Developing a community child health service for the 21st century

Abstract

Keywords: Community child health; vulnerable children; sustainability

Concerns have been expressed about the future of the Community Child Health Service in Scotland but little has been known about the state of the service and how the NHSiS should respond to raised public expectations, changes in morbidity and workforce challenges. The project has charted the current service and reviewed future options and suitable outcome measures by which the service can be evaluated and improved. Recommendations have been made to enable the necessary changes.

The CCH service focuses on children in their own communities and especially on children who are vulnerable by virtue of disability, chronic illness or disadvantage. Threats to the service will compromise the identification and care of these children.

A review of current models and what works, a survey of Health Boards and analysis of workforce issues has revealed an urgent need to adopt a strategic redesign of the service to ensure sustainability and best care for children. Suggested solutions include actions by NES, clinical redesign and establishing regional speciality networks.

Key findings are:

• The majority model for paediatrics in Scotland is of a combined service, with acute and community paediatrics co-managed as a single service. This is the preferred model.
• There are currently 2.8 WTE trained CCH doctors per 100,000 population in Scotland (2.4 WTE in England).
• 77% of the current CCH workforce are SASG doctors and 72% of these doctors are over 50 years of age. There is a 10% vacancy rate amongst these posts.
• There is no workforce plan to replace these doctors or their work.
• There has been a 16% fall in the number of consultant paediatricians working in the community since 2007 with a 6% vacancy rate whilst there has been a 47% increase in specialist paediatricians in the acute sector over this period.
• Adopting a generic model of paediatrician in DGH settings, ie working across the acute/community interface, should help the challenges in CCH and covering acute services.
• In some areas of Scotland children have to wait more than 6 months for an appointment with a community paediatrician.
• In nearly half of Scotland's health board areas, failure to attend CCH clinics ( DNA rate) is either not known or greater than 26% ( HEAT Target 2010 9.3% for first appointment).
• In two large health board areas the 18-week referral to treatment guarantee is not applied to CCH clinic attendances.