Forum outlines how child health should be prioritised in a new NHS

Under the last government, attempts to boost the standing of child health in the NHS produced meagre change. The subsequent introduction of the coalition’s NHS reforms did little to allay long-standing concerns, prompting warnings that the system could become even more fractured and unsuitable for young patients.

At the end of last year, Health Secretary Andrew Lansley charged a group of professionals with the task of producing a strategy for children and young people’s health in the new NHS.

Led by Christine Lenehan, director of the Council for Disabled Children, and Professor Ian Lewis, medical director at the Alder Hey Children’s NHS Foundation Trust, the group was intended to be a children’s version of the NHS Future Forum – an independent team of health experts assembled to advise the government on making the best of its reorganisation of the healthcare system.

The challenge of making child health a central concern of the NHS at a time of huge structural upheaval, alongside the need to find £20bn of efficiency savings, is no mean feat.

But, seven months down the line, the Children and Young People’s Health Outcomes Forum has published its final report. It includes a wide-ranging list of recommendations for government to consider, and practical suggestions for improving the way health services for children and young people are measured and held to account.

With immediate effect, the forum has called on the government to start presenting all data about children and young people in five-year age bands. This is intended to allow better local and national comparisons of how well children are doing at different stages of their development.

The forum also recommends four new outcome indicators to be included in the NHS Outcomes Framework, against which health services are judged.

These indicators are: the time between when a child first presents to the NHS with an issue, to diagnosis or treatment; a new composite measure to judge the standard of how integrated care for children is; a measure gauging the effectiveness of transitions from children’s to adult services; and an indicator to show whether age-appropriate services have been provided to young patients, particularly teenagers.

Here, we examine the key recommendations from the forum’s report and ask a director of children’s services for her views.

Children’s views
The Children and Young People’s Health Outcomes Forum consulted around 2,000 children, young people, parents and professionals about how they thought the NHS should be improved.

Young patients and families told the forum that they “struggle to get their voices heard and to be involved in decisions about their own health”. 

To tackle this, the forum recommends that the Department of Health (DH) and the NHS Commissioning Board should collate the views of young people in all national patient surveys, across all care settings, by 2013.

In addition, the forum recommends that the government develops a population-based survey of children and young people to look at trends in health and wellbeing, as well as a survey to measure outcomes for children with mental health problems.

The forum also wants the DH to work with partners to produce a children’s health charter based on the principles of the UN Convention on the Rights of the Child and aligned with the NHS Constitution. Health inspectors would then be expected to judge how well health services are meeting these principles.

Turning to Healthwatch England, the forum recommends that the body includes children and young people’s voices in its work, and is able to demonstrate this through its annual report.

At a local level, the forum suggests that all health organisations must demonstrate how they listen to children and young people, and how these views are used to improve their healthcare provision.
 
Integrated care
The forum’s report includes several recommendations to better join up care for children and young people. It suggests that every child’s NHS number should be used as a “unique identifier”
to bring together the health, education and social-care data held on them.

The forum also recommends that as regulators, the NHS Commissioning Board and Monitor should promote integrated care and work with the Care Quality Commission and Ofsted to develop a framework to measure integrated care across non-health-related services for children and young people.

In an effort to reduce the fragmentation of services, the forum calls on the NHS Commissioning Board to establish a national network for children and young people’s health services, including maternity and neonatal care. This network would be responsible for overseeing care “pathways” for children from primary care and community service provision to general hospital care and specialist services.

Locally, the forum says that clinical commissioning groups will need to develop networks and partnerships with providers to supply sustainable acute, surgical, mental health and community children’s services. These local commissioners will ?be responsible for ensuring that children can access care closer to home and that there are no gaps in provision. Each clinical commissioning group should also have a senior clinical lead for children and young people.

On child protection, the forum urges the DH to publish its accountability framework for safeguarding children in the health system as soon as possible.
 
Workforce
The forum warns that “many clinical staff have inadequate training in paediatrics and child health”, and that teacher and youth worker training in physical and mental health is “too often minimal or non-existent”.

To tackle this, the forum says Health Education England, the new health education body, must prioritise children and young people and provide strategic direction for workforce planning, education and training for the core and specialist children’s health workforce.

It also wants the Centre for Workforce Intelligence to carry out a project to identify how to make sure there is a good supply of properly trained children’s health professionals.

The forum meanwhile suggests that a stocktake of the wider children’s workforce is required, so that appropriate continuing professional development can be planned for those not directly working in health.

The Royal College of General Practitioners has already proposed that GP training be extended to allow for more of ?a focus on children’s physical and mental health. The forum strongly backs this proposal and outlines further recommendations for GPs, given that they are often the first point of contact for children when a health problem arises.
It suggests that continuing professional development should reflect the proportion of time that individual GPs spend treating children and young people in their surgeries.

In addition, the forum wants all practices to have a named medical and nursing lead for children, and all practice staff to receive specific training in dealing with children and young people.

The local authority view on child health

Ann Baxter, director of children’s services, London Borough of Camden; and policy lead on health,  Association of Directors of Children’s Services

“The Association of Directors of Children’s Services was pleased to have been part of the group that produced the children and young people’s health outcomes report and fully supports its recommendations. For too long, health outcomes for our children and young people have not been good enough, so improving health-related care for children has to be a top ?national priority.

"The report builds on the existing NHS and public health outcome framework, which did not address the specific needs of children, and the important 2010 report from Sir Ian Kennedy, Getting it right for children and young people, which was not fully implemented.

"It recommends that systems must be joined up and focused on the journey of the child or the young person and meeting their needs, rather than the current fragmented approach.

"The report is particularly strong on where the health and social care systems need to work together – in managing ?transitions from child to adult services, in supporting those with mental health difficulties and in making the links to the wider public health agenda, as well as in supporting those with long-term health conditions and disabilities.

"Given the plethora of national, regional and local bodies that will need to come together to provide an efficient and high-quality health service for children, it is necessary that there is clarity about roles and responsibilities, and shared outcome indicators to guide integrated working.

"The report provides a robust framework for health and wellbeing boards, clinical commissioning groups and the various parts of the NHS Commissioning Board to develop a shared vision for local health services that builds on other collaborative working arrangements for children and young people.

"This should include clear arrangements for the health service to fulfil its safe--guarding responsibilities, and we ?look forward to seeing the assurance framework for designated and named professionals referenced in the report.

"These arrangements will be absolutely crucial in ensuring that Local Safeguarding Children Boards and health and wellbeing boards can hold health services to account for the contribution they make to keeping children safe.

"We particularly welcome the inclusion of four new important indicators that will measure: integrated care; effective ?transition from children’s to adult’s services; whether services are age-appropriate, particularly for teenagers; and the time taken from when a child or young person first presents themselves to an NHS service to their diagnosis or the start of any treatment.

"These recognise areas of concern that have been highlighted many times from many children and their families, and will require all parties involved to work together in new ways. We are also particularly happy about the importance that the report gives to incorporating the voice of the child or young person, so they are always included and involved in their treatment.

"The health outcomes report provides the basis for a broader strategy for all the organisations involved in commissioning and delivering care, and the ADCS urges the government to fully implement all the recommendations to make sure that this is delivered.

"We also challenge everyone who has an interest in the health of children and young people to use this report to deliver change, ensuring that these recommendations improve outcomes and make a real difference.

"The report should be followed by a robust implementation plan. Without a detailed plan for implementation, some of the important messages from the report risk being forgotten.”