Children’s healthcare in England needs to be more integrated, timely and focused on individual needs, the Children and Young People’s Health Outcomes Forum has said.
The Forum’s recommendations, proposed as the basis of a national strategy, include a strong emphasis on pharmacovigilance and avoiding the use of off-label medications.
Other key recommendations relate to the goal of “joined up” care, seeking to address gaps in the consistency and continuity of children’s healthcare.
The report describes the view that children in England are well cared for as “sentimental and complacent”, and states: “the UK is worse than other countries in Europe for many outcomes that could be improved through better healthcare and preventative interventions”.
To address this situation, the report argues, it is vital for children and young people to be more involved in decisions about their care; for GPs and other clinical staff to have better training in paediatric care; and for healthcare to meet the changing needs of the young individual over time.
Four new outcome indicators are proposed:
• time from first NHS presentation to diagnosis or start of treatment
• integrated care – developing a new composite measure
• effective transition from children’s to adult services
• age-appropriate services, with particular reference to teenagers.
More generally, the report recommends that all NHS organisations “should take a life-course approach, coherently addressing the different stages in life and the key transitions instead of tackling individual risk factors in isolation”.
It also calls for better systems to allow sharing of information between care providers in different sectors, with “sentinel conditions and pathways” being selected to help identify “gaps in services, including prevention”.
The report notes high levels of medication error and use of off-label or unlicensed medications with children, and calls on the MHRA to prioritise these issues “in line with the new EU legislation effective in July 2012”.
To improve the evidence base for healthcare, it recommends breaking down health data for the first two decades of life into five-year age bands.
To improve clinical leadership, it says, the NHS Commissioning Board should appoint a National Clinical Director and CCGs should appoint a senior clinical lead in this area.
Finally, it recommends that the QOF and PbR systems for child healthcare should be developed and improved.