Looking After Children In Primary Care

A Companion to the Children's National Service Framework

Ruth Chambers, Kirsty License

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315344546
• Edition: 1
• Topic: Medicine
• Subtopic: Pediatric Medicine

Highly Commended in the 2005 BMA Medical Book Competition The Children's National Service Framework sets standards for children's and young people's services, outlining what support should be available to children and their parents in managing and preventing a wide range of conditions and problems. This book is a companion to the Children's (NSF), enabling those that work within the NHS, social care and education to the put the NSF into practice in primary care. Contributions throughout from key professionals who were involved in the evolution of the framework help by providing guidance and expertise from the knowledge and background material gained throughout its development. The authors expand on the vision, themes and goals published within the NSF and make recommendations for the ways that best practice can be implemented, particularly for children's healthcare throughout the UK and anywhere in the Western world. General practitioners, child health specialists, community nurses and anyone with an interest in or responsibility for the care of children in primary care and the interface with social care and education, will find this book invaluable reading.

CHAPTER 1

The Children’s National Service Framework and the vision for primary care

Ruth Chambers

The vision of the Children’s National Service Framework (NSF)

The Children’s NSF sets out a vision and range of national standards for children’s and young people’s health and social services, outlining what support should be available to children and their parents in managing and preventing a wide range of conditions and problems.¹ (See Appendix 1 at the back of the book.) This should drive up the quality of services, promote general health improvement and redress health inequalities.

The Children’s NSF emphasises the promotion of evidence-based clinical guidelines and provides examples of good practice for children and young people, whatever their circumstances. The NSF addresses health inequalities – between various groups of children and young people and their parents or carers, in different settings. In addition, exemplars use particular problems to illustrate what the standards mean for children and their families and health, social services and education sectors working together with voluntary organisations and the public themselves. The Department of Health (DH) will publish exemplars and other examples of good practice on related websites and as toolkits, as more material is developed to support the NSF.

Implementing the NSF will require great changes in our attitudes towards children. The NSF is a 10-year direction of travel designed to revolutionise the care of children in England. Some of the changes, such as changes to the law to aid information sharing about risk factors between staff working in different organisations, will need action by the government. Others, such as issues around accountability, will need action to be taken by strategic health authorities (SHAs) and primary care trusts (PCTs) or individual practitioners. The formation of children’s trusts will need action on a countrywide basis and not just from those working in the health sector, but also from education and social services. It is important not to be overwhelmed by the scale of these changes; real lasting change will depend on each of us playing our part.

The Children’s NSF is the way by which the government’s Children’s Taskforce will deliver the NHS Plan in England, in respect of the quality of children’s services.² The overarching aim for the NSF is to enable ‘all children and young people to develop healthy lifestyles and to have opportunities to achieve optimum health and wellbeing within the context of high-quality preventive and treatment services if and when they need them. Children and young people should be supported/enabled to have the resilience, capacity and emotional wellbeing that allows them to play, learn, relate to other people and resolve problems in life’.³ Broadly, the NSF will put children, young people and pregnant women at the centre of their care – building services around their needs.

This NSF is different from the previous disease-based NSFs in that it relates to a large section of the population – children and young people and their families. Health, social care and education sectors and voluntary sector organisations will all be responsible for implementing the NSF, which concerns children and young people from pre-birth to their nineteenth birthday, covering the transition into both adult life and services. PCTs will be instrumental in achieving the standards of the NSF, supported by SHAs. The Children’s NSF aims to describe outcomes, what good children’s and young people’s services look like, leaving practitioners to devise local arrangements to achieve good practice. This will take time though – the NSF is a means to an end and not an end in itself.

The principles upon which the policies and services for children and young people should be based were derived from the Children and Young People’s Unit (www.cypu.gov.uk):

• centred on the needs of the young person
• high quality
• family oriented
• equitable and non-discriminatory
• inclusive
• empowering
• results oriented and evidence based
• coherent in design and delivery
• supportive and respectful
• community enhancing.

