Hospital childcare is poor

BMJ 1997; 314 doi: (Published 05 April 1997) Cite this as: BMJ 1997;314:993
  1. John Warden, parliamentary correspondent
  1. BMJ

    Children in hospital in England are not receiving the best care because official guidance is not being implemented, the Commons health committee reported last week. Seven “cardinal principles” proclaimed by the Department of Health in 1991 remain aspirations rather than actual achievements, the committee's report states.

    The committee argues that in the absence of community children's nursing services it is doubtful if the NHS can achieve two of the department's cardinal principles. These are that children should not be admitted to hospital if care can be provided in another setting and that on discharge children should have adequate home and day care. But only 10% of the country has access to 24 hour community nursing for children.


    Children should stay in hospital overnight only as a last resort


    The committee's answer is for hospital services to be integrated with community services. The needs of the child should always have priority, with an overnight stay in hospital “the last resort for a sick child.”

    Many hospitals also fail to meet the department's standard of having at least two registered sick children's nurses on duty in all children's wards. With only 1 in 33 nurses qualified in the care of children, the committee recommends increased numbers of training places for at least five years.

    The MPs are disappointed that so many children are still being admitted for surgery to adult wards, often for unnecessary interventions. It is also “highly undesirable” that general surgeons and anaesthetists undertake occasional paediatric practice, contrary to clinical guidelines and assurances to parents in the patient's charter that children will receive specialist care.

    Accident and emergency services for children should specifically focus on their needs, with separate waiting and treatment areas. And although extra paediatric intensive care beds now being provided are welcome, the Department of Health is urged to make swift progress to ensure the most effective care for seriously ill children. The report advises health authorities to appoint a lead commissioner for child health services to arrange the purchase of an overall package of services for children.


    • Hospital Services for Children and Young People is published by the Stationery Office, price £8.80.

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