Back in 2010 I was a children’s nurse involved in the Children and Young People’s Emergency and Urgent Care work of the NHS Institute for Innovation and Improvement. Seven years on, the publication of QualityWatch’s 'Focus on: Emergency hospital care for children and young people' is great to see.
The things that jumped out at me in the report were:
- Emergency hospital care use by children and young people increased between 2006/07 and 2015/16
- The largest increases in emergency admission rates occurred for infants and 1 to 4-year-olds
- Eight of the 10 most common emergency admission diagnoses for 0 to 24-year olds in 2006/07 remained the same in 2015/16 (with increased attendances relating to mental health issues)
- For infants there were large increases in emergency admissions for haemolytic and perinatal jaundice and other perinatal conditions.
What seems clear is that a ‘whole systems approach’ is needed to develop and deliver accessible and responsive child health services offering a variety of interventions. Indeed, the NHS Institute for Innovation and Improvement published a ‘Whole System Approach to Improving Emergency and Urgent Care for Children and Young People: A Practical Step by Step Guide and Resource Pack’ in 2011 that is still worth dipping into for ideas.
So what could STPs and local areas consider to enhance experiences and improve outcomes for and with children, young people and their families?
Signposting to services and raising public awareness
It’s worth asking, how does the local community know about the range of services available to them - pharmacists, opening hours of GP practices/emergency clinics, urgent care centres, 111, children and young people’s mental health services, etc? Let’s ensure we make this information accessible in a range of ways. Health service information in school diaries was an idea that young people came up with. When a young man commented ‘you only find out about the NHS when you go to the NHS’, one health system took his advice and provided a colourful insert about local health services. We could roll this out to all schools.
Bradford’s health system is holding a community engagement event in July to explore ideas such as this with young people directly, whilst the London team have developed #NHSGo, an app that shares health information with young people (follow them at @HealthyLDN). The best solutions and ideas often come from young people themselves when we engage with them.
Having leaders who are committed to improving Children and Young People’s experience makes such a difference.
Luton, as part of their Children and Young People’s Urgent Care work, took a range of professionals out to community family events and had conversations with people about services. Free thermometers and education on how to take a child’s temperature went down particularly well. They have continued to grow their children’s community nursing capacity to support care closer to home thanks to ongoing support from Cambridgeshire Community Services, and the Executive team (follow them at @ccs_nhst). Another shout out has to go to West Sussex CCG, which recently won an award for engagement with GP practices. Part of this work included engagement with families who have children with complex disabilities. (Follow @TimFooks, the GP and Clinical Lead for Children and Young People there.)
Investment in skills
Investing in the clinical skills development of professionals involved in caring for children and young people is valued and has impact.
Education sessions for GPs, midwives, health visitors and practice nurses led by paediatricians and senior children’s nursing helps build competence and confidence whilst nurturing relationships between professional groups. Regular sharing of information with midwives and health visitors can stimulate local service improvement programmes. For example, knowledge of the numbers of infants brought to A&E in the postnatal period can lead to initiatives to ensure feeding is established prior to discharge from maternity units, by considering innovative approaches such as employing and training maternity support workers who specialise in supporting the establishment of feeding.
Suggestions for the way forward
So I have three suggestions for ‘where next’ for children and young people’s emergency care:
- Make it a community challenge, engage children, young people and families in the issues
- Invest in and support children and young people’s leaders, at executive and operational levels throughout the system (the National Service Framework for children and young people advocated this strongly)
- Build local multi-disciplinary and community focused education programmes
Addressing children and young people’s emergency care activity requires creativity and sustained leadership across the system. Keeping the focus on this area of care is vital and the team at QualityWatch have helped to ensure this happens. Now we all need to be committed to ongoing action.