who are admitted to specialised CAMHS inpatient settings, including over-16s. The average length of stay is longer for admissions to mental health units. Children and young people in specialised CAMHS day/inpatient settings generally participate in a structured programme of education and therapeutic activities during their admission. Taking account of the differences in patient profiles the principles and standards set out in this specification apply with modifications to the recommendations regarding the following: • Facilities and environment – essential Quality Network for In-patient CAMHS (QNIC) standards should apply.

TO SERVICE SPECIFICATION. PROVISION OF SERVICES TO CHILDREN Aims and objectives of service This specification annex applies to all children’s services and outlines generic standards and outcomes that would fundamental to all services. The generic aspects of care: The Care of Children in Hospital (Health Service Circular (HSC) 1998/238) requires that: • children Children are admitted to hospital only if the care they require cannot be as well provided at home, in a day clinic or on a day basis in hospital. • children Children requiring admission to hospital are provided with a high standard of medical, nursing and therapeutic care to facilitate speedy recovery and minimise minimize complications and mortality. • families Families with children have easy access to hospital facilities for children without needing to travel significantly further than to other similar amenities. • children Children are discharged from hospital as soon as socially and clinically appropriate and full support provided for subsequent home or day care. • good Good child health care is shared with parents/carers and they are • closely involved in the care of their children at all times unless, exceptionally, this is not in the best interest of the child; accommodation Accommodation is provided for them to remain with their children overnight if they so wish. Service description/care pathway • All paediatric specialised services have a component of primary, secondary, tertiary and even quaternary elements. • The efficient and effective delivery of services requires children to receive their care as close to home as possible dependent on the phase of their disease. • Services should therefore be organised and delivered through ‘“integrated pathways of care’ ” (National Service Framework for Childrenchildren, Young People young people and Maternity Services maternity services (Department of Health (DOH) & Department for Education and Skills, London, London 2004) Interdependencies with other services All services will comply with Commissioning Safe and Sustainable Specialised Paediatric Services: A Framework of Critical Inter-Dependencies – Department of Health DOH Imaging All services will be supported by a three 3 tier imaging network (‘Delivering quality imaging services for children’ Department of Health DOH 13732 March2010). Within the network: ; • it It will be clearly defined which imaging test or interventional procedure can be performed and reported at each site • robust Robust procedures will be in place for image transfer for review by a specialist radiologist, these will be supported by appropriate contractual and information governance arrangements • robust Robust arrangements will be in place for patient transfer if more complex imaging or intervention is required • common Common standards, protocols and governance procedures will exist throughout the network. • all All radiologists, and radiographers will have appropriate training, supervision and access to continuous professional development Continuing Professional Development (CPD) • all All equipment will be optimised for paediatric use and use specific paediatric software Specialist Paediatric Anaesthesia Wherever and whenever children undergo anaesthesia and surgery, their particular needs must be recognised and they should be managed in separate facilities, and looked after by staff with appropriate experience and training.1 All UK anaesthetists undergo training which provides them with the competencies to care for older babies and children with relatively straightforward surgical conditions and without major co- morbidity. However those working in specialist centres must have undergone additional (specialist) training (2) training2 and should maintain the competencies so acquired (3) acquired3 *. These competencies include the care of very young/premature babies, the care of babies and children undergoing complex surgery and/or those with major/complex co-morbidity (including those already requiring intensive care support). As well as providing an essential co-dependent service for surgery, specialist anaesthesia and sedation services may be required to facilitate radiological procedures and interventions (for example magnetic resonance screening (MRI) MRI scans and percutaneous nephrostomy) and medical interventions (for example joint injection and intrathecal chemotherapy), and for assistance with vascular access in babies and children with complex needs such as intravenous feeding. Specialist acute pain services for babies and children are organised within existing departments of paediatric anaesthesia and include the provision of agreed (hospital- hospital wide) guidance for acute pain, the safe administration of complex analgesia regimes including epidural analgesia, and the daily input of specialist anaesthetists and acute pain nurses with expertise in paediatrics. *The Safe and Sustainable reviews of paediatric cardiac and neuro- sciences in England have noted the need for additional training and maintenance of competencies by specialist anaesthetists in both fields of practice. References 1. Guidance for Providing Guidelines on the Provision of Anaesthetic Services (GPAS) Paediatric anaesthetic services. Royal College of Anaesthetists (RCoA) 2010 (xxx.xxxx.xx.xx) xxx.xxxx.xx.xx 2. Certificate for of Completion in of Training (CCT) in Anaesthesia 2010 3. CPD matrix level 3 Specialised Child and Adolescent Mental Health Services (CAMHS) The age profile of children and young people admitted to specialised CAMHS day/inpatient in- patient settings is different to the age profile for paediatric units in that it is predominantly adolescents who are admitted to specialised CAMHS inpatient in-patient settings, including over-16s. The average length of stay is longer for admissions to mental health units. Children and young people in specialised CAMHS day/inpatient in- patient settings generally participate in a structured programme of education and therapeutic activities during their admission. Taking account of the differences in patient profiles the principles and standards set out in this specification apply with modifications to the recommendations regarding the following: following • Facilities and environment – essential Quality Network for In-patient CAMHS (QNIC) standards should apply (xxxx://xxx.xxxxxxx.xx.xx/quality/quality,accreditationaudit/qnic1.aspx) • Staffing profiles and training - essential QNIC standards should apply. • The child/ young person’s family are allowed to visit at any time of day taking account of the child / young persons need to participate in therapeutic activities and education as well as any safeguarding concerns. • Children and young people are offered appropriate education from the point of admission. • Parents/carers are involved in the child/young persons care except where this is not in the best interests of the child / young person and in the case of young people who have the capacity to make their own decisions is subject to their consent. • Parents/carers who wish to stay overnight are provided with accessible accommodation unless there are safeguarding concerns or this is not in the best interests of the child/ young person. Applicable national standards e.g.