No one could argue with these ambitions for children’s services. Children’s services have been ignored for too long. Some question whether these ambitious proposals are realistic and achievable for GPs and their primary healthcare teams without hypothecated funding (that is, funding additional to the core NHS budget). There is little additional funding specific to children’s services contained in the quality framework of the new General Medical Services (GMS) contract.⁴

There is a strong emphasis on services being designed around children, young people and their families and their needs. It is expected that PCTs will work with local authorities to develop multiagency preventive services that meet the needs of this sector.

The first part of the NSF was published in advance of the full NSF in 2003, describing three standards for hospital services for children concerning:

1. child-centred hospital services
2. quality and safety of care provided
3. quality of setting and environment.⁵

Strong local leadership and children’s champions with the ability and commitment to influence and drive change in partnership with local people (including children and families) are seen as key to the success of implementing the hospital standards.⁵

How the Children’s NSF has evolved

The Children’s NSF was drawn up in a similar way to the other NSFs, by professionals in the field working with public sector officials to recommend an NSF to government ministers. Eight EWGs composed of over 250 professionals were drawn from across health settings, social services, education and voluntary sectors, including service users and carers and key advocates for children’s services. Many of the EWG members worked in practice and were in regular contact with patients or clients as well as having relevant senior or expert roles of some sort. The EWGs focused on: children who require acute or hospital services, maternity, child and adolescent mental health (CAMHS), children with disabilities, children in special circumstances (for instance, looked after children in local authority care), medicines management, the ill child and the healthy child and young person. Each group was supported by teams of experienced staff from the DH and other sectors, who undertook the drafting of documents and compilation of the overarching NSF.

In addition, parallel working groups focused on information, research and development/evidence, workforce and the built environment. These parallel groups considered the practice implications of the draft recommendations in the NSF, such as changes in skill mix or the need for premises and resources in order to improve access arrangements. As the interventions in the NSF became more defined, experts gathered evidence of their effectiveness and undertook an economic analysis.

Proposals in other key documents relating to child and public health were carefully considered and incorporated into the NSF’s ongoing development.

There were local and national consultations between professionals from the NSF and the general public, throughout the drafting of the NSF. Consultations were undertaken that involved children and parents from vulnerable groups and not just those who were relatively easy to access. A primary care advisory group provided a reality check for the application of the evolving NSF in the primary care setting which led to a nationwide consultation. A consultation organised by the Royal College of General Practitioners (RCGP) considered final drafting of the NSF in relation to primary care.

Addressing health inequalities

Promoting health and wellbeing and preventing illness means tackling the root causes of inequalities to enable all children and young people to achieve the best health possible. The main causes of mortality in the adolescent age group are accidents and self-harm. Injuries, self-harm and other risk-taking behaviour all show marked social class gradients in incidence and prevalence, for example increased risk of injury to child pedestrians and from fires and increased prevalence of smoking with lower social class. Addressing health inequalities requires a multiagency approach. Interventions profiled in the Children’s NSF include helping children and young people to manage health-related risks, e.g. from smoking and substance misuse; preventing injuries and accidents; providing healthy settings in schools and other locations used by children and young people.

Box 1.1 Campaign targets second-hand smoking⁶

More than 40% of children and 20% of non-smoking adults are exposed regularly to second-hand smoke. The second phase of a campaign aimed at encouraging parents to give up smoking around their children and raising general awareness about second-hand smoking risks was launched at the end of 2003.

The campaign featured billboards, TV spots and cinema and press adverts with a slogan that appears to be written by a child in crayon: If you smoke, I smoke. It also included the distribution of bibs with the same slogan to all babies bom in December 2003 and the promotion of survey results that show the majority of children dislike exposure to second-hand smoking.

Over the last century the risk of dying in infancy has fallen dramatically. In 2002, the infant mortality rate (the number of deaths of children under one year of age per 1000 live births) was 5.3 per 1000 live births in England and Wales. But infant mortality rates are 70% higher in the most deprived areas than the most affluent areas.⁷ The wider determinants of health such as income, employment, education and other social and environmental factors such as housing conditions all contribute to the relatively poorer health of...