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A new dawn for children’s health and wellbeing
NHS England’s National Clinical Director for Children and Young People highlights how the journey to integrated care presents a real opportunity to join up pathways around the needs of children and families:
Often our narrative about the challenges facing health and care is dominated by a very adult view of the world.
Writ large are the issues of an ageing population and people living longer with multiple conditions.
At the other end of the spectrum we have babies, children, young people and their families who are starting a lifelong association with our health services, and where early intervention and prevention can have the greatest and most lasting impact.
Successful programmes, such as immunisation, help to get infants off to the best start in life. Many children, unfortunately, have long-term conditions – diabetes, epilepsy and asthma – and complex health issues, like neurodisability, which continue into adulthood.
We know that half of all lifetime mental health illness can be diagnosed at the age of 14 so early intervention will alter the life chances of these young people.
We also face the increasing and serious prevalence of childhood obesity. Overweight children are more likely to require more medical care, be absent from school, experience health-related limitations and have mental health problems. The risks of going on to develop Type 2 Diabetes are also higher.
Managing these systemic problems is complex and the reality is that no hospital or GP surgery can tackle them alone. The way we are working now must change as demands on our GPs, hospitals, community services and social care continue to rise.
Integrated care systems are now emerging across the country – creating new partnerships that are taking a more ambitious approach to the way services interlink. They represent an innovative and fantastic opportunity for children’s health.
These systems bring together services and communities in a number of ways. Firstly, they build better links between GPs and hospital care.
There is huge potential here. The Royal College of Paediatrics and Child Health has identified only 7 per cent of GP practices are linked to a consultant paediatrician and just 17 per cent of acute general children’s services are working with local primary care and community services to develop care pathways for common acute conditions.
With more children and young people than over 65s going directly into emergency departments, we clearly are missing opportunities to better organise the care we deliver to children. We have a unique possibility now to keep most children in the community where they can be safely looked after, and only refer to hospitals those who really need those specialist skills.
Some very promising models are emerging, such as Connecting Care for Children in North West London, which is responding to disproportionately high rates of paediatric A&E and outpatient attendance. Hospital paediatricians are going out into the community to work with local GPs and other health and care professionals.
A second essential feature of the integrated care systems is the relationship between physical and mental health. We know that children and young people have difficulty telling their story when they move between services and we launched a mental health passport to help – an idea developed by some brilliant young people, parents and carers.
However, more needs to be done. Under the New Care Models programme, new teams working more closely together have started to emerge – integrated care systems can build on these. For instance, the Foundation Healthcare Group vanguard developed its services for children with epilepsy, building better collaboration between a district hospital and a specialist children’s hospital, and introducing a specialist nurse to provide better community support, a psychologist, a hospital dietician and a paediatric pharmacist.
The third important element of ICSs is joining up our health services with social care – true horizontal integration – developing relationships that tackle the social determinants of health across the community, and involving voluntary organisations, charities and community groups. Surrey Heartlands ICS, for example, is responding to a challenge from their local councils to address these social determinants, making the first 1,000 days of life a major focus of their partnership.
To spread and scale up change, we can learn from other new care model vanguards – Improving Me brought together a network of 27 women’s and children’s services – maternity, gynaecology, neonatal and paediatrics – across Cheshire and Merseyside.
They are introducing advanced paediatric nurse practitioners. Working with a community interest group, Kids’ Health Matters, they created an online education platform that includes specialist paediatric modules for MSC Advanced Practice university programmes. Nurses are already training for these posts which will act as a welcome conduit, linking GPs and consultants in A&E to ensure young people get the right care.
The journey to integrated care must tackle the needs of an older population but it must also be about young people. They are our future and deserve the best we can deliver. This makes such sound socio-economic sense and the evidence supports the case for change.
Integrated care systems represent a new dawn for children in this country and could have a profound and long-lasting impact on children’s health and their quality of life as adults.
Adult physicians challenge us as paediatricians that our service is broken. How else do you explain the unfilled vacancies in paediatric medicine both for nurses and doctors? Reform is required and this needs to be radical root and branch reform. We need to make paediatrics an attractive career choice again. Without an engaged workforce paediatrics in the UK will continue to decline.
I am really interested in exploring how secondary schools can become part of this integrated approach. Having read abot the school based health care models that operate in the US – are you aware of a similar approach being developed anywhere in the UK? I am the deputy headteacher of a school that serves families in challenging contexts and am eager to build links with the community services so that we can better support the young people and their families. If you are aware of any projects or support that I could draw upon so that we can begin to get this started I would be very grateful. Thanks
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When I started as a Consultant Paediatrician 20 years ago we had a fully-integrated Child Health Directorate. Since then it has been systematically disintegrated through dogma and adult-driven initiatives. We single-handedly fought but lost (in this order): school nurses, paediatric dietetics, SALT, OT and CAMHS. These services have been swallowed-up and asset-stripped the by an aggressive and predatory Community Trust who “does the talk but not the walk” seemingly with the blessing of an adult-centric CCG. We have been left with a number of inadequate Paediatric Community services, particularly CAMHS. The first step in rebuilding UK Paediatric Services should be to fully integrate Community and Paediatric secondary care services to form Children’s Trusts, ultimately merging with Primary Care in an area hub and spoke model. Personally I do not mind who I work for, provided when I speak to the right person to help a child I am NOT told “I am not contracted / commissioned to do that”