NHS changes 'risk making child health care worse'

A child at the doctors
Image caption Children make up about 25% of an average GP's practice, but around 40% of the workload

Reforms of the NHS in England are putting the healthcare of children at risk, according to an article in the British Medical Journal.

The doctors and academics who wrote it say healthcare for children already lags behind the best European examples.

But they say giving GPs control over the lion's share of the NHS budget could make the system even worse.

The Department of Health insists its plans mean children's needs will be met.

The authors of the article include senior paediatricians, public health specialists and family doctors.

Experience matters

They argue that health services for children in England are too disjointed and that too many family doctors lack specialist training and experience in looking after children.

The article says that while children make up about 25% of a general practice population, they represent around 40% of its workload, with young children being particularly frequent users.

But while many senior general practitioners have extensive experience of paediatrics, the authors say fewer trainees now have paediatric training.

"Experience matters, especially in recognising rare but serious illnesses in children," say the authors. But they add that few trainee paediatricians spend any time in general practice.

They conclude that this has a real impact on children's health in England, which compares poorly to other European countries.

"Death rates from illnesses that rely heavily on first access services - for example, meningococcal disease, pneumonia, and asthma - are higher in the UK than in Sweden, France, Italy, Germany, and the Netherlands. Survival rates are lower in the UK for some childhood cancers.

"These contribute to the UK's higher all-cause childhood mortality compared with other European countries. Although the incidence of many diseases is affected by socioeconomic conditions, deaths from the diseases cited here should be preventable by healthcare."

The authors say that if the UK health system performed as well as that of Sweden, the best performing country they look at, as many as 1,500 children might not die each year.

NHS reforms

Their criticism of the government's plans for the NHS in England focuses on plans to give GPs control of the budget to buy services for patients.

"We believe that the coalition government's proposed changes to the NHS do not sufficiently account for children's needs and may exacerbate the problems...not least because of conflicts of interest and because national planning and investment are required to tackle workforce shortages and to improve child health data to ensure services are planned and commissioned on the basis of health needs."

A spokesman for the Department of Health says the government's plans will bring about better healthcare for children:

"Our proposals for health and wellbeing boards will bring together key players across the NHS, social care and public health to integrate services and ensure that the needs of children and their families are met.

"We are also working with the profession to improve GPs' paediatric expertise, and have committed to employing an extra 4,200 health visitors to support children and families in the crucial early weeks and years."

A spokesman at The Royal College of Paediatrics and Child Health said it was working with the government to try and ensure children's services were more co-ordinated.

"Children and families must receive the right health care swiftly, linking effectively with other local services so all children get the best start in life.

"The Royal College of Paediatrics and Child Health is the leading authority on healthcare services for children and young people and we are working with the Department of Health, local decision makers and other partners to ensure the proposed reforms to the NHS will result in a step change improvement in children's health."

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