National children’s care report shows disparities in treatment

Hospital care for children and young people is good, but ‘worrying’ gaps remain in how some of the most vulnerable are treated, according to the first official national children’s survey

Hospital care for children and young people is good, but ‘worrying’ gaps remain in how some of the most vulnerable are treated, according to the first official national children’s survey.

The Care Quality Commission (CQC) review, which received responses about the care of nearly 19,000 under-16s in England, found 87% of children and young people and 88% of parents and carers would rate the care given as seven out of ten or above.

However, responses for patients with mental health conditions and physical and learning disabilities were not so positive. One of the most striking findings was that less than half of parents and carers of children with these conditions felt staff ‘definitely’ knew how to care for their child’s health needs, compared with nearly three quarters of parents who had children without such needs.

  • Less than half thought staff were aware of their child’s medical history before caring for them or treating them, compared with 59% for parents or carers of children without these conditions
  • Less than half of parents felt that staff definitely knew how to care for their child’s individual needs. This compares to nearly three quarters of parents and carers of children without these conditions
  • About two thirds said the ward had appropriate equipment or adaptations suitable for their child, compared with eight in 10 parents and carers whose children did not have these needs
  • One in 20 awarded overall experience scores of between 0 and 2, compared to virtually no score this low given by those without these conditions

Performance was also rated significantly poorer in terms of having the right equipment and knowledge of the child’s medical history. One in 20 parents gave a rating of between 0 and 2, compared with only a handful (effectively 0%) that gave such low ratings for the care of children without these needs.

Young Minds chief executive Sarah Brennan says the findings are ‘very disturbing… The survey sheds an important light on the massive gulf that we see. We have to see change happen for those desperately struggling children, young people and their families,’ she says.

CQC deputy chief inspector of hospitals Professor Edward Baker agrees, saying this element of the survey is particularly worrying. ‘This needs to be addressed straightaway so that services meet the needs of all children, irrespective of any disability or specific need.’


RCN professional lead for children’s and young people’s nursing Fiona Smith says the variation between hospitals is ‘unacceptable… Immediate action is essential if we are to eradicate inadequacies in the care of children with mental health conditions or disabilities.’

However, Professor Baker also believes there is ‘much to celebrate’:

  • Nine out of ten children/parents and carers said they/their children always felt safe
  • Eight out of ten of all eight to 15 year olds reported staff did everything they could to help control their pain
  • Nearly three quarters of children and young people who had surgery or a procedure received explanations about what had happened in a way that was easy for them to understand
  • 78% of eight to 15 year olds said staff always listened to them

But the review also highlighted areas of significant weakness. These included that 43% of 12-15 year olds said they were not fully involved in decisions about their care, while more than one third of parents and carers said they were not definitely encouraged to get involved.

Less than half of children aged eight to 15 liked the food on offer and one in three parents or carers said that staff were not always available when their child needed attention. In addition, one in every eight children were not told who to talk to or what to do if they were worried when they got home, while one fifth of parents or carers were not given any written information to take home.

Improving communication

Royal College of Paediatrics and Child Health president Professor Neena Modi believes improving communication is crucial. She says: ‘The importance of clinicians, patients and their families communicating effectively with each other cannot be underestimated.’

Professor Modi says this should ‘start with taking a detailed history’ and also mean ‘providing frequent opportunity for patients and their parents to discuss plans and progress’.

But despite the scale of the survey, questions have been asked about exactly how it was conducted. National Children’s Bureau (NCB) young member Jack Welch highlighted the absence of the views of older teenagers. In a blog post on the charity’s website, he wrote: ‘Young NCB members are concerned that the limited age range means that issues relating to the transition to adult services are somewhat neglected.’


Concerns have also been raised about variations in performance by individual trusts. Eight trusts received better than expected responses in one quarter of all questions, with one – East Grinstead’s Queen Victoria Hospital NHS Foundation Trust – achieving that in 21 of the 24 questions. But there were two trusts that had worse than expected responses to 11 questions.

NHS England head of patient experience for children and young people Kath Evans wants to see NHS trusts act where weaknesses have been found. ‘All patients including children and young people deserve the very best healthcare experiences,’ she says.

Ms Smith adds that surveys of this nature ‘are only valuable if the findings are evaluated and acted upon… This report reveals several elements of children’s care that require rapid improvement.’

More information

Children and Young People's Survey 2014





This article is for subscribers only