It is, to paraphrase Alan Bennett, a good job childhood happens at the beginning of our lives. Otherwise, we’d never be able to cope. This is particularly true of disadvantaged children who often receive the poorest services, grow up in the greatest poverty and, according to a recent Select Committee report, are indirectly responsible for large overspends in council services. Funding of Local Authorities’ Children’s Services, from the Housing, Communities and Local Government Committee not only indicates that services are at breaking point, but also challenges the government to come up with 'systemic' changes to reform how they are run.
And if further evidence for change were required, you need look no further than the tragic deaths of Ben, Max and Olivia Clarence (all with spinal muscular atrophy) in 2014 at the hands of their mother. There were over 80 professionals involved in the children’s care, including GP’s, social workers, a designated nurse, nine health organisations, schools and charities.
The solution, to answer the Select Committee’s systemic challenge, lies in a new model of integrated and collaborative services on a scale never previously seen – and with nursing playing a prominent role. It does not require any more of the wide re-organisations that paralyse services for years to come, but instead new community hubs of multi professional teams coming together. They would consist of community and sometimes specialist nurses, social workers, paediatricians, teachers, GP’s and health visitors with the additional part-time involvement of housing, income maintenance and leisure staff.
Why is it that most of the debates around 'integrated care' are only concerned with elderly services and the delayed discharges home from hospitals? In terms of caring for children, the arguments in favour of collaboration and integration – though more complex – are even more compelling.
It would take huge political courage, cross-party collaboration, a 10-year strategy and the secondment of staff to these new interdisciplinary teams, each serving a local population. Nurses would maintain their professional identify but become members of a collaborative multidisciplinary team which determined which profession was best suited to meet the needs of specific children. With a shared database, referral process and IT system, it would at last become possible to offer holistic care for children. The alternative is to muddle along with more reports on how we fail the most vulnerable children. They deserve better than that.
Dr Chris Hanvey is a former chief executive of the Royal College of Paediatrics and Child Health, and author of Shaping Children’s Services (Routledge 2019)