Improving child health services in the UK: insights from Europe and their implications for the NHS reforms

Abstract

The coalition government's Health and Social Care Bill is unlikely to deliver the improvements in children's health services that are urgently needed. Useful lessons can be learnt from how other European countries deliver healthcare for children, say Ingrid Wolfe and colleaguesThe care provided by UK children's health services is inferior in many regards to that in comparable European countries. Although there are many examples of good practice, health services too often provide poor outcomes and are seemingly planned around the needs of organisations rather than those of children, young people, and families. Service models are often inefficient and wasteful. Budget constraints and dramatic changes in the NHS make it more important than ever that children's healthcare is planned carefully and appropriately for their needs (box 1). However, current plans insufficiently recognise children and young people's special requirements and fail adequately to acknowledge important recommendations made in Ian Kennedy's review of children's healthcare.1The Marmot review emphasises the importance of investment in children to reduce health inequalities at all ages.2 Health services in the UK need to adapt both to the changing nature of the challenges of

Safety Incidents in the Primary Care Office Setting

“…37 Such failures likely contribute to the United Kingdom's relatively high child death rates from meningococcal disease, pneumonia, and asthma, where first-access services such as primary care are integral. 38,39 Diagnosis and assessment incidents tend to be a reflection of providers' skills and competencies and may be less likely to be reported.…”

“…9,11,36,39 For example, most (75%) pediatric asthma-related hospital admissions are thought to be preventable with better primary care. 40 Our findings reflect the significant potential for harm to children that exists as a result of poor management and treatment of longterm pediatric conditions in primary care.…”

Understanding why children die in high-income countries

“…147 The analysis of 'first contact models' in those countries with better child survival outcomes can provide useful insight into different ways of integrating healthcare across community and hospital boundaries. 141,148 The management of chronic childhood diseases such as asthma, diabetes, and epilepsy, requires a shift in focus from a hospital-centric model of provision to an integrated system that transcends arbitrary boundaries between primary and secondary care. Much might be lifted from the model of chronic care provision in the elderly with collaborative organisational arrangements between health and social services and supportive financial processes.…”

Patterns of child death in England and Wales

“…A recent analysis of WHO data identified higher mortality specifically in conditions that are influenced by health service provision such as meningococcal disease, pneumonia and asthma, and concluded that if the UK health system performed as well as that of Sweden, as many as 1500 children might not die each year. 6 There are several possible explanations for this, some of which illustrate weaknesses of health care provision for children in this country, and further work is needed to identify and respond to such gaps in care. While cross-country comparisons are fraught with difficulty, it is essential that we take such data seriously and use them as a stimulus to action.…”