Care for children is changing
Transforming care has become a buzz phrase in the health service. Since NHS England’s Five-Year Forward View was published in autumn 2014 a great deal of interest has been expressed in changing services to improve care and save money
Transforming care has become a buzz phrase in the health service. Since NHS England’s Five-Year Forward View was published in autumn 2014 a great deal of interest has been expressed in changing services to improve care and save money.
According to the Nuffield Trust, however, services for children and young people have been neglected.
The think tank’s report, entitled The Future of Child Health Services, states that most examples of service changes involve the care of older people. Consequently, services for children tend to focus on acute care rather than on helping children, especially those with chronic long-term conditions, to stay well.
The Nuffield Trust report, published in February, highlights six issues:
- A lack of capacity and capability in general practice to deal with children’s issues.
- Insufficient access to high quality paediatric and child health expertise in the community.
- Little communication and joint working between hospital specialists and staff in the community.
- Unnecessary use of emergency departments (EDs), likely to be a result of difficulties getting access to GPs and fragmentation of care.
- A need for a greater emphasis on health promotion and disease prevention.
- Improving the way the NHS listens to children and their families, and works with them to improve health literacy.
The report authors, Nigel Edwards, Lucia Kossarova and Delan Devakumar, say they hope the findings ‘provide an opportunity to improve the quality of services’.
They accept there are challenges because of financial constraints and an inequity in provision, but add that resistance to change and lack of motivation are also ‘significant barriers’ to service improvement. The development of new models of care therefore provide an opportunity ‘that should not be missed’.
RCN professional lead for children and young people’s nursing Fiona Smith says: ‘There is a tendency to concentrate on adult and older people’s services, but at least 25% of ED attendees are children. There is a shortage of children’s nurses in the community and hospital sectors, which must be addressed if we are to change services for the better.’
The Nuffield Trust report notes that the Five-Year Forward View and subsequent vanguards programme, which has prompted the development of 50 pilot schemes to pioneer new ways of working, have started to inspire innovation.
The Nuffield Trust highlights 12 schemes to ensure that GPs have access to paediatric expertise. Five of these are set out below.
In some areas, clinics are run by specialist nurses, while ‘one-stop shop’ services are being set up so that patients can see, for example, speech therapists, school nurses and paediatric consultants.
There are also examples of ‘horizontal integration’ between health services and those in other sectors, such as education, social care and youth justice, and projects that make greater use of technology.
One of these models is the Children and Young People’s Health Partnership, in south London. Its director, Ingrid Wolfe, says the principles of young people’s care, co-ordination and keeping people well, are similar to those for older people.
Integration of services for young people should involve the education sector, whereas social care services tend to be involved in older people’s care.
‘Rare and serious childhood illnesses, and the specialised services they need attract attention easily,’ she adds. ‘But everyday healthcare services for children are crucial. Get the front line right and everything else works better. Fail to focus on these and the whole thing starts to teeter and fall.’
'Not yet fully adapted'
NHS England new models of care programme director Samantha Jones acknowledges that service delivery ‘has not yet fully adapted’ to the kinds of long-term illness children and young people face.
She says: ‘It is clear from the report that services that focus on health promotion are being developed and there is a growing understanding of the needs of different sections of the child population. We should prevent ill health from occurring rather than focus solely on treatment and care.’
Children and Young People's Health Partnership
In Lambeth and Southwark specialist nurses work with children who have long-term conditions. They hold joint clinics with GPs and children’s specialists, provide emotional resilience training in schools, and offer support to school nurses, social and youth workers.
Salford Children's Community Partnership
To reduce the number of short-stay hospital admissions, advanced children’s nurse practitioners assess and treat acutely unwell children for fever, respiratory problems and mild dehydration.
Smithdown Children's NHS Walk-in Centre
This nurse-led service for assessing, diagnosing and managing children’s unplanned minor illnesses and injuries was set up in Liverpool to reduce the number of children with primary care problems attending emergency departments.
Upskilling GPs in north Staffordshire
After high rates of hospital admission were recorded, children’s specialists offer primary care staff referral guidelines and online training in managing the ten most common conditions.
Electronic personal child health records
Pilot projects for electronic personal child health records, or e-records, are under way in Liverpool, Warwickshire and London. Devised in partnership with the Royal College of Paediatrics and Child Health, e-records contain information on screening tests, immunisations and reviews.