Final Report > Chapter 29: The Care of Children > Introduction

Introduction

1 We argue that children and their healthcare needs should be given greater recognition and higher priority in the health service. We suggest that a National Service Framework (NSF) for children is urgently needed and welcome the Government's recent recognition of this. We make proposals for improving the leadership of children's healthcare services at every level. Finally, we address two areas of particular concern arising from the events in Bristol: staffing and communication.

2 All of the principles and recommendations in this report, though not intended specifically to address healthcare services for children, will, once implemented, have a marked effect on children's services. In addition, however, there are a number of issues which are particular to the provision of healthcare services for children and which we believe demand special attention.

3 The relatively low status in the overall scheme of things which was given to healthcare services for children undergoing open-heart surgery in Bristol is all the more poignant given that there existed within the Bristol group of hospitals a dedicated children's hospital, with expertise in looking after sick children. Sadly, that expertise was not linked effectively to the BRI. The comment of Dr Peter Martin, consultant paediatrician, who worked as a senior house officer at the Bristol Royal Hospital for Sick Children between 1988 and 1989, is telling:

`... myself and colleagues thought it was rather bizarre that the sickest children post-operatively were managed in a unit where the resident staff were generally not paediatrically trained and the nursing staff were also not paediatrically trained. This was in stark contrast to the children requiring less intensive surgery who were looked after on a paediatric intensive care unit with paediatric anaesthetists, resident and paediatric medical staff, as well as of course, nursing staff who only looked after ill children.' [1]

4 National and professional organisations concerned with the provision of children's healthcare services contributed to the first Seminar in Phase Two of the Inquiry. The clear message from their submissions was that shortcomings in acute healthcare services for children were by no means unique to Bristol. More disturbing, they told us that, while there has undoubtedly been improvement since 1995, notably in the fields of paediatric intensive care and in a number of specialist services for children with specific conditions such as cleft lip and palate, children's healthcare services as a whole still remain a low priority. This was borne out in evidence throughout the Inquiry. We were told, for example, that healthcare services for children are still, generally, fragmented and poorly co-ordinated. Furthermore, we were told that although well-established guidance exists, the extent to which it is implemented varies across the country. There is no system for ensuring that the guidance is put into operation, nor are there any sanctions against those trusts which persistently fail to implement it. The particular performance of those services connected with children's healthcare, as distinct from the quality of services in general, is not systematically monitored. Thus it is not surprising that very little information is available locally or nationally about the quality of such services.

5 We welcome the decision of the Department of Health (DoH) to begin to develop a National Service Framework for children (March 2001). Such a framework should help to overcome the reluctance of some of those responsible for planning and managing healthcare services to recognise the particular requirements of children and families. In our view, one of the central priorities for the Framework must be acute care for children, including that which takes place in district general hospitals as well as in the more well-known specialist hospitals for children. It is in the general, non-specialist hospitals that constant vigilance is especially needed to ensure that the particular needs of children are not overlooked. The Framework must address this.

Footnotes

[1] See Annex A Chapter 9 for further evidence about the split site and split service