The national service framework for children

The national service framework for children, young people, and maternity services is the culmination of a process started three years ago and has been heavily influenced by the Kennedy and Laming reports.^1-3 That it responds to two of the most critical reports on child health service adds to its importance. It provides the NHS with measures to assess the quality of service provided for children and mothers.

Children have been invisible in the NHS. Until now they have been regarded as an addendum to adult services. In the NHS Plan children were largely ignored.⁴ Recent reforms have focused on adult services, with targets set by government to achieve them. One can argue that, as patients, pregnant women and children benefited from these reforms in terms of quantitative measures such as waiting times. However, the care of children requires a clearer vision in the more difficult qualitative areas. The national service framework emphasises that the majority of service needs for children are in the community and can only be provided by the NHS in partnership with education and social services as envisaged in Every Child Matters and the Children's Bill.⁵

The national service framework provides the opportunity for service developments that allow the holistic needs of children and pregnant mothers to be met. Key to this is the recognition that children and young people are different and individuals in their own right, with specific requirements which can be met only by reorganisation of service delivery. This requires a change in how health professionals and managers view maternal and child health and a reassessment of how parents, children, and young people participate in and are consulted in planning services.

The national service framework sets out a comprehensive, long term (10 year) agenda for change and a framework for healthcare provision in the broadest context. Its 11 standards for care, applying to children (defined as under 19 years) and their families, cover all aspects of NHS care including maternal health and primary care. It is encouraging that mental health is a constant strand, and that maternal health is seen as part of the continuum of health care. Key features include better consultation with children and families; changes towards care focused on children and women; and facilities designed for children with input from children and parents. A central concept is of services designed around the child's journey, to meet children's needs, with emphasis on holistic and integrated approaches including proper engagement with the voluntary sector.

The earlier framework for hospital services implied that NHS trusts needed to critically examine services for children.⁶ It inferred that reallocation of resources was needed, along with reconfiguration of service provision and incorporation of the overriding principles in all new hospital design and development. Change in how children are currently seen within adult services is also required. Children must be seen as important users, and their needs given similar weight to those of adults.

The impact of the national service framework on out of hospital services will be huge, especially with the emerging public health agenda.⁷ Primary care trusts have a central role in ensuring that the needs of mothers and children are addressed. Community based services must look at how they are organised and relate to other non-health services, including social care and education. Recent high profile cases around child abuse and child deaths highlight the needs of the most vulnerable in our society, and this is emphasised in the framework. Current concerns about the future of community child health should be noted.⁸ The national service framework suggests strengthening of out of hospital services, and commissioners must consider how they can use and develop current services. The challenge for general practice is also clear. Despite the absence of specifics in their new contract, the role of primary care in the development of better services for children is critical, and the national service framework sets out this agenda.

Development of tool kits to help organisations assess their current status against the national service framework and to measure progress is a priority. The lack of set targets and a clear budget stream is a criticism that can be levied at the document. Like all documents it is a compromise, a balance between the desired and the possible. However, the message is clear—we need a radical shift in our mindset towards children and we must develop a society where maternal and child health is a priority and not a luxury.

The vision of the national service framework is huge and implies considerable cultural change in the NHS, and beyond. The aim is child and family centred services, designed and delivered around their needs rather than those of organisations. The NHS must grasp this opportunity. The national service framework is government policy, strengthened by concurrent reports, and signals a higher priority for children and maternity services across all areas of government.⁹,¹⁰ If the service and all clinicians working with women and children do not respond, children will be the losers.