The Royal College of Paediatrics and Child Health’s new ‘landmark’ blueprint is shining a light on what can be done to improve the provision of child health services both on the frontline and with support from the Government. Saša Janković investigates.
Earlier this year, The Academy of Medical Sciences described what it called ‘a crisis in child health’, with the UK ‘failing too many of its children’. And The Children’s Commissioner for England noted that access to children and young people’s healthcare services is a ‘postcode lottery’. Yet while the need for care is rising, the capacity for, and quality of, care is not always keeping up.
NHS Providers points to evidence suggesting children and young people’s services are ‘recovering at a slower rate post Covid-19, in comparison to adult services, impacting on waiting lists and the availability and accessibility of services’.
According to NHS Provider’s ‘Forgotten Generation’ report, in May 2024, 356,200 children and young people were waiting for planned acute care – an increase of 110,000 in just three years. A further 282,000 children and young people were on the community health services waiting list, with 88,900 of this group waiting over 52 weeks.
The latest data for mental health services also paints a concerning picture. The Care Quality Commission’s ‘Monitoring the Mental Health Act in 2022/2023’ report highlights that almost half a million children and young people were waiting for mental health services in November 2023 – a record number that the CQC says had increased by almost 20,000 by January 2024.
The Royal College of Paediatrics and Child Health (RCPCH) has gone further in stating that we are ‘failing a generation of young people’ through a lack of dedicated focus and attention, blaming ‘a decade of chronic underinvestment and lack of national prioritisation in children’s health’.
According to the RCPCH, over three-quarters of respondents to a snapshot poll of its members reported regularly seeing children who have waited over 18 weeks for an appointment, with 83% saying there is not ‘an appropriate level’ of capacity locally to meet demand.
‘The impacts of long waits are as devastating as they are far-reaching,’ says Dr Ronny Cheung, consultant general paediatrician at Evelina London Children’s Hospital, and RCPCH officer for health services. ‘Children and their families are denied child disability payments until seen by a paediatrician. Mild symptoms progressing into much more complicated conditions and a reduced quality of life, school exclusions and wider family stress are impacts that will have life-long consequences and, tragically, are repeated hundreds of thousands of times across the UK.’
RCPCH child health services blueprint
In a bid to tackle these issues, the RCPCH’s newly published policy report, entitled ‘From left behind to leading the way: a blueprint for transforming child health services in England’, highlights how the lack of investment in children’s health is having severe consequences. It provides a blueprint which, if taken forward, the Royal College says leaves it ‘hopeful for change’.
The blueprint makes a series of evidence-based recommendations to the new UK Government for change across seven key areas of child health services in funding, workforce, integration, data and digital innovation, urgent and emergency care, community services and primary care. It urges key actions to address the longstanding underinvestment in children’s health services in England built on four national foundations: fair funding, workforce sustainability, improved data systems and prioritisation of children within integrated care systems (ICSs).
Suggestions include developing a child health workforce strategy, introducing a children and young people specific waiting times standard for ICSs, prioritising the development of a digital child health record, and adequately investing in community paediatrics and health visiting and school nursing services.
It also calls for a Children’s Health Investment Standard to address the disparity in funding between adult and child health services and recommends expanding paediatric training posts to ensure a sustainable child health workforce.
Reducing pressure on urgent and emergency care
One major recommendation in the blueprint is to reduce pressure on urgent and emergency care by embedding paediatric-specific advice and assessment services within NHS 111 – known as Paediatric Clinical Assessment Services. The report says this model has shown significant potential to manage cases earlier, increase self-care rates and reduce emergency department attendances.
Dr Helen Stewart is the RCPCH’s officer for health improvement, as well as a consultant in paediatric emergency medicine at Sheffield Children’s Hospital NHS Foundation Trust, which is one of only three dedicated children’s hospital Trusts in the UK. She says reducing pressure on urgent and emergency care requires properly funded and staffed community services.
