The Family Friendly Framework

Written by Simon Lenton

The Family Friendly Framework represents two years of joint work between the British Association for Community Child Health and the British Association for Child and Adolescent Public Health to address the concerns of their memberships that recent NHS changes based on competition and market principles, particularly in England, were creating fragmentation rather than integration in services for children and their families.

Stated simply, the intention of the Family Friendly Framework is to create a system that ensures the right things happen, to the right children, in the right way, at the right time, in the right place coupled within a system that guarantees all parts are in place and working well together. This is complemented by a process to detect the weakest links, create appropriate feedback loops and then innovate and evaluate in order to create continuous improvement through evaluation and learning at every level.

The Family Friendly Framework brings together the values contained within the United Nations Convention on the Rights of the Child (UNCRC) and best evidence to create professional and organisational culture, within a systems framework that is dedicated to learning through innovation and improvement.

The Framework recognises the changing epidemiology of morbidity in childhood and brings together service pathways and life course pathways-with a focus on prevention throughout the system. The service pathway defines the component parts-based on best evidence, delivered by competent teams, all working together within a network to create improved outcomes. The life course pathway recognises both the positive and negative factors that influence health, divides them into those that families have influence over-namely lifestyles and those outside their control-the wider social determinants. The outcomes of both service and life course pathways are combined when considering "whole system impact".

The potential ramifications of the Family Friendly Framework are considerable. The intention is to create alignment and synergy between those commissioning, those providing and those regulating services. To ensure all the parts are in place and working well together the system must evolve from competitive commissioning to collaborative networks. Regulation must evolve from inspection of organisations to improvement based on pathway/networks. Throughout the system, learning based on meaningful measures coupled with innovation and evaluation form the bedrock of improving outcomes.

The potential benefits are enormous-for children and families greater participation, improved experience and outcomes. For professionals the opportunity to develop highly competent teams collaborating in networks and learning through innovation. For managers greater efficiency by breaking through organisational silos to create integrated care from the perspective of families. Finally, from a planning perspective the integration of prevention and provision, clear lines of accountability and improved whole system value.

The challenge is to overcome traditional patterns of service delivery maintain a focus on the family throughout all decision-making, embed a culture of individual and organisational learning throughout involving structures to create a sustainable system that improves health, improved equity and uses resources wisely.

The intention for BACCH and BACAPH is to promote discussion of the Family Friendly Framework, support members in implementation and disseminate examples of good practice. The Framework and a range of supporting materials can be found on the BACAPH website here.

Simon Lenton
Consultant Paediatrician in Community Child Health Bath, Bath and North East Somerset (retired)
BACAPH co-chair

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