The Department of Health for England has announced a radical shake up in the way hospitals are organised to meet the needs of children.
New standards set out in the first part of the national service framework for children will require hospitals to provide child friendly services, including dedicated children's units in emergency departments, separate and private facilities for adolescents, play areas and teachers for children on wards, and the sort of food that children want to eat.
In a direct response to the Laming inquiry into the death of Victoria Climbié (BMJ 2003; 326:239), hospitals will need to ensure that every child is discharged with an individual care plan and that all staff who deal with children are appropriately trained. Adequate plans should also be made for children who need care when they become adults, so that they do not get lost in the system, said Professor Al Aynsley-Green, the national director for children, at the launch of the document last week.
The secretary of state for health, Alan Milburn, committed the government to producing a national service framework for children in July 2001 after the Kennedy inquiry into the deaths of children having heart surgery at Bristol Royal Infirmary. The inquiry criticised children's services for being subordinate to adult services and for being managed along the lines of “club culture,” rather than being based on openness and transparency (BMJ 2001;323:181).
The new standards for hospitals are part of a 10 year programme for children's services. Other standards on the quality and safety of care and of healthcare environments will be launched in the next few months. All hospitals are required to appoint a “children's champion” at board level to oversee the introduction of the standards. Plans to meet the standards will be examined as part of the Commission for Health Improvement's rolling inspection of hospitals.
“This is an enormous task, and we are not going to change things overnight,” said Professor Aynsley-Green. “This is our most ambitious NSF [national service framework], but we recognise that things have got to change. We have to put children on the agenda. To do that we have to overcome the cynicism that exists within the NHS because of staff shortages and other problems.”
The Royal College of Paediatrics and Child Health welcomed the new framework, saying it offered a chance to capture examples of good practice and spread them to every NHS trust in the country.
Figure.
KING'S COLLEGE HOSPITAL
Staff member and child in paediatric emergency department, King's College Hospital, London
Footnotes
Getting the Right Start: National Service Framework for Children—Standard for Hospital Services is available at www.doh.gov.uk/nsf/children/gettingtherightstart