Analysis

Ahead of the curve but aiming higher

Creating a seven-day NHS has emerged as one of the key health issues since the general election. And now that the doctors’ union, the British Medical Association, has agreed to discuss how the consultant contract could be altered – it allows consultants to opt out of non-emergency care at weekends – change seems likely

Creating a seven-day NHS has emerged as one of the key health issues since the general election. And now that the doctors’ union, the British Medical Association, has agreed to discuss how the consultant contract could be altered – it allows consultants to opt out of non-emergency care at weekends – change seems likely.

But what does this mean for children’s services? There has been little detail so far from ministers, although NHS England wrote to hospital trusts in the summer asking them to concentrate on access to consultants, diagnostics and complex interventions such as urgent radiotherapy.

If that is the goal children’s care, it seems, is already ahead of the curve. An audit by the Royal College of Paediatrics and Child Health (RCPCH) in 2013 found nearly three quarters of patients admitted to a paediatric department at the weekend with an acute medical problem were seen by a paediatrician (consultant or middle-grade doctor) within four hours. This was only marginally worse than the picture on weekdays.

Not surprising

But such performance should not be surprising. Improving access to hospital services in the evenings and weekends has been championed by the college and its partners, including the RCN, for a number of years.

In 2010 the RCPCH published the Facing the Future standards setting out requirements for seven-day care for hospitals. These were updated earlier this year and accompanied by a blueprint for how services should look in the community.

RCPCH vice president Carol Ewing says that, while the ‘majority’ of hospital children’s units already deliver what could be considered seven-day care, more still needs to be done.

Blueprint

She believes the standards provide a blueprint for what needs to happen and urges all those involved in care to help break down ‘the artificial barriers between primary and secondary care’. ‘Children can deteriorate quickly and it’s important that parents and carers know where they can go and be confident that their child is being seen by a suitable health professional – wherever they are and whatever the time,’ she adds.

RCN professional lead for children and young people’s nursing Fiona Smith agrees, saying that inside and outside hospital more needs to be done. ‘There is a great deal of variability among hospitals. It is not just about medical consultants, but also nurses, lab technicians and all the other staff that form part of the neonatal and children and young people’s healthcare teams.

Community teams

‘And in the community, the push on seven-day GPs services will be of benefit for children. But an important element of what is needed is 24/7 access to community children’s nursing teams. It is clear that in some places this is going to require significant investment to achieve.’

Indeed, the Facing the Future update this year recommended significantly increasing the number of consultants and registered children’s nurses, while acknowledging the number of hospital inpatient sites would need to be reduced.

 

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