Paediatric care symposium: Put children at the centre of their care
“Innovation in paediatric care” was the
title of a Conference symposium on 16 September. Olivia Timbs (Editor
of The Journal) reports on the progress of the National Service Framework
for Children, Young
People and Maternity Services — “Getting
the right start”
Do children get a good deal, was the question Professor Al Ansley-Green
asked as he launched his plea to pharmacists to play their part in improving
the health services for children and young people.
Professor Ansley-Green, national clinical director for children and Nuffield
Professor of Child Health at the Institute of Child Health, University
College London and Great Ormond Street Hospital for Children, is leading
the development of the National Service Framework for Children, Young
People and Maternity Services. He argued that although nothing matters
more to families than their children and most people recognise they are
the lifeblood of the nation, there is a mismatch between this emotional
reaction to children and the attention they receive through health, social
services and the education system.
National Health Service performance indicators suggest that there are
no difficulties with the care provided for children. “You can always
get a sick child into hospital,” Professor Ansley-Green commented.
But when you consider the implications of the Kennedy and Laming inquiries
(into the care of babies undergoing heart surgery in Bristol and the
maltreatment of Victoria Climbié, respectively) the situation
is rather different. The care of children is often subordinated to that
offered to adults and there is often a lack of concern for the most vulnerable
individuals. The care of children is fragmented and with no individual
taking overall responsibility. As a result effective planning is lacking
and there is no effective leadership. “The chapter on children
in the Kennedy report was written with anger,” he added.
Expecations for the NSF
Professor Ansley-Green then explained how the NSF
for Children, Young
People and Maternity Services should help address the inconsistencies
in care provided for children. He repeated the words of former Health
Secretary, Alan Milburn, who stated when the development of the NSF
was announced in February 2001: “The lottery in care in children’s
services must now end.”
When the NSF is fully published — which Professor Ansley-Green
hopes will be at the beginning of next year — it will be only the
beginning of a 10-year plan to improve the experience of children and
their families by focusing the care on the child (rather than the disease).
The module on standards in hospital services has already been issued.
This will be followed by a related module on the ill child, with others
also expected on maternity services, mental health and psychological
well-being of children and young people, children in special circumstances,
disabled children, healthy children and young people and, most importantly
for pharmacists, medicines for children.
The focus of these modules will be on the needs of the whole child (which
go beyond health to embrace social care, education and the environment
in which they live). “This approach will demand new partnerships
and mean that different professionals will have to leave their bunkers,” Professor
Ansley-Green emphasised. He cited the example of children who are unable
to go to school because no one at their schools is prepared to take the
responsibility for giving medicines regularly.
Implications for pharmacists
Professor Ansley-Green indicated some specific areas in which pharmacists
can play a part and may bring some influence on developments. For example,
he is determined that play is integrated into health service provision
through the NSF despite opposition to the suggestion. “Play helps
children understand their medication and can be used to prepare them
for injections and other treatment,” he explained.
He also expects trusts to develop written policies on the treatment of
pain, and every trust dealing with children should have a policy for
transition to adult services. In addition, hospital pharmacists should
have a system of communicating with their community counterparts when
children are discharged. The clinical governance framework should have
a focus on children.
Professor Ansley-Green spoke about his concerns over the medicines that
are frequently prescribed for children. Some of the concerns have been
widely discussed and reported, such as the use of products that are not
licensed for children, but he also raised other less usual issues. He
pointed out that there has been a great deal of research into the benefits
of human milk for babies in terms of their ultimate intellectual achievements. “What
impact,” he asked, “do drugs given to neonates have on their
later life?” He pointed out that although it has been established
that there are serious later effects from cytotoxics given in the early
years of life there are few data available for other medicines given
to young children.
The difficulties in establishing the correct dose for a child, depending
on his age, weight, height and surface area, were known — the challenge
was to ensure that all children were given the most appropriate dose.
Professor Ansley-Green also pointed out the need for decent patient information
for parents and for children: children need to know what they are taking
and understand why they are taking it, he said.
Research into paediatric medicines
Attention then turned to what Professor Aynsley-Green dubbed “UK
pharma Plc”, and the mismatch of its power and the duty of care
it should exercise for the 25 per cent of the population that children
constitute. Incentives need to be created for the pharmaceutical industry
to research the effects of medicines on children. This is only part of
the problem, he suggested. Although networks of groups with an interest
in paediatrics who exchange information about medicines do exist, he
would like to see the development of paediatric pharmacology research
units in different parts of the country. The difficulty is finding suitably
qualified people: “Why are people not interested in drug delivery
in children,” he wondered.
Professor Ansley-Green reminded the audience that children are now firmly
on the government agenda. The NSF is only part of the jigsaw and it is
not a report, it is Government policy. Earlier this summer a Minister
for Children, Margaret Hodge, had been appointed and last week a Children’s
Green Paper “Every child matters” had been published.
Pharmacists have the potential to influence the political process by
being the champions for the use of medicines in children: “The
question pharmacists need to address is how do they engage with local
politicians to make a difference to the lives of children.” The
challenge for the NHS is to get children to be taken seriously and to
ensure that children’s services are considered part of the mainstream
in the everyday business of trusts, he emphasised.
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