Low birthweight babies are being treated increasingly in district general hospitals, even though survival rates are better at specialist regional centres, and the care more cost-effective. Most surgery on children aged 10 or under is carried out by doctors with little practical experience in the field.
Widespread criticism of hospital services for children comes today in an Audit Commission study, based on visits to 31 children's hospital wards and a review of recent comparative studies. None of the wards met Department of Health guidelines that at least two registered sick children's nurses should always be on duty. The low status of these specialist nurses was frequently cited among the reasons for the shortage.
'The root problem is that clinicians, managers and other staff do not give sufficient attention to the needs of children and their families,' the report states. 'It is manifest in a lack of written policies, management focus, and poor communication between staff and parents.'
The Patient's Charter says that every patient should have a 'named nurse' responsible for an individual's care throughout the hospital stay. But a spot check of 47 wards by the commission found that none had a policy of allocating a named nurse for all children for the duration of the stay.
Children account for one in seven hospital admissions and about pounds 1.4bn, or 10 per cent, of spending on hospital and community health services. But the outcomes of treatments on children are not routinely monitored. Despite a consensus among medical researchers on the need to treat children at home where feasible, some hospital procedures carried out on them are of doubtful value, the Audit Commission said.
Glue ear, one of the most common childhood complaints, is generally treated surgically by adenoidectomy or a myringotomy (incision of the eardrum). But several studies have found that up to one-third of these operations are carried out unnecessarily because of spontaneaous natural recovery. Even where the surgery can be justified, the grommets (plastic tubes) inserted in the ear often fall out, and the operation is repeated.
Moreover, high hospital admission rates for asthma in children are often due to inexperienced junior doctors, usually the patients' first point of contact in accident and emergency departments.
Despite increased demand, there are 'serious deficiencies' in the provision of accommodation for parents. One-third of children's wards had no showers or washing facilities for parents.
The commission urges district health authorities, now the purchasers of health care on behalf of local populations, to specify certain standards of care when placing contracts for children's health services.
Hospitals must set targets for improving current practices, and put in place arrangements for monitoring progress, it says.
Children First: A Study of Hospital Services; HMSO; Price pounds 9.50Reuse content