annex 2: health for all children, fourth edition
Executive Summary, Fourth Edition of Health For All Children
Edited by David M B Hall and David Elliman (2003)
Reprinted by permission of Oxford University Press
- The 2002 programme sets out proposals for preventive health care, health promotion and an effective community-based response to the needs of families, children and young people. It takes account of, and is in line with, Government policies and initiatives. The report does not address issues of hospital or acute care but provides links to other sources of information on these topics.
- Primary care organizations ( PCOs) working in partnership with other agencies will need to ensure that the programme is available and accessible to all families within their boundaries, including socially excluded and hard-to-reach groups.
- In the light of growing evidence that communities, relationships, and the environment are important determinants of health, investment in community development and social support networks is increasingly important; health professionals should contribute to and sometimes lead in these aspects of health care.
- PCOs should ensure that allocation of resources between and within areas reflects the greater needs of neighbourhoods that are challenging by reason of deprivation, violence, language barriers, lack of facilities, hostility, etc. Staff recruitment and support should take account of the difficulties of working in such areas.
- The holistic approach of family medicine is commended and the importance of considering the impact on children of parental mental and physical illness, domestic violence and substance misuse is stressed. Health professionals working with adult patients should enquire about their children and liaise closely with paediatric services where needed.
- Every child and parent should have access to a universal or core programme of preventive pre-school care. The content of this is based on three considerations: the delivery of agreed screening procedures, the evidence in favour of some health promotion procedures, and the need to establish which families have more complex needs.
- Formal screening should be confined to the evidence-based programmes agreed by the Child Health Sub-group of the National Screening Committee. The agreed screening programmes are given in the table on page 351. Screening activities outside this framework are important in order to ensure continuing refinement of the evidence base, but should be treated as research, reviewed by an ethics committee, time limited, and reported for peer review.
- There is good evidence to support health promotion activity in a number of areas including prevention of infectious diseases (by immunization and other means), reducing the risk of sudden infant death, supporting breastfeeding, encouraging better dental care, and informing and advising parents about accidental injury.
- There is as yet no single health promotion measure to reverse the emerging problem of obesity, but the importance of the problem and the need to address it as a public health issue are stressed.
- There is growing evidence that language acquisition, pre-literacy skills, and behaviour patterns are all amenable to change by appropriate patterns of child management. These insights can be incorporated into programmes like Sure Start but can equally well be provided in non-Sure Start areas.
- Many illnesses, disorders, and disabling conditions are identified by means other than routine preventive care programmes, but health professionals must respond promptly to parental concerns. Reluctance to carry out appropriate assessment or refer for more expert advice remains an important cause of delays in diagnosis in both primary and secondary care. Clear pathways of care are vital to facilitate prompt and appropriate referrals and need to be developed at local level.
- Formal universal screening for speech and language delay, global developmental delay, autism, and postnatal depression is not recommended, but staff should elicit and respond to parental concerns. An efficient preliminary assessment or triage process to determine which children may need intervention is vital.
- The core programme includes antenatal care, newborn examination, agreed screening procedures, support as needed in the first weeks with particular regard to breastfeeding, review at 6-8 weeks, provision of health promotion advice either in writing (where appropriate) or by face-to-face contact, the national immunization programme, weighing when the baby attends for immunization, and reviews at 8 or 12 months, 24 months, and between 3 and 4 years. However, it is expected that staff will take a flexible approach to the latter three reviews according to the family's needs and wishes, and face-to-face contact may not be necessary for all families.
- The Personal Child Health Record is commended. There should be a basic standardised format for universal use, which should be used to gather a core public health dataset.
- Children starting school should receive the agreed screening programmes and their
pre-school care, immunization record, and access to primary health care schedule should be reviewed.
- There is an evidence base for the health care of school-age children derived from a range of interview studies with teachers and children designed to establish what they perceive as their main needs. It should include the following: support for children with problems and special needs; participation in Health Schools programmes designed to improve the school environment and social ethos, promote emotional literacy, exercise opportunities and healthy eating, and reduce bullying; health care facilities for young people in line with their clearly stated and well-established requirements for privacy and confidentiality.
- There is an urgent need to secure the provision and the quality of a range of more specialized services to back up those working in primary health care, education and social services.
- Access to a child development centre or team and a network of services, including referral to tertiary units when needed, is essential for the assessment of children with possible or established disabilities. There is ample evidence as to what parents expect, in terms of quality, from those services. The care of children with disabilities involved all the statutory agencies and, in many cases, the voluntary sector as well.
- Emotional and behavioural disorders are common, but service provision is often inadequate and fragmented. A substantial investment involving all statutory agencies is needed, both in preventive programmes at community level and in managing both straightforward and complex problems.
- There are statutory duties in respect of child protection, looked after children, and adoption procedures. The requirements for staffing are set out in the body of the Report. Child abuse in all its forms is a major but often unrecognized problem, and there is an urgent need for better multi-agency training of all staff and for improved support for those working in this difficult area.
- There are also statutory duties in respect of liaison work with education authorities with regard to children who have special educational needs. In addition, the development of health promoting policies and programmes for school age children, in collaboration with education professionals, parents, and young people, requires staff time and expertise.
- The report stresses the importance of leadership and management of the whole programme. A coordinator is needed to develop and sustain an overview of the health of all children within the district for which the PCO is responsible.
- It must be clear who is responsible for screening programmes, maintenance and reporting of immunization uptake, introduction of new immunization programmes, health promotion, care pathways for children with health or development problems, socially excluded groups, child protection, looked after children, links with education, staff training, and data management.
- Since all these activities are interlinked, there is a need for a multi-agency steering group to ensure a focus on desired objectives and outcomes.
- All staff in contact with children should be appropriately trained and take part in regular continuing professional development.
Health for all children, edited by David M B Hall and David Elliman (2003)
Published by Oxford University Press ( www.oup.com )