How the NHS hopes to improve children’s care by investing in the community
NHS Long Term Plan looks to bring key staff together in primary care networks
More investment promised in neonatal care and school-based mental health support
When it comes to the health of children and young people, the NHS Long Term Plan admits that the health service's record has been mixed in recent years.
The plan praises the progress made in cancer treatment and the reduction in stillbirths and neonatal deaths in England, and calls for this to continue.
It states that, by the end of this year, all children with cancer should receive whole genome sequencing to aid diagnosis and treatment.
For neonatal care, the plan promises more intensive care cots and extra nurses, alongside a host of pledges on maternity services.
But it also says it is time to broaden the focus of the NHS in caring for children, and accepts that care for those with long-term conditions and mental health problems needs improvement.
Investing in the community
To make these improvements, the plan sets out the case for investing in the community.
One third of the extra £20 billion that will be available for the NHS by 2023 will go to community, primary care and mental health services, which means their funding will rise at a quicker rate than that for hospitals.
The long-term plan states that primary care networks should be established to help create multidisciplinary teams that bring key staff together.
For children, this could mean hospital children’s nurses working alongside GPs, health visitors, mental health staff and community nurses. The child health hubs that have been established in north west London and helped to reduce the number of hospital appointments are also highlighted as an example of this multidisciplinary approach in action.
Child mental health is expected to benefit from investment in school and college-based support teams and improved access to support for eating disorders, and a new four-week waiting time target will be piloted for child and adolescent mental health services.
extra funding is being made available to the NHS by 2023
Source: NHS Long Term Plan
There is also expected to be a new 18-25 service to support the transition of young people into adult care, while hospitals are being asked to set up all-age psychiatric liaison services.
Children’s commissioner for England Anne Longfield says that, with less than one third of children and young people with a mental health condition getting NHS support, these initiatives are welcome but long overdue.
However, with the school-based mental health support expected to reach only one quarter of the country by 2023, for example, she is concerned the plan does not go far enough.
‘The government must be more ambitious,’ she says. ‘Every year, thousands of children will still fail to receive the help they need.’
School and Public Health Nurses Association chief executive Sharon White believes the plans represent a missed opportunity.
is to be spent on community and mental health services
Source: NHS Long Term Plan
She says that initial recruitment of educational mental health practitioners has involved new posts being set up at band 4.
‘We cannot understand why the money for this is not being invested in school nurses,’ she says. ‘We are perfectly placed to support children – we have been doing it already with stretched resources.’
She is also critical of the disjointed approach to public health. While the NHS budget will rise next year by more than 3.5% in real terms, public health funding for councils is being cut by more than 4%.
At the same time, the number of health visitors and school nurses has been falling – health visiting numbers have dropped by 23% and school nursing by 7% in the past three years
Ms White says: ‘There is so much talk about prevention, but the reality is that public health nursing has been squeezed because of what has happened to council funding – and that impacts on what we can do to improve the health and well-being of children. There should not be this divide between public health and the NHS.’
This point is also made by the Royal College of Paediatrics and Child Health in its recent State of Child Health report, published shortly after the NHS Long Term Plan.
children have long-standing illnesses, such as asthma and epilepsy
Source: NHS Long Term Plan
The report praises the plan for putting children at the heart of NHS services, but expresses ‘grave concern’ about child poverty and inequality, saying cuts to public health are leaving the most vulnerable struggling to access vital services.
RCN professional lead for children and young people Fiona Smith agrees. She says: ‘Vulnerable children are continuing to miss out on essential physical and mental health interventions, storing up problems for them and the health service further down the line.’
She says nurse numbers working with children and young families have been cut in several areas, adding that the ‘perilous’ state of the workforce is the ‘elephant in the room’.
The government is promising a workforce strategy, delayed from last year, will be published in the coming months.
Ms Smith says it will need to have an impact. ‘Without substantially increasing numbers and committing to treating public health as a fundamental part of the prevention agenda, any ambitions to build on and sustain improvements in child health will remain just that.’
Step by step: how children’s services will be transformed
- By 2021, each area will have an integrated care system bringing together hospital, community and council teams to plan services
- £4.5 billion extra investment in community services to pay for multidisciplinary teams by 2023
Maternity and neonatal services
- 50% reduction in stillbirth, maternal and neonatal deaths and brain injury by 2025
- All maternity services to start offering ‘care bundles’ targeting smoking cessation and closer monitoring of at-risk pregnancies
- Extra nurses and intensive care cots in neonatal units
- Expanding the reach of specialist perinatal mental health services from 12 months after birth to 24 months
- £2.3 billion extra for mental health by 2023 with children’s services prioritised for investment
- One quarter of country to have school and college-based mental health teams by 2023
- Access to child and adolescent mental health to be expanded
- All-age psychiatric liaison in 70% of hospitals within five years and all children to be able to access crisis care in community
- New 18-25 service to support the transition of young people into adult mental healthcare
Improving care for long-term conditions
In north west London, a network of six community child health hubs has been set up. Since 2014, GPs, health visitors, school nurses, mental health staff and dietitians have come together with hospital staff from Imperial College Healthcare NHS Trust.
Monthly clinics are held for patients with specialists and community staff to provide integrated care. Hospital specialists also provide phone support to community staff, while the hubs have recruited patient champions to promote self-management and provide peer support.
The initiative has had a major effect, particularly on children with long-term conditions. In one hub, hospital appointments have been reduced by 80% – half have been moved into the community and half avoided altogether through better management of conditions, such as asthma and epilepsy. Emergency department visits are also down by one fifth.