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Child health services require major shake-up, census reveals

Paediatricians say pressures are ‘unsustainable’

Jo Carlowe

Thursday, 15 January 2015

A radical shake-up in the delivery of child health services is required, according to a new workforce census published this week. 

The Workforce Census 2013 published by the Royal College of Paediatrics and Child Health (RCPCH), warns that paediatricians are being put under increased and ‘unsustainable’ pressure. 

The Census identified recruitment fears across nearly half (49.7%) of the UK and wide variations in provision. 

The RCPCH says the census, which provides a snapshot of how the UK’s paediatric services are structured, provides further evidence of the need to take pressure off acute services, deliver more care outside hospitals, and ensure that there are more child health experts working in community settings.

Figures show there has been a fall in specialty doctors working in the community (646 in 2011 to 521 in 2013). In addition, the RCPCH points out that community paediatricians are on average three years older than other paediatric consultants and therefore likely to retire sooner, presenting a challenge in sustaining community child health services in its current form.

Commenting, Dr Hilary Cass, President of the Royal College of Paediatrics and Child Heath, said: “The workforce is doing an incredible job under increasingly difficult circumstances – with huge demand on services but cuts in funding and recruitment problems. We have to look at delivering child health services differently; more care in the community, more primary care healthcare professionals trained in child health and more paediatricians operating outside the hospital setting. 

“The aim is to stop children escalating into hospital in the first instance and also to ensure that those providing general paediatric care outside hospital can support the acute rotas. Only then will we be able to ensure that in the future, children and young people have access to high quality, appropriate health care, at the time of need and wherever they live.”

This, the eighth biannual paediatric workforce census, also found that:

  • There has been a 31.9% decrease in the number of academic consultants in the paediatric workforce meaning less research is being conducted.
  • England has the lowest proportion of ‘career grade’ paediatricians (consultants and specialty doctors) working in community paediatrics (26.4%) compared to 30.7 in Scotland, 32.9% in NI and 39.4% in Wales.
  • 47% of child protection rotas are part of acute care provision therefore only 53% of child protection rotas are dedicated to safeguarding, but of those, only half can provide a review for suspected sexual abuse.
  • Positively, there is an increase in the proportions of specialists in hospitals from 24% in 2011 to 26.1% in 2013 (Scotland has highest proportion of specialists 42.2% compared to 33.4% in England, 26.2% in NI and 23.7% in Wales).

Commenting on the variation in the workforce, Dr Simon J Clark, Officer for Workforce Planning at the RCPCH, said: “The census suggests some variation in the level of services provided to children living in one region in the UK compared to those living in another. This could also mean, where child health needs are comparable across populations, that there is an increased pressure on paediatric staff in regions where there are fewer doctors. That coupled with 38.6% of the workforce saying their clinical workload is putting too much pressure on them, means the way services are currently delivered and configured will not be safe or sustainable.”

Concerns in the way that children and young people with mental health conditions are diagnosed and managed have also been highlighted by the Census, with a reduction in the proportion of services stating they have regular (15.4% to 12.7%) and ad-hoc educational (42% to 26.8%) meetings with Child and Adolescent Mental Health Services (CAMHS).

Dr Clark added: “The 2013 Workforce Census has highlighted a number of issues that require all organisations involved in child health matters to work together, as is happening in some areas already, this should lead to seamless delivery of child health across the UK.

“At the College we call on funders, NHS service commissioners and all those involved in providing child health to work together with the RCPCH to ensure that children, no matter where they live, are provided with the same level of high quality paediatric care.”

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