After years of progress the UK is stalling in areas such as infant mortality and immunisation levels and is lagging behind similar countries on mortality, breastfeeding, and the prevalence of obesity.
Several new reports detail the worrying state of the nation’s child health. Health professionals say that the latest figures are cause for alarm and are calling on the government to act urgently to develop a comprehensive child health strategy.
Launched on 16 May 2017, the RCPCH Sustainability and Transformation Partnership (STP) report is based on a review of the 44 published STP plans, which reveal major deficiencies – they are failing to take into account the needs of infants, children and young people. STPs are the proposals put together by the NHS and local councils to meet the health needs of the local population in 44 areas of England.
This is a comprehensive list of 25 measures of the health of UK children, ranging from specific conditions such as asthma, diabetes and epilepsy, risk factors for poor health such as obesity and a low rate of breastfeeding, to child deaths. The data provide an “across the board” snapshot of child health and wellbeing in the UK.
Responding to the publication, Dr Max Davie, Assistant Officer for Health Promotion for the Royal College of Paediatrics and Child Health (RCPCH), said:
“After years of campaigning we are very pleased to see Government moving forward with this draft legislation.
“The sugary drinks that will be affected by this tax have no nutritional benefit and often contain levels of sugar that are above a child’s daily recommended limit…”
In this article we lay out factors that bear on the success of clinical consultations and the maintenance of the essential clinician–parent relationship at progression or deterioration of life-limiting conditions or life-threatening illnesses.
Nilesh M. Mehta, M.D. N Engl J Med 2016; 374:1190-1192 March 24, 2016
Full Text Here Adequate nutrient delivery may help to offset the catabolic burden imposed by critical illness, preventing nutritional deterioration and improving outcomes. However, questions regarding the most appropriate dose of macronutrients, the route of delivery, and particularly the timing of supplemental parenteral nutrition in critically ill children remain unanswered (Areas of Consensus and Controversy in Critical Care Nutrition for Children.). Enteral nutrition is preferable in patients with a functioning gut but may not always be feasible. Intestinal failure was incompatible with life until the 1960s, when the development of stable intravenous amino acid solutions and lipid emulsions allowed the administration of life-sustaining nourishment through the parenteral route.1 Parenteral nutrition was subsequently extended to critically ill patients when enteral nutrition was insufficient or contraindicated. As awareness of the unintended side effects of parenteral nutrition has increased, patient selection and the timing of administration are being investigated and the optimization of enteral nutrition emphasized.2
Tom Fivez, M.D., Dorian Kerklaan, M.D., Dieter Mesotten, .et al. Engl J Med 2016; 374:1111-1122 March 24, 2016
Recent trials have questioned the benefit of early parenteral nutrition in adults. The effect of early parenteral nutrition on clinical outcomes in critically ill children is unclear.
The Nuffield Trust has published The future of child health services: new models of care. This briefing describes the current state of child health and quality of care in the UK, including problems around increasing use of hospitals to treat conditions that could be dealt with in other settings; capacity issues in primary care; and the often disjointed care provided between hospitals and the community. It then looks some examples of new models of care which have been emerging both within the Vanguard scheme and inspired by it and how they are responding to these issues.
This report highlights what the problems are in current health care services for children and young people, and investigates how emerging new models of care could provide an opportunity to address these.
‘The future of child health services: new models of care’ sets out examples of emerging new ways of delivering care for children and young people.
The report describes the current state of child health and quality of care in the UK, including problems around increasing use of hospitals to treat conditions that could be dealt with in other settings; capacity issues in primary care; and the often disjointed care provided between hospitals and the community. It then looks some examples of new models of care – which have been emerging both within the Vanguard scheme and inspired by it – and how they are responding to these issues.
The report is based on a workshop run by the Nuffield Trust, as well as on presentations, discussions, case study materials submitted by representatives of the new models who attended the workshop, and published literature. It is the first report in our new series ‘The future of…’, which is looking at the future of service delivery in various specialisms within the health service.
Read the full report here Read the related blog post here
This guidance is for clinical commissioning groups when assessing the needs of children and young people (0 to 17 years) whose complex needs cannot be met by universal or specialist health services.
The ‘Decision support tool’, which should be used with the framework, provides a structure to help in reaching a decision.
The guide for young people and parents is for use by local health organisations who can add their own contact details.
A network has also been established on NHS Networks for anyone working in this field, to share information, good practice, or seek advice on difficult issues from colleagues. Once you have registered, request to join on the children and young people’s continuing care network page (click on ‘join this network’ when on the page).
The updated framework follows a public consultation. Comments and suggestions received in the consultation are reflected in the new framework.