Final Report > Chapter 29: The Care of Children > A framework for the future of children's healthcare services > Greater integration of healthcare services for children

Greater integration of healthcare services for children

22 Healthcare services for children are currently provided at every level of the NHS: primary care, in the community, and in hospitals (Accident & Emergency, secondary care and specialist tertiary care). As we have said already, historically, it is a feature of the provision of healthcare in hospitals that the care is organised around the needs of the organisation or the healthcare professionals. Children's healthcare services are no exception. This must change. Child-centred care must be care centred around the child. Strategic guidance is needed, based on evidence from the UK and abroad, as to which type of organisational model would best achieve the optimal integration of all the relevant services so that they are organised around the needs of children and their families, rather than around the needs of providers.

23 We were told of emerging models of service in England such as that in Newham, London, where a community trust manages the whole range of healthcare for children, including the acute ward in the local acute hospital trust. The Royal Liverpool Children's NHS Trust runs a `hospital at home' service for children with long-term needs. Efforts are also being made around the country to establish paediatric clinical networks to share good practice. One example is the Partners in Paediatrics Network, a partnership of acute and community trusts in Staffordshire, which work together on matters such as manpower planning, professional education and planning paediatric care. Outside the UK, we were particularly impressed by the high level of integration achieved in Philadelphia in the USA, where the Philadelphia Children's Hospital runs the paediatric wards in a number of local district hospitals, as well as the community health clinics for children and some primary care centres. While all aspects of this model may not be transferable here, given the well-established strengths of our primary care system, we take the view that there is much to learn from the Philadelphia experience. We see scope for a pilot project where a large children's hospital, with its experience in paediatric care and leadership in children's healthcare, could take responsibility for the management of children's acute healthcare and community services in a number of related general acute hospital trusts in a specific geographical area. Thus, for example, in the future there could be Birmingham Children's Hospital `at' Walsall Hospitals NHS Trust; or Great Ormond Street Hospital `at' the Greenwich Healthcare NHS Trust. These are just illustrations of what might develop into a hub and spoke model, where the hub is the specialist paediatric hospital, and the spokes are district general hospitals which include paediatric care amongst many other services. Equally, the development of primary care trusts offers significant opportunities for the closer integration of primary care, community care and general paediatric secondary care, always provided that the system created is informed by a comprehensive view of children's needs. This is the crucial message of the experience in Philadelphia. Not only must the services be more closely integrated, they must also all be imbued with the philosophy of
child-centred care.