TO SERVICE SPECIFICATION. PROVISION OF SERVICES TO CHILDREN Aims and objectives of service This specification annex applies to all children’s services and outlines generic standards and outcomes that would fundamental to all services. The generic aspects of care: The Care of Children in Hospital (Health Service Circular (HSC) 1998/238) requires that: • children Children are admitted to hospital only if the care they require cannot be as well provided at home, in a day clinic or on a day basis in hospital. • children Children requiring admission to hospital are provided with a high standard of medical, nursing and therapeutic care to facilitate speedy recovery and minimise minimize complications and mortality. • families Families with children have easy access to hospital facilities for children without needing to travel significantly further than to other similar amenities. • children Children are discharged from hospital as soon as socially and clinically appropriate and full support provided for subsequent home or day care. • good Good child health care is shared with parents/carers and they are • closely involved in the care of their children at all times unless, exceptionally, this is not in the best interest of the child; accommodation . Accommodation is provided for them to remain with their children overnight if they so wish. Service description/care pathway All paediatric specialised services have a component of primary, secondary, tertiary and even quaternary elements. The efficient and effective delivery of services requires children to receive their care as close to home as possible dependent on the phase of their disease. Services should therefore be organised and delivered through ‘“integrated pathways of care’ ” (National Service Framework for Childrenchildren, Young People young people and Maternity Services maternity services (Department of Health & Department for Education and Skills, London, London 2004) Interdependencies with other services All services will comply with Commissioning Safe and Sustainable Specialised Paediatric Services: A Framework of Critical Inter-Dependencies – Department of Health Imaging All services will be supported by a three tier imaging network (Delivering quality imaging services for children’ Department of Health 13732 March2010DH). Within the network: • it will be clearly defined which imaging test or interventional procedure can be performed and reported at each site • robust procedures will be in place for image transfer for review by a specialist radiologist, these will be supported by appropriate contractual and information governance arrangements • robust arrangements will be in place for patient transfer if more complex imaging or intervention is required • common standards, protocols and governance procedures will exist throughout the network. • all radiologists, and radiographers will have appropriate training, supervision and access to continuous professional development (CPD) • all equipment will be optimised for paediatric use and use specific paediatric software Specialist Paediatric Anaesthesia Wherever and whenever children undergo anaesthesia and surgery, their particular needs must be recognised and they should be managed in separate facilities, and looked after by staff with appropriate experience and training.1 All UK anaesthetists undergo training which provides them with the competencies to care for older babies and children with relatively straightforward surgical conditions and without major co- morbidity. However those working in specialist centres must have undergone additional (specialist) training (2) and should maintain the competencies so acquired (3) *. These competencies include the care of very young/premature babies, the care of babies and children undergoing complex surgery and/or those with major/complex co-morbidity (including those already requiring intensive care support). As well as providing an essential co-dependent service for surgery, specialist anaesthesia and sedation services may be required to facilitate radiological procedures and interventions (for example magnetic resonance screening (MRI) scans and percutaneous nephrostomy) and medical interventions (for example joint injection and intrathecal chemotherapy), and for assistance with vascular access in babies and children with complex needs such as intravenous feeding. Specialist acute pain services for babies and children are organised within existing departments of paediatric anaesthesia and include the provision of agreed (hospital- wide) guidance for acute pain, the safe administration of complex analgesia regimes including epidural analgesia, and the daily input of specialist anaesthetists and acute pain nurses with expertise in paediatrics. *The Safe and Sustainable reviews of paediatric cardiac and neuro- sciences in England have noted the need for additional training and maintenance of competencies by specialist anaesthetists in both fields of practice. References 1. Guidance for Providing Anaesthetic Services (GPAS) Paediatric anaesthetic services. Royal College of Anaesthetists (RCoA) 2010 (xxx.xxxx.xx.xx) 2. Certificate for Completion in Training (CCT) in Anaesthesia 2010 3. CPD matrix level 3 Specialised Child and Adolescent Mental Health Services (CAMHS) The age profile of children and young people admitted to specialised CAMHS day/inpatient settings is different to the age profile for paediatric units in that it is predominantly adolescents who are admitted to specialised CAMHS inpatient settings, including over-16s. The average length of stay is longer for admissions to mental health units. Children and young people in specialised CAMHS day/inpatient settings generally participate in a structured programme of education and therapeutic activities during their admission. Taking account of the differences in patient profiles the principles and standards set out in this specification apply with modifications to the recommendations regarding the following: • Facilities and environment – essential Quality Network for In-patient CAMHS (QNIC) standards should apply