10. Too much at risk?
Children and Young People's Specialist Care Forum
(R) That this meeting of RCN Congress asks Council to oppose service redesign which results in the loss or fragmentation of specialist knowledge, expertise or staff who deliver quality services for all vulnerable groups.
Result
The resolution was passed.
For: 462 (98.93%)
Against: 5 (1.07%)
Abstain: 6
Debate report
Rachel Hollis, from the Children and Young People Specialist Care forum, asked Congress to request Council oppose service redesign which results in the loss or fragmentation of specialist knowledge, expertise or staff who deliver quality services for vulnerable groups. “Vulnerable groups depend on the care of specialist staff,” she said. Using examples from children’s and young people’s nursing, she said that in some circumstances service redesign can bring improvements, but it must be focused on patient needs.
Roger Milligan, from the Derbyshire Branch, seconded the resolution and listed initiative after initiative which has failed to improve specialist care for older people with long-term conditions and dementia.
Charlotte McCulloch asked what impact assessments had been carried out before changes are made which result in a detriment to patient care.
Steven Miles used the example of paediatric continence nursing staff to illustrate his case. Their work toilet-training children with learning disabilities results in a substantial long-term saving for the NHS, he said. Despite this a recent poll showed a 23 per cent reduction in continence nurse specialists.
Doreen Crawford said you could not trust the current Government with specialist services and she urged RCN Council to maintain vigilance and continue to raise concerns. Neil Thompson emphasised that it was so easy to lose specialist staff but said it was “hard and expensive to get them back.”
Background
The Health and Social Care Bill is currently being debated in Westminster. However, there has been limited consideration of the implications for children and young people; changes to the commissioning of children’s services may result in increased fragmentation, with a loss of well established networks and pathways of care.
While service redesign is necessary to centralise some highly specialised areas (such as cardiac services), this needs to be undertaken in the context of planned and managed networks of care which preserve the specialist knowledge, skills and expertise required.
In addition, following the Munro Review (2011), statutory guidance on safeguarding children in England is being revised. This has raised concerns that the loss of individuals in ‘designated’ safeguarding roles will impact the ability of organisations to fulfil statutory duties within a more fragmented health care system, where the accountability and responsibilities framework is unclear.
In Scotland the RCN has engaged with service planners in NHS Highland and Highland Council, expressing concerns that proposed service redesign could result in fragmentation of services for children; the transfer of health visitors and school nursing staff to the Council risks loss of continuity with other NHS child health services and general practice. The RCN in Scotland is developing a set of principles for the integration of health and social care in the Scottish context.
In Northern Ireland the RCN is engaged in a joint initiative with the Public Health Agency and trusts to scope and develop a job planning tool kit for specialist nurses, ensuring the contribution of specialist nursing roles is valued.
The redesign of children’s services has received much media attention in Scotland and across England (primarily in relation to future children’s cardiac services), while high profile child protection cases across the UK highlight the importance of integrating health and social care services and the key role of specialist nurses. Despite this, financial constraints have led to the closure of the Sure Start and Connections government programmes, and a loss of funding to a range of services provided by third sector organisations.
The RCN consistently highlights the unique contribution made by specialist nurses to service efficiency and patient care, and continues to collaborate with the Royal College of Paediatrics and Child Health in relation to the future provision of specialist services for children and young people.
References and further reading
Kennedy, I. (2010) Getting it right for children and young people: overcoming cultural barriers in the NHS so as to meet their needs, London: Department of Health. Available at: www.dh.gov.uk/en/Publicationsandstatistics (accessed 1/3/12).
Royal College of Paediatrics and Child Health (2011) Facing the future: a review of paediatric services, London: RCPCH. Available at: http://www.rcpch.ac.uk/ (accessed 1/3/12).
Wolfe, I., Cass, H., Thompson, M., Craft, A., Peile, E., Wiegersma, P., Janson, S., Chambers, T., and McKee, M. (2011) Improving child health services in the UK: insights from Europe and their implications for the NHS reforms, British Medical Journal, 342, 8 March, d1277. Available at: http://www.bmj.com/content/342/bmj.d1277 (accessed 1/3/12).
