Final Report > Chapter 29: The Care of Children > Leadership of children's healthcare services > Leadership in the NHS

Leadership in the NHS

36 Few English health authorities have a senior officer with specific responsibility for commissioning children's healthcare services. Apart from free-standing children's hospital trusts, there is scant evidence within trusts which care for children as well as adults that any senior, board-level manager, or non-executive director, is responsible for taking an overall view of the entirety of healthcare services for children and young people within the trust. This may reflect a historical reality that services have tended to be managed by reference to specialty (for example, cardiac surgery) rather than by reference to patients. A way must be found within healthcare organisations to allow the voice and needs of those who use the service to be heard, as well as that of the specialists (it is not a case of `either/or'). In our view, it is this absence of a significant voice for children, at any level of policy-making or management within the NHS, which both signals and reinforces the low priority given to children's healthcare services. Thus all acute care trusts which care for children as well as adults should have a designated executive member of the board whose responsibility it is to ensure that the interests of children are protected and that they are cared for in a paediatric environment by paediatrically trained staff.

37 Speaking up for children's healthcare services also calls for clinical leadership. Despite the efforts of many individuals, there are considerable barriers in the way of progress. Paediatrics, as a specialty, historically has had a low status. This can be seen in those acute hospital trusts which are not exclusively devoted to the care of children, where the importance of children as a distinct group of patients, and of those who provide children's healthcare services, is not systematically recognised at a senior level. We were told, for example, by the RCN, that, according to a comprehensive survey which it undertook in 1998, few acute hospital trusts have a paediatrically qualified nurse working at a level of seniority above ward level. Thus, nurses with specialist training in the care of children are not routinely involved in the development of policy within a trust. They struggle to influence the development of appropriate child-centred policies, especially in areas where children receive care alongside adults, such as in general surgery, outpatient departments, and in accident and emergency.

38 We have already noted and commended the efforts of two of the Royal Colleges in taking a lead on developing standards for children's healthcare services. This has taken place, however, in a wider context in which, as we have said, paediatrics as a specialty, historically, has been undervalued within the clinical professions. This was a strong theme in the evidence from the RCN. The late Professor David Baum, then President of the Royal College of Paediatrics and Child Health (a Royal College since 1996), told us:

`Across the world, the independent voice of paediatrics has been later than physicians and surgeons as an identifying group in the world of medicine ...' [15]

In the light of the evidence which we heard and read, we believe that a very substantial effort is required to change the way in which children's healthcare services are thought about, led and managed.

Footnotes

[15] T18 p.21 Professor Baum, then President of the Royal College of Paediatrics and Child Health