Integrating acute services for children and young people across primary and secondary care

DELIVERING INTEGRATED CARE: WHY FOCUS ON CHILDREN?

‘We are guilty of many errors and many faults, but our worst crime is abandoning the children, neglecting the fountain of life. Many of the things we need can wait. The child cannot. Right now is the time his bones are being formed, his blood is being made, and his senses are being developed. To him we cannot answer, “Tomorrow”, his name is today.’ Gabriela Mistral, Nobel Laureate.¹

This poem delivers a powerful message; children are the future. Much of the current paediatric focus in The NHS Long Term Plan ² relates to public health initiatives such as tackling obesity and ensuring emotional wellbeing; benefits that will take years or decades to realise. While these should not be forgotten, acute services for children and young people (CYP) are rarely prioritised when new models of care are considered, especially when the older population accounts for over 75% of NHS spending.^2,3 What reason is there for commissioners and clinical leaders to focus on improving non-elective services for CYP when the needs of the frail and older population are so pressing?

CYP under 18 years of age currently account for approximately 25% of attendances to primary and secondary care but <12% of non-elective hospital admissions.^4,5 The fact that children are the most likely age group to attend emergency departments unnecessarily⁶ suggests that high levels of parental anxiety is driving health-seeking behaviour.⁷ This observation justifies initiatives to deliver integrated acute services for CYP that achieve consistency across primary and secondary care. Consistent management and safety netting by healthcare professionals reduces parental anxiety, which in turn reduces urgent care presentations by empowering parents to confidently self-manage minor illnesses.^8,9 Addressing this avoidable activity would relieve pressure on our currently overstretched urgent care services, improving …