People have no faith in our institution's ability to fix anything - and they are right. They may blame the individuals rather than the system but it is within those people’s power to change the system.
As doctors, it's within our power to change the system; a daunting task, but collectively possible. That’s what has been identified by the Darzi review and the report has thrown weight behind child health. Although the report is NHS England-focused, many of the findings and lessons can be applied across the border in Wales too. Now we have two new sponsors, or champions, in Wales - the other being the Minster for Children and Social Care, Dawn Bowden MS.
How we work with these sponsors is up to us all.
What does a sponsor do? The value of a sponsor cannot be understated, whether within the directorate, regionally or nationally. They’ve been key to the progress of many of my teams’ projects to improve access to care.
Early on as consultant, I realised our small team in Oxford had to change how we influenced upwards as we sought to make our new efficient and accessible way of working sustainable. We had become trapped by this, continually having to justify our approach using old metrics and hampered by isolation in an old orthopaedic institution with no other paediatricians, or medical alliances, based within the organisation. “Patient power” helped engage local politicians, but when we found Theresa Warr, CEO of South Central Strategic Health Authority (SHA), new conversations began to happen.
This started with the validation Theresa herself provided. She quickly understood the model and mirrored its value in future meetings. She brought in the Public Health Resource Unit to capture our processes and data - the busy one-stop and network clinics, interdisciplinary care and expansion into new areas of chronic pain, skeletal dysplasia and sport and exercise. This independent report underpinned new conversations with our board, the board of the SHA and with other hospitals. The effects rippled not only across the region but also into my subsequent service in London. It also initiated a new funding model to scale our service.
Confident the model could be taken to South London and the South East region, I quickly realised my conversations had to start from scratch - there were different assumptions and cultures. It was only when I met the new service’s benefactor that I realised his style and engagement brought people to the table to listen. It wasn’t just about the money and he held us all to account. We had immediate influence, new reports of our rapid growth in productivity demonstrated this, and there was a considerable return on investment for all.
So what’s to be achieved with sponsorship from Lord Darzi and the Children’s Minister?
We in paediatrics have been assigned the Cinderella role, but now with an emphasis on upstream, not just preventative, care to reduce future costs, child health has become the focus and we need to give meaning to this silver slipper. We know it is going to be paraded around the towns and villages, so we at the College, in the strategic network, in our health boards and communities need to capture and develop new ways of delivering care that enacts this. The RCPCH Blueprint is a good start and something we hope to replicate in Wales.
"The government needs to make health a cross-society endeavour." - Lord Darzi, Guardian, September 2024
This isn’t a revamp of the five year or long-term plan. This report, and the Welsh Government Minister for Children and Social Care, speaks to cross-government working and improved integration across education, communities and social care.
Within healthcare it should mean redistribution or stewarding of funds and whole workforce planning. Within health and education, it means ensuring preschoolers are ready for classrooms and older pupils are supported in managing their symptoms, basic needs and anxieties to want to remain and achieve more from being there. This also means devolving power to integrated care within communities, supported by social care and charities, to ensure such projects as Flying Start are locally sensitive and sustainable.
"Health is a human right … it is also vital to a strong economy. …With record numbers out of work because of sickness, there is no path to either wellbeing or growth without prioritising health." - Lord Darzi
We hope for the Minister for Children and Social Care to be visible, listening and cajoling, bringing parties together and leveraging change. We need advances on children’s rights to improve their voice and our accountability, effective data capture and transparency to operationalise SMART internationally recognised outcomes - school attendance, physical activity, healthy weight and dental health for instance. We need someone to enable innovations to quickly flourish, or fail, and enhance real time learning, that motivates rather than inhibits.
A final word is for George Koukis, CBE who passed away in August. He was a transformational benefactor for the paediatric rheumatology and chronic pain services at the Evelina, London, and gave so much more to other healthcare projects across Europe, and to diverse interests including opera and leadership programmes. I know his effect on me and others will continue to “ripple”. George became a good friend, was an inspiration, bon vivant and above all made a real difference.
- Case history
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The CEO of an NHS Trust became aware of a discrepancy in care for three young people with localised musculoskeletal pain.
Two university students competing at an elite level in sport were seen in a joint clinic with surgeons for pain that significantly affected their performance. At the same time the therapy team and I were looking after a year 11 student, aspiring to attend university, but hampered by pain associated with a school attendance of 39%. The two older patients were offered immediate access to the latest surgery and a full post-op rehabilitation plan. The younger was added to a 12-month waitlist for a suitable multidisciplinary rehabilitation programme in an unofficial paediatric pain service.
The CEO responded by gaining more details from across the Trust and soon approved a project manager to work with the paediatric MDT on service specification and a standard operating procedure for chronic pain management. Funding was agreed for 12 months and activity monitored. The service became fully operational the following year, acquired new clinical space and began further innovations with adjacent teams shortly afterwards.
The three patients did well.