Improved paediatric care needed

This year marks the 50th anniversary of The Platt Report,1 which saw the beginnings of radical change in the provision of paediatric care in England. Focused on the treatment of children in hospital, the report marked a step-change in policy and saw, for the first time, children isolated and treated separately to adults. Platt’s recommendations led to the establishment of specialist children’s services and a review of health services for children, with a resulting emphasis placed upon improving paediatric training for healthcare professionals. Despite this, meeting the healthcare needs of children is still a problem today and is a service that is understaffed and underestimated in the UK. The medical care of children is complicated and often requires access to a number of paediatric experts at the same time to complete one procedure. It is, therefore, imperative that hospitals have appropriately trained professionals across all areas of paediatric care that are accessible at all times. This includes nurses, anaesthetists and surgeons. The Department for Health’s 2008 white paper on the commission of safe and sustainable specialised paediatric services in the UK, however, recognised that there is a significant shortage in paediatric specialist care. As a result, children’s healthcare provision is more often than not carried out by one consultant rather than a team of professionals. This evidence is made worse by recent research that revealed only 40% of trainee GPs cover paediatrics while doing their training in hospitals or in their year in general practice before they qualify.2 Consequently, major cases of child neglect by health professionals can arise.

A lack of appreciation

One issue is a lack of appreciation for the needs of children, and understanding that they differ entirely from the adult population. We cannot simply treat the young as “mini adults”. This was highlighted in the Bristol Royal Infirmary review, which examined the centre’s paediatric cardiac services in light of higher than average mortality rates for children and babies that underwent complex heart surgery. Liz Jenkins, Fellow at the Royal College of Nursing and witness at the Bristol Royal Infirmary inquiry stated that: “the majority of adult qualified nurses and doctors see children as small adults, who simply need smaller beds and smaller portions of food. They do not see them as a client group that have wholly different needs.”3 Health conditions in babies, toddlers and adolescents are wide-ranging and often unique, characterised by the age of the patient, the complexity and severity of the health condition and any complications in treating the condition. In the case of Bristol, inappropriate paediatric cardiac surgery was to blame for the incompetent care of at least a third of child patients.4 The Platt Report’s recommendations led to a focus on paediatric services in this country and to a series of reforms affecting how children are cared for. More recently, in 2004, we saw the establishment of a children’s National Service Framework, a 10 year programme to achieve long-term and sustained improvement in children’s health, and the introduction of the Child Health Strategy, “to ensure that healthcare and children’s services work together to help every child to have a healthy and happy start to life.”5 Other organisations such as “Action for Sick Children” and The Royal College of Paediatrics and Child Health have also been established to provide a co-ordinated voice for children, young people and the healthcare provision they require. While these overarching bodies do a great job raising awareness of the importance of paediatric care at both a national and local level, the value attributed to the specialist skills required to carry them out remains poor. A “payment by results” process, where national tariffs are set against the provision of specialist services, causes further problems as the decision by a hospital to provide specialist child services has become dependent upon whether it is financially able to do so. Another key issue is how much of a priority paediatric care is to the NHS? A recent report by Ian Kennedy6 described NHS child healthcare provision as “mediocre” and stated that “the single most important change that needs to take place is prioritising children’s health services as highly as adult services.” In his review of children’s services, Kennedy found that there were big differences in the level and quality of care provided across the UK, highlighting that a main reason for inadequate standards of child healthcare was a disconnect between the different units and teams involved in childcare and the lack of communication between them.