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| 'It's time to say: we're not getting it right on children's health' – paediatricians' leader | 'It's time to say: we're not getting it right on children's health' – paediatricians' leader |
| (4 days later) | |
| Medical colleges are normally deeply conservative, so when Dr Hilary Cass, president of the Royal College of Paediatrics and Child Health, says five children a day are dying unnecessarily in Britain because child health is in crisis, it is time to take notice. Not least to ask: where is this issue in the debate around the NHS? Do we not care what happens to our young people? | Medical colleges are normally deeply conservative, so when Dr Hilary Cass, president of the Royal College of Paediatrics and Child Health, says five children a day are dying unnecessarily in Britain because child health is in crisis, it is time to take notice. Not least to ask: where is this issue in the debate around the NHS? Do we not care what happens to our young people? |
| "What's visible to the public are the changes to the NHS, hospital closures and the pressures on accident and emergency," says Cass, 55, who took over the role representing more than 11,000 paediatricians in the UK last year. | "What's visible to the public are the changes to the NHS, hospital closures and the pressures on accident and emergency," says Cass, 55, who took over the role representing more than 11,000 paediatricians in the UK last year. |
| "If we don't do something radical now about children's health, the cost will accumulate down the line and will be massive. But children's deaths are a blunt tool for looking at whether services are doing well or badly. For every child who dies there are a large number whose care could be a whole lot better and whose long-term conditions have not been managed well. That is unsatisfactory and unfair." | "If we don't do something radical now about children's health, the cost will accumulate down the line and will be massive. But children's deaths are a blunt tool for looking at whether services are doing well or badly. For every child who dies there are a large number whose care could be a whole lot better and whose long-term conditions have not been managed well. That is unsatisfactory and unfair." |
| In 1976, a government report on child health said parents should expect "a considerably greater level of paediatric competence … than exists at present". | In 1976, a government report on child health said parents should expect "a considerably greater level of paediatric competence … than exists at present". |
| Thirty-seven years later, the situation continues to be extremely poor. The statistics are shocking. For instance, one in four children who sees an A&E doctor sees a junior doctor instead of a consultant with appropriate skills, resulting in a reduced chance of a correct diagnosis. | Thirty-seven years later, the situation continues to be extremely poor. The statistics are shocking. For instance, one in four children who sees an A&E doctor sees a junior doctor instead of a consultant with appropriate skills, resulting in a reduced chance of a correct diagnosis. |
| "It is really difficult to spot a sick child," Cass says. "Most people who have been a paediatric registrar have had a 'There but for the grace of God go I' reaction when they nearly missed a seriously sick child. Children are well one minute and very sick the next. So you have much less time than you have with adults." | "It is really difficult to spot a sick child," Cass says. "Most people who have been a paediatric registrar have had a 'There but for the grace of God go I' reaction when they nearly missed a seriously sick child. Children are well one minute and very sick the next. So you have much less time than you have with adults." |
| In health services across western Europe, she points out, the UK has moved from the average position to the worst for childhood mortality between the ages of 0 and 14. Only 3% of children with asthma have a care plan to prevent and manage the illness. As a result, there are many preventable hospital admissions, and mortality rates are higher than comparable European countries. | In health services across western Europe, she points out, the UK has moved from the average position to the worst for childhood mortality between the ages of 0 and 14. Only 3% of children with asthma have a care plan to prevent and manage the illness. As a result, there are many preventable hospital admissions, and mortality rates are higher than comparable European countries. |
| In Britain, one in three children is overweight or obese yet only 4% of children with diabetes receive care consistent with the current guidelines [see footnote]. In addition, deaths from meningococcal disease are two to three times higher than in the rest of western Europe. | |
| But what does Cass mean by "unnecessary" deaths? | But what does Cass mean by "unnecessary" deaths? |
| "These exclude accidents and children with severe congenital abnormalities who have good palliative care and die within weeks of being born," she said | "These exclude accidents and children with severe congenital abnormalities who have good palliative care and die within weeks of being born," she said |
| "Unnecessary deaths are those that would not happen if services improved: children with meningitis that we miss or who have illnesses in which we don't intervene early enough. | "Unnecessary deaths are those that would not happen if services improved: children with meningitis that we miss or who have illnesses in which we don't intervene early enough. |
| "We have some superb GPs but they have 10 minutes and limited paediatric training so they often aren't able to explore in more detail, for instance, a child with a wheeze – has he or she got an asthma plan in place? | "We have some superb GPs but they have 10 minutes and limited paediatric training so they often aren't able to explore in more detail, for instance, a child with a wheeze – has he or she got an asthma plan in place? |
