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NHS children's services 'not fit for purpose'

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The NHS’s failure to reconfigure children’s services, has left it with a model of care not fit for purpose, the president of the Royal College of Paediatrics and Child Health has said.


Hilary Cass issued the warning after a major study by the college, shared with LGC’s sister title Health Service Journal, found the NHS has failed to centralise paediatric inpatient units despite mounting pressures.

The college believes reconfiguration of paediatric services is necessary to help ensure high quality care for children and to help tackle UK child mortality rates, which are significantly higher than those in Europe.

Hilary Cass

RCPCH president Hilary Cass is calling on the NHS to fundamentally reimagine the children’s services workforce

A census of the UK paediatric workforce carried out in September by the college revealed the total number of inpatient units had fallen by 20 to 191, since 2011. This is significantly short of the target of 170 units the RCPCH had said the NHS should have in place by 2013.

Although there has been an almost 9% growth in the number of consultants between 2011 and 2013, to a total 3,718, the NHS is struggling to fill rotas as many consultants move to work resident on-call shifts in hospitals.

In total the number of full time equivalent vacancies on rotas increased by more than a quarter to 528 compared with 421 vacancies in 2011.

The census also revealed wide variation in the number of paediatricians per 100,000 children across the UK, with the Midlands and East of England region having the lowest ratio at 28.7 full time equivalent paediatricians per 100,000 children, while London had the highest, at 47.8 full time equivalent staff.

Dr Cass told HSJ the census gave a clear signal to the NHS that it was failing to reconfigure services. She said: “In essence we have got a model of care that is wrong for children and that we can’t sustain. The way in which the health system is designed is not fit for purpose for children.
“We are not reconfiguring services and we are not redesigning how those services manage children.”

She said increases in consultant numbers were helping the service to “hold the line”, but she added research showed the highest costs were incurred by caring for well children or those with minor illnesses in an acute setting, when the greater impact could be had in helping children with long term conditions and specialist care.

“What we are doing is pouring more and more people into plugging the acute care gap,” she said. “We have got to fundamentally reimagine the workforce; we need far more paediatricians working in the community.”

Dr Cass said the NHS needed a full mix of staff in the community, including more children’s nurses, which she said would be in line with the NHS Five Year Forward View and sit between GPs and acute hospital paediatricians.

“If we invest in a multiprofessional children’s healthcare workforce based in the community it will pay for itself, and we can justify the cost of more paediatricians and children’s nurses by putting them where the patients are, providing much better proactive and preventative healthcare, including mental health,” she said.

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