Ravi's blog

Hi, I’m Ravi, I’m 19 years-old and I’ve just finished my first year of medical school. So I’m sure you won’t be surprised when I say I have a real passion for medicine and how the health service is run.

This - my first blog for the RCPCH – aims to give you an insight into my view of The Future Forum.

The Future Forum was a consultation created by England’s Secretary of State for Health. Its job was to find what needs to be improved in children’s health. The final report was released in July where around sixty recommendations were put forward containing solutions to the problems identified. I am going to focus on two key themes of the report: the life-course model and appreciating children’s unique needs.

There is no single point where we suddenly transform into adults. And when adult, there is no abrupt change that makes our state of health completely different. Childhood merges into adulthood. The forum recommend this holistic ‘life-course’ perspective to highlight to all decision-makers that what happens to one’s health as a child has a large impact on what their health outcomes will be in adulthood. It is clear that giving children and young people the best start possible will benefit the nation’s health and economy in the long-run.

With the life-course course model, we see that childhood is remarkably important for the development of a person’s state of health. It is therefore important to recognise the different and unique needs children and young people have. Most importantly, these have to be recognised in all healthcare settings and not just within paediatrics. But the Kennedy Review highlighted this is not the case:

'Lack of training in treating children and young people may lead staff to treat them inappropriately, however unintentionally. This includes not recognising children’s different clinical needs, or not engaging with them in an age-appropriate way'

With primary care being the 'front door of the NHS' and under eighteens accounting for 20-25% of the patients seen, it is surprising that there is no compulsory training for primary care staff  for them to be aware of this patient group’s needs. In many cases, the forum found paediatric training for GPs to be absent or inadequate. It recommends that the training of GPs is extended to four years so compulsory training helps all GPs understand children and young people’s unique needs. 

Despite criticism, targets and incentives appear to meet their goals. The Quality Outcomes Framework has proven to be a successful tool in order to improve outcomes for patients. However it appears children and young people are forgotten with very few outcomes specifically for them. The result of this means that children and young people do not get the same focused attention as adults. The forum recommends that there be dedicated outcomes for children and young people for GPs to aim for.

To assess the success of the recommendations above, an overarching Outcomes Indicator is proposed: to measure the interval between the first presentation and the point when a correct diagnosis is made or a treatment is started. With staff being acutely aware of children’s needs, they will be more apt at meeting such needs by themselves or by appropriately referring them to more specialist services. This will result in paediatric patients receiving the targeted expertise they deserve, leading to better outcomes, and a more efficient health service. This should result in the interval decreasing.

It was disappointing to see the Health and Social Care Act have virtually no specific commitments towards the health of children and young people. However the remedial gesture to create the Future Forum is welcomed. The views and experiences of paediatric patients and those involved in their care have provided the basis for the Future Forum Report. This report’s recommendations present a bold, yet robust, vision for the future of children’s services in England. What needs to be done now is to translate these recommendations into policy, and consequently translate policy into practice to make this vision a reality for our children and young people.