| "If the child is referred to A&E, a junior doctor might just patch him or her up rather than say, 'Let's really get under the skin of this'… So some of the crisis is about better training for all the workforce. Some is about increasing pressure on the system and some is due to the system of primary and secondary care, with children falling between the two." | "If the child is referred to A&E, a junior doctor might just patch him or her up rather than say, 'Let's really get under the skin of this'… So some of the crisis is about better training for all the workforce. Some is about increasing pressure on the system and some is due to the system of primary and secondary care, with children falling between the two." |
| Tomorrow the Royal College publishes the findings of its biennial workforce census. It is calling for a 50% increase in the number of consultants (not least to fill 86 vacancies); a reduction in the number of smaller paediatric units and more specialist centres so treatment can be of a higher standard – and a reduction in the number of trainees. "Paradoxically, when they qualify there won't be enough posts for them to fill," Cass says. | Tomorrow the Royal College publishes the findings of its biennial workforce census. It is calling for a 50% increase in the number of consultants (not least to fill 86 vacancies); a reduction in the number of smaller paediatric units and more specialist centres so treatment can be of a higher standard – and a reduction in the number of trainees. "Paradoxically, when they qualify there won't be enough posts for them to fill," Cass says. |
| Based at Guy's and St Thomas' Evelina children's hospital in London, Cass is involved in a two-year pilot scheme to redesign services and move the focus from hospitals and into the community – a move backed by the finding that 50% of children in outpatient clinics and A&E have no need to be referred to either. | Based at Guy's and St Thomas' Evelina children's hospital in London, Cass is involved in a two-year pilot scheme to redesign services and move the focus from hospitals and into the community – a move backed by the finding that 50% of children in outpatient clinics and A&E have no need to be referred to either. |
| "We need to take primary and secondary care out of our language and focus on healthcare," she says. "When I make a decision, I can draw on a multiprofessional team in hospital that includes physiotherapists, speech therapists and a range of specialists." | "We need to take primary and secondary care out of our language and focus on healthcare," she says. "When I make a decision, I can draw on a multiprofessional team in hospital that includes physiotherapists, speech therapists and a range of specialists." |
| Her aim is to move that multiprofessional team closer to GPs via a children's health centre. Local GPs will spend, perhaps, a day a week in the centre working alongside a paediatrician and health team, including children's nurses. "Instead of sending a child to A&E, a GP could immediately refer them to a member of the team in the centre. We have to stop seeing hospitals as the solution to everything. GPs and paediatricians working closely together also drives up skills." | Her aim is to move that multiprofessional team closer to GPs via a children's health centre. Local GPs will spend, perhaps, a day a week in the centre working alongside a paediatrician and health team, including children's nurses. "Instead of sending a child to A&E, a GP could immediately refer them to a member of the team in the centre. We have to stop seeing hospitals as the solution to everything. GPs and paediatricians working closely together also drives up skills." |
| "Kids get ill fast but they also get better fast," Cass says. "There's a real magic when a child comes in sick as a parrot and you give him or her some medicine and two hours later they are whizzing around. That doesn't happen with an 80-year-old with chronic obstructive pulmonary disease." | "Kids get ill fast but they also get better fast," Cass says. "There's a real magic when a child comes in sick as a parrot and you give him or her some medicine and two hours later they are whizzing around. That doesn't happen with an 80-year-old with chronic obstructive pulmonary disease." |
| Among the many issues that may hinder the pilot is the way in which GPs and hospital consultants are funded and the willingness of GPs in clinical commissioning groups to participate. "These are really difficult challenges. I don't know if my solution is the right one but you can't have 250 CCGs trying to tackle the problem individually." | Among the many issues that may hinder the pilot is the way in which GPs and hospital consultants are funded and the willingness of GPs in clinical commissioning groups to participate. "These are really difficult challenges. I don't know if my solution is the right one but you can't have 250 CCGs trying to tackle the problem individually." |
| Cass adds: "I have always stood up for the groups who are marginalised, whether junior doctors or children with disabilities, and I care passionately about children's health. | Cass adds: "I have always stood up for the groups who are marginalised, whether junior doctors or children with disabilities, and I care passionately about children's health. |
| "Somebody has to put their hand up and say none of us is getting this right. As the saying goes, 'Not all change is improvement, but there is no improvement without change'. I believe in change." | "Somebody has to put their hand up and say none of us is getting this right. As the saying goes, 'Not all change is improvement, but there is no improvement without change'. I believe in change." |
| • This article was amended on 17 July 2013. The original referred to children with diabetes and went on to say that diabetes can be related to obesity. To clarify: only a small percentage of children with diabetes have Type 2, which can indeed be related to obesity. The large majority (90%-95%) of diabetes in the age group 0 to 14 is Type 1, which is an auto-immune condition, not lifestyle-related at all. |