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Published: 17/04/2003, Volume II3, No. 5851 Page 12 13

The publication of the first part of the national service framework for children could usher in a new era for a long-neglected service. Jeremy Davies reports Ifthe government's commitment to a group of patients could be measured by the number of guidance documents, children would at last be a major priority for the NHS.

So long referred to as a 'Cinderella service', last week the Department of Health published the first part of the national service framework for children - this one aimed at improving hospital services. The rest are due to emerge by the end of the year. It also presented more wide-ranging 'emerging findings' from the government's children's taskforce, and highlighted more specific guidance on improving hospitals and hospital food in line with children's needs. On the same day, it launched the report of its expert review of neonatal intensive care services, with£72m of extra funding attached (see box).

The three-part hospital standard calls on trusts to ensure hospital services are child-centred, so staff consider the 'whole child' rather than simply treating particular illnesses; to make sure children get high-quality, evidence-based care from well trained staff; and to develop safe physical environments suited to children's needs.

Among the standards are plans for dedicated children's units within accident and emergency departments, separate facilities for children and teenagers, and special training for staff dealing with children.

The standard is, according to Ashfield primary care trust chief executive Clive Brookes, who sat on the panel that developed it, an example of the DoH's 'new, less prescriptive style of framework'.

'The framework doesn't tell people how to achieve things, but there is a clear expectation that there will be rapid change nonetheless, ' he says.

Following recommendations made by the Bristol inquiry, trusts must now have a named 'children's champion' in place at board level to ensure framework standards are met. Post-Climbié, trusts must also ensure no child is ever discharged from hospital without a care plan in place. Trusts will also be assessed against a range of children's service indicators being developed by the Commission for Health Improvement, as part of the star-ratings system. This will include surveys of children and their parents.

The NHS priorities and planning framework for 2003-06 made reference to the importance of the children's framework, but there is no new money attached to the hospital standard. So any improvements to training, clinical quality and buildings must be implemented against a backdrop of big regional differences in paediatric staffing levels and what the Royal College of Nursing calls 'massive understaffing and a serious lack of training places for nurses wanting to become neonatal nurses'.

And organisationally, some trusts may be better placed than others to deal with the challenges thrown up by the framework, says Royal College of Paediatrics and Child Health president Professor Alan Craft, who cites Huntingdonshire primary care trust as a rare, if not unique, example of a PCT which directly manages acute and community children's services.

Janet Dullaghan, its director of children's services, says integrated management has enabled the PCT to take a more joined-up approach to planning for everything from mental health and learning disability services to physiotherapy, outreach work in schools and child protection.

But she stresses that children's services in the area were under a single acute/community directorate from 1994, which gave the PCT and its acute provider, Hinchingbrooke Healthcare trust, a big head start when they came to discussing the managerial handover in April 2002.

Mr Brookes warns against a 'one size fits all' approach to managing children's services, stressing that the framework deliberately avoided pushing everyone towards all-embracing 'children's trusts':

'Different models will emerge.The important thing is that there needs to be that child-focused ethos throughout the organisation, and people need to work together in a truly integrated way.'

So the guidance is there now... even if turning the rhetoric into a reality proves far more than child's play.

Birth control: the new neonatal strategy

The Department of Health's review of services for newborns calls for all neonatal care to be provided within managed clinical networks across hospitals, each with a consultant or other clinician acting as co-ordinator on a rotational basis. It will work to agreed protocols, standards and care pathways, with a joint approach to clinical governance including audit, incident reporting and clinical training.

Hospitals will be categorised into four types - those with midwifery only, providing routine care; level-1 units with a special care baby unit; level-2 units with special care plus a high dependency unit; and level-3 units with special and high dependency units plus an intensive care unit.Each network will have one or more level-3 units, headed by a consultant neonatologist.

There is£72m attached to the strategy -£20m capital and£12m revenue funding for 2003-04, then£19.9m and£20m revenue funding for 2004-05 and 2005-06 respectively.The DoH says this will fund up to 75 new cots and other equipment for babies weighing less than 1,500 grams.