Pulling children's services together

Physios are welcoming the new children's charter and its drive to promote joined-up and seamless working.

The government's 10-year blueprint for children's healthcare will pose opportunities and challenges for physiotherapists in a changing workplace, say paediatric specialists. Members of the Association of Paediatric Chartered Physiotherapists (APCP) gave firm backing to the new national service framework (NSF) for children, young people and maternity services. The NSF outlines 11 service standards designed to ensure children and young people in England receive the best possible care in the most appropriate setting, according to their individual needs.  Sarah Crombie, an APCP national committee member, told Frontline: 'Physios are involved in children's care in many different areas, and I think this NSF will have a huge impact on us.' She added: 'We're going to have to put quite a lot of resources into making sure that these standards happen. That's a big challenge for the health service.' Fellow committee member Linda Fisher praised the NSF for raising the profile of all children and recognising the importance of paediatric specialists. 'The challenge for us is that we will have to look at how we work and plan how to work differently and together with other services,' she said. Some of the new NSF standards apply to all children and young people. Others apply to groups with specific problems, such as disabilities and mental health disorders. Overall, the framework stresses the importance of achieving early diagnosis and intervention, improved access and social inclusion. It also aims to promote healthy lifestyles, reduce health inequalities and involve children more in treatment decisions. The NSF says long waits for rehabilitation and therapy can 'greatly harm' children's educational attainment and wider development. Children with disabilities and other complex health needs should have 'increased access' to therapy and equipment services, it states, adding that therapy should be carried out in a convenient setting, such as at home or at school, with interventions agreed and 'overseen by specialist paediatric therapists'. There should be multi-agency assessments and, where appropriate, services located together in places such as child development centres to make family access easier. Health secretary John Reid said the NSF marks a 'fundamental change' in thinking about children's health. Closer integration between all relevant bodies will deliver 'age-appropriate' services based on children's needs, not those of providing organisations or professionals, he said. Ministers expect health, social and educational organisations to meet the service standards by 2014. However, they have not allocated extra funding specifically to implement the framework. They say existing NHS allocations will enable primary care trusts to 'increase the capacity of the allied health professional workforce to help meet identified need' and redesign services so as to improve access and reduce waiting times. Sarah Crombie, a superintendent paediatric physiotherapist based at St Richard's Hospital, Chichester, said the NSF standards should help to 'pull children's services together' and support the work physiotherapists are doing in service development. But she said she would have liked to have seen extra money ring-fenced for children's services. 'Paediatric resources are really very stretched at the moment,' she told Frontline. She suggested adult services in the community may also need 'extra input' to ensure a smooth transition when children with long-term chronic illnesses grow old enough to transfer. Mrs Crombie said she hopes to see some system of benchmarking introduced to help health professionals measure progress towards the service standards. Linda Fisher, therapy coordinator at Southend Hospital's children's therapy services, said: 'The NSF truly promotes child-centred planning and working together to enable coordinated support. Our challenge - and it's a huge one - is for us to review how we all work together to meet the standards.' CSP professional adviser Léonie Dawson said the plan will drive the impetus for providing children's services in a different way. It will mean more physiotherapists working in community settings - such as schools and nurseries - as part of multidisciplinary teams and alongside social services and other allied health professionals. She said robust systems will be needed to support physios in these roles, so they can continue to share professional issues and maintain their continuing professional development. 'There's going to be a need for more clinical specialists out in the field as well as in hospitals, and that is going to be a resource issue,' Ms Dawson told Frontline. Physiotherapists will have to review the way they are working and put the case to commissioners for a bigger share of resources where they are needed, she added. Al Aynsley-Green, the national clinical director for children, commented: 'Effective change will only happen if staff at all levels seize the opportunities provided by the NSF.'
Matthew Limb

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