Models of care: Foreword

Hear from the leads of this workstream and read a summary of what children and young people think about models of care.

From the workstream leads

Mind the Gap!

Children are the future and yet the data clearly show that we currently do not meet their needs in the health sector.[1] In the UK, we are falling behind comparative countries, with poorer health outcomes across a range of child health indicators.[2] Children are asking for us to do things differently – we need to meet their needs. To do this we have to review the way we deliver services and ensure they are equitable for all, regardless of the colour of your skin or the area you have grown up in. The conditions children experience have changed over time, with a predominance of mental health problems, chronic illness and much shorter stays in hospital when they are acutely unwell. We still need to retain our hospital bed base for when children are seriously ill, however we have all started to question whether the way we currently offer services suits the managers and health care staff more than it does children and families.

Models of care, what does this mean? Most do think initially of the services we offer – such as an outpatient service or inpatient beds – but is that all we should consider? The traditional offer of primary care, secondary care and tertiary care is a tiered approach, dating back to the inception of the NHS. More recently, it is recognised that this archaic structure has for decades taken power away from those who are most likely to know families well, including health visitors, school nurses, midwifes and other sectors such as schooling.

For any care to be effective, it needs to be accessible. In the simplest terms, people need to be able to ‘get there’ and given the fact 30%[3] of children live in poverty, transport costs could be a barrier. So when a single parent with a wheezy child needs to attend ED, does that mean an ambulance?… Navigation of the NHS system is also complex and creates barriers for those with communication problems. We live in a multicultural society, yet language can too often influence a family’s ability to access care.

Families have to choose everyday between taking a day off work for an appointment or losing a day’s pay – and the further you need to travel to ‘access’ the care, the more likely this is to occur. Families also need to be able to express their problem in a way that is understood, feel comfortable doing that and being able to have a two-way communication that results in an acceptable outcome. Seeing children in an artificial environment such as clinic room does not allow you to understand the factors potentially impeding the family’s ability to successfully engage with management plans offered.

We are writing this in 2020, a year in which COVID-19 has created waves of change in the ways we work in healthcare. Technology and innovation have meant we are delivering care in ways we wouldn’t have though possible just 12 months ago. In this work we are thinking about the future, and whilst we absolutely do need to consider where we offer services (the physical healthcare environment), we also need to be asking ourselves about the other “w”s –  who, when, how and why. Later we talk in more detail about what we mean, we hope in a practical way that is useful to paediatricians and service planners alike.

We need to simplify the system, try to keep care as close to home as possible and communicate any change well, concentrating especially on hard to reach populations.

Dr Nicola Jay, Co-Chair for the Paediatrics 2040 Models of Care Workstream

Dr Simon Clark. Co-Chair for the Paediatrics 2040 Models of Care Workstream

Professor Russell Viner, RCPCH President 2018-2021

Alison Firth, Paediatrics 2040 Project Manager, RCPCH

From RCPCH&Us, the voice of children, young people and families

We have had lots of discussions about what we would like to see in the future in the way that services work together or how we access the help we need.  It’s important that there is choice for the patient and family, so that they can choose to have online appointments even after the pandemic because it stops it being stressful going to the hospital on public transport or missing school for example.

“home, school visits, virtual and phone appointments. Appointments should be available for all school children after 4pm so they avoid missing school” RCPCH &Us 2021, Scotland

All services have to be “equipped with the available equipment needed” and learn to work as one service, so it’s easier to see all the people at one place, at one time but also they all know the same information. RCPCH &Us 2021, Northern Ireland

So if we do have 3 or 4 doctors helping us, that everyone has access to the same details so that we don’t have to carry round with us big folders of information and spend time explaining things that should have been passed on. That would also help too if we have to move between services or if we get referred to a new service, all the information can just be there.

We think it’s really important to integrate physical and mental health services together so that:

“at general appointments take time at the end to ask children and young person about their mental health, this may require longer appointments” RCPCH &Us 2021, Scotland.

“I feel reassured that moving forward, young people in 2040 will have their rights and wishes respected when treated medically” RCPCH &Us 2021, Wales.

We also talked about how important it is that the NHS and the government listen to and involve children and young people so that they can create the best services possible.

Illustrations by children and young people with RCPCH&Us

References

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(1)

RCPCH State of Child Health 2020. https://stateofchildhealth.rcpch.ac.uk/

(3)

Child poverty action group. Child poverty facts and figures. https://cpag.org.uk/child-poverty/child-poverty-facts-and-figures

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