COMMUNITY CARE CHILDREN’S ADMISSIONS
WHAT’S THE SOLUTION? If out-of-hours helplines aren’t reassurance enough for parents, what other options do we have to tackle the issue? Dr Hilary Cass, president of the Royal College of Paediatrics and Child Health, says that whatever the reason behind the increase in child admissions, it needs to be addressed before care quality is compromised. “The way health services are currently arranged means we’re in danger of not providing the highest possible standard of healthcare for children when they fall ill,” she says.
“These growing numbers are unsustainable. We need to look at offering more services outside hospitals – for example in community child health centres – and have paediatricians working more closely with GPs. Not only would this enhance the skills of the whole community and primary care team, there would also be long-term improvements in paediatric care and a reduction in the numbers of children using hospital services, so that the posts will ultimately pay for themselves.” This solution would offer parents a place to take their children to get specialist advice and support, and importantly, see someone face-to-face rather than be triaged over the phone.
A TARGETED APPROACH Another possibility could be to take a targeted approach by addressing local variation in children’s admissions. In 2008, Luton PCT was identified as having the highest rate of emergency admissions for epilepsy per 100,000 children in England. The Eastern Region Public Health Observatory compared Luton PCT’s rate with those of other PCTs that had a similar demographic and similar levels of deprivation, and found that Luton PCT’s rate of emergency admission was double that of nearly every other PCT. At the same time, analysis by Luton and Dunstable Hospital
NHS Foundation Trust showed that the number of children with epilepsy attending A&E was almost twice the national average, and was one of the highest of any NHS Trust in the East of England region. Of all hospital attendances for children with epilepsy, 48% did
not require treatment in the emergency department. Despite this, 81% of attendances resulted in the child being admitted to the children’s ward. Various opportunities for intervention were highlighted,
including a higher than normal number of South Asian admissions; a lack of clarity in the required criteria for admission to hospital for epilepsy and what was described as “suboptimal” pre-hospital care for epileptic children from families and paramedics. These areas were then systematically tackled by providing improved health education for South Asian children and families and better training in pre- hospital management for paramedic staff. The criteria for hospital admissions were also rewritten. Combining this type of targeted approach with Cass’s suggestion
of providing specialised children’s health centres could go some way towards reducing non-urgent admissions, by identifying contributing factors and also providing a more appealing alternative to hospital. But until parents have enough faith in out of hours services to use them as they are intended – and until the NHS can offer a service that cultivates that sense of trust – there will still be a long way to go.
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