THE FUTURE OF PAEDIATRIC SERVICES

During the last 2 decades there have been dramatic changes and challenges to the way that care for children and young people is provided in the UK

During the 1990'S it was more likely that a family would contact their gp practice if they had urgent concerns about their child's health. However, since the changes to gp practice since 2004 there has been an evolution of emergency care settings and providers.

It is partly due to this that the healthcare services for children and young people in England have become disjointed resulting in poorer health outcomes for this group in comparison to health outcomes of children and young people in comparative European countries

Whilst children and young people make up only around 25% of a gp's population, they represent about 40% of its workload and although many senior gp's have extensive paediatric knowledge there are fewer trainees with this necessary training.

As experience matters in recognising rare but serious illness in children this mismatch in experience has a real negative impact on children's healthcare in England resulting in poorer health outcomes.

The NHS needs to address these poor outcomes and develop and innovate new ways of working in order to address poor outcomes in child health. It needs to respond to the changing needs of children, young people and their families rather than expecting them to respond to the system.

THERE HAVE BEEN CHALLENGES TO THE HEALTH CARE DELIVERY SYSTEM

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• Since 2004 increased attendances of cyp to gp surgeries, short stay centres and ER.
• Sir Ian kennedy's report of 2010 highlighted inadequacies and lack of joined up care approach.
• The 2009 laming report highlighted failures in the system of children's healthcare practices.
• Time to treat standards of 2012 were updated to within 60 minutes

In response to the challenges and negative reviews the doh has announced that from 2013 the 4 strategic clinical networks across England are to now incorporate maternity and children and in 2015 the rcpch has published the standards for acute general paediatric services document focusing on key standards for paediatric care delivery.

NEVER HAS THERE BEEN SUCH A DEMAND FOR CHANGE

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• Current systems need to develop and adapt
• A culture of innovation, improvement and learning is needed
• Services need to be organised to facilitate patients achieving their outcomes in the most efficient, effective and safe way.

There are 3 key themes highlighted as ways forward to increase the health care outcomes for children and young people in the UK

THESE INCLUDE:

• An increased recognition that nurses can positively enhance the current paediatric services
• The use of integrated care models such as teams without walls
• NHS commissioning board's clinical network proposals ( 2012 )

NURSING CONTRIBUTION

Traditionally nursing has been seen as a vocational profession but as recognition of their contribution is becoming more apparent these traditional roles and practices are changing

CHANGING ROLES

• Clinical decision making
• Executive and political management
• Academic study and research based practices
• Planning and delivery of healthcare for children and young people

Nurses have responded to the changing demands of the paediatric population and are leading colleagues in the shift towards more contemporary roles

NURSES WHO PRACTISE ALONGSIDE MEDICAL COLLEGUES INCLUDE

• Nurse practitioners
• Paediatric emergency nurse practitioners
• Specialist nurses
• Consultant nurses

PAEDIATRIC NURSING SKILLS

• An understanding of the dynamic developing anatomy of children that may influence presentation of disease processes
• Ability to distinguish potentially life threatening illness from minor problems
• specific knowledge base of childhood diseases, treatment protocols and discharge criteria
• Mostly they are resident and non transient unlike junior doctors

The role of nurse practitioners has been scrutinised in the literature in recent years and they have been noted as more proficient than junior doctors at recording medical histories, there have been fewer unplanned follow up attendances and less follow up needs for parents seeking advice.

INTEGRATED PRACTICE

As a result of a working party initiative between the royal college
Of physicians, the royal college of general practitioners and the royal college of paediatrics and child health the 2008 teams without walls initiative was developed

This integrated care model proposes changes in children and young persons health care delivery that puts the patient at the centre of everything the NHS does.

ASPIRATIONS

• Primary and secondary care teams working together
• Manage patients using care pathways designed by local practitioners
• Translating the latest evidence into practice
• Delivery of services closer to home when it is safe and sustainable
• That the patient sees the right person at the right time in the right place

EXAMPLES OF THE SUCCESSFUL USE OF THIS MODEL IN PAEDIATRICS

• Co located urgent care centres and emergency departments in homer ton hospital
• Children's community teams for life threatening conditions in bristol
• Training systems by paediatric nurses to care facilities via telephone advice available 24/7

NHS commissioning board clinical network proposals
( 2012 )

NETWORK CONCEPT

• Managed network will allow a whole care pathway for a baby/child/ young person to be delivered
• Collaboration of NHS organisations working within an integrated structure
• Care delivery improvements by combining clinical experience, input of patients and vision of NHS staff
• Improve local accountability and promote a regional approach to care delivery

EACH LOCALITY HAS A SUPPORT TEAM WITH THE AIMS OF:-

• Building and overseeing network arrangements
• Providing leadership and management expertise
• Develop annual qi programmes and audits
• Focus on a single model of change to promote spreading of best practice

The rcpch has clearly stated that
Network strategies, supported by strong clinical leadership and sound management, are fundamental to improving the quality of paediatric care

( 2012 )

An example of a successful specialist network Is the neonatal network. Established in 2003-2004 there are currently 27 networks within hospitals. These have ensured that every infant has the access to the right level of care; the right resources and the right staff. Since its introduction there has been significant reduction in long transfers of babies and more consistent cot availability.

CONCLUSION

• There is a push to bring together key services and professionals across the NHS, social care and public health sectors in order to enhance the delivery of care for children and young people.
• Because of their in depth paediatric knowledge and skills specific to children, paediatric nurses have much to offer in areas of health care assessment and policy development.
• The aspiration of the NHS is that these patients will be cared for by competent teams in a safe and sustainable manner close to home.

It is hoped that the proposed changes and initiatives for moving paediatric services forward will result in an enhanced patient experience whilst ensuring patient safety . Perhaps if the goals can be achieved we can reduce the number of paediatric deaths by 1,500 per year in line with Swedish statistics and raise our performance levels in the care of children alongside those European countries who are the best performing.

( bmj, 2011 )

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