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The United Kingdom is improving its health services for children—particularly in specialised services such as neonatal care and mental health—and for pregnant women, a three year review has concluded. The review says that more resources and better coordination among service providers are needed to achieve the targets in a national 10 year plan for child health.
The review assessed progress in achieving the recommendations in the national service framework for children, young people, and maternity services, published in 2004, which set standards for all organisations that provide services to children.
Although the review found that the UK is one of the safest countries in the world in which to give birth, it calls for a greater focus on disadvantaged women and for services to respond to the changing profile of pregnant women, who now include more older mothers and women with complex health needs. Despite a fall in the proportion of teenagers who become pregnant, teenage mothers and their children continue to face disproportionately poor health outcomes, the report warns.
Services have become more flexible and responsive, but more needs to be done to give women a greater say in the care they receive, as recommended in the framework. Initiatives that are proving effective include maternity support workers working alongside qualified midwives to help care for mothers and babies, thus enabling midwives to focus on their specialist role, and delivery of antenatal and postnatal care in the community.
The recent Public Service Agreement (PSA)—which sets out the priorities the government wants to achieve in 2008-11—included several performance indicators to monitor child health. One of these will measure the percentage of women who have seen a midwife or a maternity healthcare professional by the 12th week of pregnancy for assessment of their needs, risks, and choices.
The review considered that the establishment of 24 neonatal care networks across England is helping to improve outcomes. The child health promotion programme has been set up to promote health, prevent sickness, and identify risks and problems as early as possible. All families are offered core services in primary care, alongside specialist services, focusing on key areas such as obesity. A new long term PSA indicator aims to reduce the proportion of overweight and obese children by 2020 back to the 2000 figure.
For adolescents the Department of Health has developed a set of criteria designed to help raise the standard of service provided to this age group. It has also commissioned the Royal College of Paediatrics and Child Health to produce a continuing professional development programme that focuses on adolescent health, which all doctors and nurses working with teenagers will be able to access by 2008.
Patricia Hamilton, president of the Royal College of Paediatrics and Child Health, said, “The college strongly supports the significant achievements that have been made in implementing the NSF [national service framework], but there is still a long way to go.
“Whilst there are many areas of good practice, there are still places that are not giving children's services the focus they deserve. The report highlights improvements in child and adolescent mental health services, but we need more resources for children with behavioural disorders. Neonatal networks are indeed in place, but referrals to most specialist units are difficult because they are full or lack sufficient nursing staff.
“We have yet to see real action after the Healthcare Commission's report, which highlighted deficiencies in implementing some key NSF standards. We must invest in services and in the workforce to reduce inequities in children's health outcomes.”
Children's Health, Our Future: A Review of Progress Against the National Service Framework for Children, Young People and Maternity Services 2004 is available at www.dh.gov.uk.