Disgraceful post-code differentials in the care of children. We are losing our humanity because we fail to address the rationing issue..

We are facing disgraceful post-code differentials in the care of children. We are losing our humanity because we fail to address the rationing issue..

Emma Forde for the BBC News 12th November 2017: ‘I’m dealing with life-threatening situations – but I’m not a clinician, I’m a mum’

Hayley Smallman’s 15-year-old daughter Holly has a series of complex, life-limiting health conditions.

Her cerebral palsy, chronic lung disease and epilepsy mean she needs 24-hour care at their home in Liverpool.

It is estimated there are 40,000 children like Holly living with life-limiting and life-threatening conditions in England alone.

Many of them need palliative care round-the-clock, which is largely provided at home by their families but with the support of community children’s nurses and community paediatricians.

‘Alone and scared’

Hayley says: “I have a community matron and a community physio. They work Monday to Friday, 9am till 5pm. They are great.”

But when it comes to out-of-hours and weekends, Hayley says she is left without any support…..

On the same day: ‘Postcode lottery’ for dying children’s care, report finds

Families of dying children lack support because of a “postcode lottery” in palliative care services, according to a report.

The Institute for Policy Research says 49,000 children have life-limiting or life-threatening conditions in the UK.

The report says Scotland is “leading the way” in ensuring the right care is available to all, but the rest of the UK must follow suit.

The government says it is committed to tackling end of life care variations.

The IPR, based at the University of Bath, blamed a “piecemeal” approach to polices around palliative care and helping the bereaved for a wide difference in services across the UK – notably for children.

According to children’s charity Together for Short Lives – which contributed to the report – seriously ill children are “being forgotten or ignored” by nearly one in ten clinical commissioning groups (CCGs) in England as important services are not being made available.

Only 73% of CCGs provide palliative children’s nursing out of hours and at weekends, meaning children have to go into hospital rather than be treated in the community, the report found…..

…James Cooper, public affairs and policy manager at the charity, said: “The way in which children’s palliative care in the UK is planned and funded represents a postcode lottery.

“The current policy and funding environment has failed to adequately acknowledge the needs of these children, their families, or those that work to support them.”

He said families of children with life-limiting conditions have to co-ordinate a “vast array of professionals and agencies” for the care their children rely on.

“While a number of positive policy initiatives are being developed by the UK’s governments and other agencies, more work is needed to make sure that they bring about more joined-up plans, assessments and services with children and families at their centre,” he added.

The IPR report praised work in Scotland where the government is investing £30m following a pledge to provide palliative care for all who need it by 2021, “regardless of age, gender, diagnosis, social group or location.”

But it criticised the rest of the UK for being “ill-prepared” for the ageing population, and left with “disjointed policies” for people of all ages.

The report’s lead author, Dr Kate Woodthorpe, said: “For too long we have been complacent about death’s social and economic consequences, and our policy responses.

Government can no longer ignore the many, many challenges outlined in this brief.”

Other issues highlighted in the report

  • Only one in six employers have policies in place for employees providing palliative care for someone with a terminal illness
  • Growing funeral poverty – 45,000 people annually seek help from the state to meet the cost
  • A lack of burial space and concerns regarding crematoria capacity
  • One of the lowest rates of organ donation in Europe, while more than one in ten people die in the UK before they get the transplant they need
  • Nearly two-thirds of the UK population do not have a will

The report said the example of the devolution of powers and resources to Scotland offered a framework to tailor services to local populations and allow best practices to be shared.

“National and regional devolution is showing early indications that innovation and modernisation is possible, and Scotland is arguably leading the way with ambitious targets and re-organisation of key policy areas,” added Dr Woodthorpe.

“It is up to the rest of the country as to whether they wait to see how well Scotland fairs, or whether they use this as an opportunity to review, consolidate and improve how they support dying, death and bereavement.”

Scotland’s Health Secretary Shona Robison, said it was “extremely heartening” to be recognised by the report, adding: “It is a tribute to the compassion, commitment and dedication of those working across our health and social care services.

“To achieve our aim it is essential we create the right conditions nationally to support local communities in their planning and delivery of those services and support – to help ensure that the unique characteristics of each individual and family are met.”

The Department of Health said it had made a commitment to address variations within end of life care, including investing £11 million from NHS England into funding for the Children’s Hospice Grant.

A spokeswoman said: “We want all children and their families to receive high quality, compassionate and tailored care at the end of their life, regardless of where they live. That’s why we have committed to improving care in all settings.”

Update 12th November – And I forgot to mention child and adolescent mental health. A letter from an exasperated mother in the Sunday Times reads:

Psychiatry crisis takes toll on young anorexics

The woeful provision for young people with eating disorders led to my daughter being transferred in March to Edinburgh — even though we live in Hampshire (“Crisis in child psychiatry as vacancies soar”, News, last week).

It is totally unsustainable and she cannot build a life outside while she receives care. In early summer she was ready to move on but beds and/or funding were not available, so she has relapsed and lost hope.

This happens to patients time and again; hence the cyclical nature of anorexia. As a mother, I feel I am fighting on all fronts every day to get the right treatment for my daughter — with her condition and her daily or future care — while also dealing with grief and sadness for all that has been lost for our daughter and family, and the fears over what lies ahead for her.

There is a desperate need for more inpatient beds and a variety of treatment settings community, acute or inpatient and step-down) in which there is a greater range of therapy options to enable all the complexities of the illness to be addressed. One size does not fit all.

Incentives to train more psychiatrists, mental health nurses and support workers, plus a specialist eating disorders pathway for therapists, are essential.
Jemma Perkins, Andover

This entry was posted in A Personal View, NHS managers, Nurses, Post Code Lottery, Professionals, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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