Real progress now depends on empowering clinicians to lead local transformation that delivers the right care, in the right place, at the right time.
Health systems around the world are struggling to cope with the demands being put upon them by changes in the burden of health affecting their populations, especially non-communicable diseases and mental health conditions. As part of the Westminster government’s three shifts to drive transformation and improve the health of the nation, the Neighbourhood Health framework, published last week, sets out how to deliver the ‘hospital to community shift’ by providing health and care closer to home. Within the framework, I am pleased to see that children and young people have been identified as a high priority cohort for Integrated Care Boards (ICBs) when implementing their “neighbourhoods”.
But what is a “neighbourhood”? I think this is simply an alternative to terms used by earlier governments such as “community”, “care close to home” or “integrated care”.
And the underlying strategy is nothing new. Even the 1976 “Fit for the Future” report advocated a shift from hospital to community.
So why has change been so glacial over the last 50 years? As with all things there are many reasons, perhaps the principle being uncertainty as how best to adapt health services or trying to deliver strategic change to services whilst still trying to meet the current demand. The framework provides a strategic overview but is short on operational details, ie who is going to do what to whom and where? But this is because there is no one-size-fits-all solution, what works for your population is best identified locally. We know that successful models of care in one region often don’t work when rolled out more widely. We also know that successful transformation usually involves a multidisciplinary team lead by a few highly motivated individuals, and usually an element of good timing. Local needs, geography and staff availability vary hugely across the UK and require local solutions, here are some examples.
Paediatricians and our healthcare colleagues need to lead – we can see the challenges and the solutions. We cannot expect non-clinical managers and politicians to provide the finer details; the clinical workforce needs empowerment to lead transformation and provide the right care for the right patient at the right time and in the right place. I have first-hand experience of transformation; it brings challenges but also huge fulfilment. Relatively small changes yield much larger benefits to patients. If you’ve got a great example of local transformation, we’d love to hear about it! Get in touch at health.policy@rcpch.ac.uk.
Since I first drafted this blog, the world is an even more difficult place, as evidenced by ongoing conflict in the Middle East and the antisemitic attack on ambulances in a Jewish community in North London this week. My thoughts are with all members and children impacted by these deeply troubling events.
#WDYCD4U – Consultation responses
Our policy and external affairs department regularly respond to consultations from across the UK, on behalf of our members. Recently, we responded to the DfE consultation on proposals for a Child Protection Authority, with the support of our Child Protection Standing Committee. We support the concept of an overarching Authority in England and in our response we highlighted the importance of it providing oversight and leadership while listening to lived experience and frontline practitioners.
Outbreak of meningococcal disease
The UK Health Security Agency (UKHSA) is continuing to investigate an outbreak of meningococcal disease (meningitis and septicaemia) in Kent. Investigations have confirmed that some of the cases are group B meningococcal disease. We've published a briefing page summarising key information made available by UKHSA.
As part of the incident management response, last week UKHSA published an dedicated alert to outline priority steps that primary care and hospital clinicians should consider taking to manage suspected cases, potential contacts of cases, and to reduce the risk of infection spreading. All relevant clinicians are encouraged to read the alert in full.
Campaign win: two-child limit scrapped
Last week the two-child limit to benefit payments officially scrapped. The Universal Credit (Removal of Two Child Limit) Act received Royal Assent on 18 March 2026, making the change law. We know how passionate our members are about this. The College has long campaigned for this change to address the insidious impact poverty has on child health.
Children waiting to leave hospital
Yesterday, the Children’s Commissioner published a new report revealing that while most children spend only short periods in hospital, a significant number remain for months or even years - not because they need medical care, but because safe, appropriate discharge options are unavailable. The report identifies two main groups particularly affected: children with complex, life limiting medical conditions and children admitted due to social, emotional, behavioural or mental health needs. System gaps - including delayed care packages, shortages of children’s social care placements, unsuitable housing, gaps in community nursing and palliative care, and inconsistent multiagency coordination - leave medically fit children stuck on wards, depriving them of family life, education and play, while placing huge strain on families and professionals. You can read the report and the RCPCH response.
In case you missed it... Your voice matters: Complete the 2026 member survey
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Best wishes all round,
Steve
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