10:49pm Sunday 22 October 2017

Urgent shake up of children’s unscheduled care needed to tackle UK’s poor child health outcomes

Children make up more than a quarter of emergency department attendances in the UK –and in England alone there has been a 28% increase in admissions for children to hospital over the last ten years. Today healthcare professionals are warning that unless there is an overhaul of unscheduled care services, there is a risk that growing demand will result in poorer outcomes for children.

Facing the Future: Together for Child Health says that in order to deal with these pressures, and to improve child health outcomes, not only do unscheduled care services need more investment but there also needs to be a shake-up of how services are designed, with more children being cared for outside the hospital, in the community and closer to their home. 

The new set of standards produced by the Royal College of Paediatrics and Child Health, Royal College of Nursing and Royal College of GPs, states that:

  • Every child should have timely access to high-quality unscheduled care services
  • No child should be in hospital when care can be provided to an equivalent or better standard outside the hospital
  • Service providers, planners, commissioners and users should work together  across hospital and community services, primary and secondary care and paediatrics and general practice to design and deliver efficient and effective unscheduled care in a geographical network which is responsive to the needs of local children and their parents and carers

Dr Hilary Cass, President of the Royal College of Paediatrics and Child Health, said: “The vast majority of children’s illnesses are minor and require little or no medical intervention.  So a significant number of these attendances at the emergency department are unnecessary – and putting extra pressure on the system and causing undue distress and disruption for families.

“But of course every attendance means that a parent is worried about their child’s health, and either unable or unsure about how to access a more appropriate service. We therefore need to help patients navigate the options available to them  and to get the most appropriate care – but also make sure that those services, and the healthcare professionals who deliver them, are fully skilled and best equipped to provide the best possible care.”

The Facing the Future: Together for Child Health standards are designed to improve healthcare services for children and ensure that specialist child health expertise and support are available to strengthen primary care services, supporting GPs to care for children safely in the community.

There are 11 standards in total, including:

  • GPs assessing or treating children with unscheduled care should have access to immediate telephone advice from a consultant paediatrician
  • Each acute general children’s service should provide a consultant paediatrician-led rapid-access service so that any child referred for this service can be seen within 24 hours of the referral being made
  • Each acute general children’s service should be supported by a community children’s nursing service which operates 24 hours a day, seven days a week, for advice and support, with visits as required depending on the needs of the children using the service
  • When a child presents with unscheduled care needs the discharge summary should be sent electronically to their GP and other relevant healthcare professionals within 24 hours and the information is given to the child and their parents and carers
  • There should be documented, regular meetings attended by senior healthcare professionals from hospital, community and primary care services and representatives of children and their parents and carers to monitor, review and improve the effectiveness of local unscheduled care services

Dr Maureen Baker, Chair of the Royal College of GPs (RCGP), said: “A quarter of a GP’s patients are under 19 years of age and the best place for children and young people to be cared for, wherever possible, is close to home.
 
“Our young patients and their families can’t plan when they will be poorly so it is crucial that they have access to high quality services in the community whenever they need them.

“This is not only good for our patients, but good for the entire NHS as care in the community is more cost-effective than in hospitals.

“These standards mark a coming together of professional expertise from across the health service. They will help to break down barriers and encourage us all to work together more closely in the best interests of our young patients.”

Facing the Future: Together for Child Health says there is consensus as to what needs to be done and that the health profession are committed to working with services, commissioners, planners and inspectorates to support them to implement the changes needed to meet these standards.

Dr Peter Carter, Chief Executive and General Secretary of the RCN, said: “As well as the high number of children being admitted to emergency departments, there is also worrying variation in the rates of attendances and admissions across the UK.  These standards are important not only to reduce these inconsistencies, but also to make sure children are getting the most appropriate care.

“Of course there are times when it is necessary for children to be cared for in hospital, which is why a number of these standards focus on reducing the length of stay and enabling these children to go home again as safely and as quickly as appropriate. There is no doubt that some episodes of acute illness could be safely and better managed without a visit to the emergency department or an admission to an inpatient ward.

“Investment is urgently needed in community care, especially in community children’s nursing services that can provide crucial support to general children’s services, and offer advice for worried parents.”

The full list of standards in Facing the Future: Together for Child Health are:

  • GPs assessing or treating children with unscheduled care needs should have access to immediate telephone advice from a consultant paediatrician
  • Each acute general children’s service should provide a consultant paediatrician-led rapid-access service so that any child referred for this service can be seen within 24 hours of the referral being made
  • There is a link consultant paediatrician for each local GP practice or group of GP practices
  • Each acute general children’s service provides, as a minimum, six-monthly education and knowledge exchange sessions with GPs and other healthcare professionals who work with children with unscheduled care needs
  • Each acute general children’s service is supported by a community children’s nursing service which operates 24 hours a day, seven days a week, for advice and support, with visits as required depending on the needs of the children using the service
  • There is a link community children’s nurse for each local GP practice or group of GP practices
  • When a child presents with unscheduled care needs the discharge summary is sent electronically to their GP and other relevant healthcare professionals within 24 hours and the information is given to the child and their parents and carers
  • Children presenting with unscheduled care needs and their parents and carers are provided, at the time of their discharge, with both verbal and written safety netting information, in a form that is accessible and that they understand
  • Healthcare professionals assessing or treating children with unscheduled care needs in any setting have access to the child’s shared electronic healthcare record
  • Acute general children’s services work together with local primary care and community services to develop care pathways for common acute conditions
  • There are documented, regular meetings attended by senior healthcare professionals from hospital, community and primary care services and representatives of children and their parents and carers to monitor, review and improve the effectiveness of local unscheduled care services

Further Information

RCGP Press office: 020 3188 7574/7575/7581
Out of hours: 0203 188 7659
press@rcgp.org.uk

Notes to editor

The Royal College of General Practitioners is a network of more than 50,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.


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