‘We get a number of families attending who say they can’t get a GP appointment, and we know primary care is overwhelmed, but there has been a reduction in health visitor numbers as well, so families don’t have anywhere to turn when they are worried and come to the emergency department as a last resort,’ she explains. ‘Then there are young people waiting years for assessments for ADHD across the country and families struggling to access mental health services and so they present to [the emergency department] in crisis.’
Respiratory child health services
A key focus of the RCPCH 2024 blueprint is significant concern around respiratory services, particularly childhood asthma, where the UK has some of the highest emergency admission and death rates in Europe.
To address these issues, the blueprint recommends several key actions, including the expansion of structured asthma care reviews delivered in both primary and secondary care settings, to ensure every child has a personalised asthma action plan and access to specialist support when needed.
Additionally, the report stresses the importance of improving the availability of community-based asthma management services, which can reduce pressure on emergency departments. Another key recommendation is to standardise the approach to early intervention, particularly in schools and community settings, to identify and manage early signs of poorly controlled asthma, thus preventing avoidable flare-ups and hospital visits.
To this end, Amanda Allard, co-chair of the Children and Young People’s Health Policy Influencing Group and director of the Council for Disabled Children, says improvements in information sharing across agencies – for example schools, children’s social care services and the health system – have proven to be ‘essential’ to safeguard children’s health outcomes, wellbeing and safety, but more work needs to be done to optimise this.
‘At the moment, little communication between these services often means not all necessary information is shared about a child who then may not get the care they require,’ she says. ‘More information sharing, as well as using a single child identifier – such as a child’s NHS number – across agencies will significantly improve health outcomes for children and young people, as well as have other positive effects on other aspects of their care and wellbeing. And we also need to improve the quality of the data that we are sharing [otherwise] commissioners don’t have a complete picture of need when they are planning services.’
Primary and secondary care connections
On the subject of cross-sector integration, Ms Allard adds: ‘We would like to see health professionals working more closely with colleagues in primary care and other agencies such as education and social care to support those colleagues in meeting lower-level needs without the need for referral to secondary care. There are some brilliant examples of this happening such as the Balanced System and Connecting Care for Children. We need these to become universally available.’
NHS Providers is also calling for a cross-government plan to improve the wellbeing of children and young people, with its outgoing CEO Sir Julian Hartley saying that Trusts are ‘ready to play their part in making things better for children and young people’.
But he also stresses that ‘it will require concerted, joined-up working between Trusts, Government, NHS England and local partners including councils, schools and the voluntary sector.’
From Ms Allard’s perspective, ‘the Darzi review acknowledges that “the patient voice is simply not loud enough”, so more must be done to listen to the voices of children, young people and their families, for example by including them in the co-production of guidelines and policies.’
Top-down and bottom-up approaches
Since most change is reliant on Government funding and top-down approaches, the RCPCH report says if the new UK Government is serious about improving the health of children and young people to raise the healthiest generation of children in our history, then the children’s health workforce needs ‘greater support and changes are needed at a national level to restore and improve health services for children’.
Until there’s movement on this, there are ways in which clinicians and other healthcare professionals in both secondary and primary care can bolster their support for children’s health. According to Dr Stewart, one such way to achieve this is to hone in on ‘the approach that every contact counts’. This, she says, is particularly important as ‘it can be hard for families, especially those in difficult socioeconomic circumstances, to access healthcare – for instance if they are in insecure employment, it’s hard to take a day off work.’
As such, making every contact count can streamline access to healthcare information and make a positive difference to children and their families. ‘If healthcare professionals were able to signpost to relevant services and address other things in their consultations that would be very helpful – such as are vaccinations up to date, healthy eating advice, mental health support – a lot of these only take a very short conversation and some information about where they can access support,’ Dr Stewart says. ‘It can be hard to do when you are really busy but each time we do it, [we] might be helping a family in an important way.’
