Framework for children aims to produce "cultural change"
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《英国医生杂志》
The government has announced a 10 year plan to change the way children's health services are delivered in England, putting children at the centre of care.
Health Secretary John Reid proclaimed at the launch of the national service framework last week that children need more personalised services that are tailored to meet their individual needs. "Children and young people are not just mini-adults," he said.
The child-centred character of some children's wards, like the one pictured above, needs to be emulated elsewhere, the framework says
Credit: COLIN CUTHBERT/SPL
The standards in the framework promise accessible and age appropriate services, earlier diagnosis and intervention, and a smoother transition from child to adult services.
It details more services for adolescents, closer working with parents, and a reduction in inequalities in health between children. The framework also aims to integrate health, social, and education services in children's centres.
The framework, which has been three years in the making, was first announced as a response to criticism by the Kennedy inquiry into children's heart surgery at Bristol Royal Infirmary ( BMJ 2001;323: 302). It was developed further after the Laming report into the death of Victoria Climbié ( 2003;326: 239).
Professor Al Aynsley-Green, national director for children's services, said that one of the main aims of the framework was to engineer a cultural change in the way children are dealt with.
He said, "Deficiencies in the system have led to children's care being dominated by the demands of adult services. There has been a failure to listen to children and their families.
"Children have been ignored for more than 50 years, but they are vital for our economic future, and the seeds of adult diseases lie in the early years. We need to invest heavily in our most precious resource."
Professor Aynsley-Green expected that the changes would lead to more doctors working in children's health in the future.
The largest national service framework so far, it encompasses children and young people and maternity services. The framework is divided into 11 sets of standards: the first five cover core services; the remainder refer to specialist services, including mental health. Part of the standards covering hospital services was announced in April 2003 ( BMJ 2003;326: 840).
The 11 standards of the national service framework for children
Promoting health and wellbeing, identifying needs, and intervening early
Supporting parents or carers
Child, young person, and family centred services
Age appropriate services as children grow into adulthood
Safeguarding and promoting the welfare of children and young people
Children and young people who are ill
Children and young people in hospital
Disabled children and young people and children with complex health needs
Mental health and psychological wellbeing of children and young people
Drugs management for children
Maternity services
No targets have been set for implementation of the standards outlined in the framework. The new standards must be brought in by NHS trusts and local authorities over the next 10 years, although the timing and planning are to be determined locally.
Progress will be tracked by inspections by the Healthcare Commission. Trusts that are not working convincingly towards the standards will be criticised and their star rating may be affected.
No new funding has been allocated for the implementation of the plan. Trusts will be expected to find resources within their current budgets.
Stephen Ladyman, the community health minister, cautioned that not all facets of the framework would be implemented immediately, owing to "practical constraints," but that the cultural shift needed so that professionals see children as having different needs from adults should start now.
He said, "Those changes limited by human resources will be the slowest, as there is a need for recruitment and training. Planners and managers need to start getting to grips with what is needed to mainstream and resource children's services."
The framework was broadly welcomed. Professor William Dunlop, president of the Royal College of Obstetricians and Gynaecologists, fully endorsed the framework. He said, "It is important to remember that this is a 10 year plan for improving care, and the college will now encourage the dissemination of the framework down to a local level so that it can be implemented to best support the needs of local populations."
Professor David Hall of the Royal College of Paediatrics and Child Health said, "This gives us an outstanding opportunity to build on the good work already being done in many areas and to ensure that improving lives and wellbeing of our young people is given the priority it deserves."(Kathryn Godfrey)
Health Secretary John Reid proclaimed at the launch of the national service framework last week that children need more personalised services that are tailored to meet their individual needs. "Children and young people are not just mini-adults," he said.
The child-centred character of some children's wards, like the one pictured above, needs to be emulated elsewhere, the framework says
Credit: COLIN CUTHBERT/SPL
The standards in the framework promise accessible and age appropriate services, earlier diagnosis and intervention, and a smoother transition from child to adult services.
It details more services for adolescents, closer working with parents, and a reduction in inequalities in health between children. The framework also aims to integrate health, social, and education services in children's centres.
The framework, which has been three years in the making, was first announced as a response to criticism by the Kennedy inquiry into children's heart surgery at Bristol Royal Infirmary ( BMJ 2001;323: 302). It was developed further after the Laming report into the death of Victoria Climbié ( 2003;326: 239).
Professor Al Aynsley-Green, national director for children's services, said that one of the main aims of the framework was to engineer a cultural change in the way children are dealt with.
He said, "Deficiencies in the system have led to children's care being dominated by the demands of adult services. There has been a failure to listen to children and their families.
"Children have been ignored for more than 50 years, but they are vital for our economic future, and the seeds of adult diseases lie in the early years. We need to invest heavily in our most precious resource."
Professor Aynsley-Green expected that the changes would lead to more doctors working in children's health in the future.
The largest national service framework so far, it encompasses children and young people and maternity services. The framework is divided into 11 sets of standards: the first five cover core services; the remainder refer to specialist services, including mental health. Part of the standards covering hospital services was announced in April 2003 ( BMJ 2003;326: 840).
The 11 standards of the national service framework for children
Promoting health and wellbeing, identifying needs, and intervening early
Supporting parents or carers
Child, young person, and family centred services
Age appropriate services as children grow into adulthood
Safeguarding and promoting the welfare of children and young people
Children and young people who are ill
Children and young people in hospital
Disabled children and young people and children with complex health needs
Mental health and psychological wellbeing of children and young people
Drugs management for children
Maternity services
No targets have been set for implementation of the standards outlined in the framework. The new standards must be brought in by NHS trusts and local authorities over the next 10 years, although the timing and planning are to be determined locally.
Progress will be tracked by inspections by the Healthcare Commission. Trusts that are not working convincingly towards the standards will be criticised and their star rating may be affected.
No new funding has been allocated for the implementation of the plan. Trusts will be expected to find resources within their current budgets.
Stephen Ladyman, the community health minister, cautioned that not all facets of the framework would be implemented immediately, owing to "practical constraints," but that the cultural shift needed so that professionals see children as having different needs from adults should start now.
He said, "Those changes limited by human resources will be the slowest, as there is a need for recruitment and training. Planners and managers need to start getting to grips with what is needed to mainstream and resource children's services."
The framework was broadly welcomed. Professor William Dunlop, president of the Royal College of Obstetricians and Gynaecologists, fully endorsed the framework. He said, "It is important to remember that this is a 10 year plan for improving care, and the college will now encourage the dissemination of the framework down to a local level so that it can be implemented to best support the needs of local populations."
Professor David Hall of the Royal College of Paediatrics and Child Health said, "This gives us an outstanding opportunity to build on the good work already being done in many areas and to ensure that improving lives and wellbeing of our young people is given the priority it deserves."(Kathryn Godfrey)