Improving health care for children and young people; what should we focus on?
Kath Evans is both a registered Children’s Nurse and also Experience of Care Lead for Maternity, Infants, Children and Young People at NHS England. In this blog, she reflects on the findings from the 2016 Children and Young Person’s Survey, and calls on some of the leading voices in the UK’s children’s health care sector to share their views.
Hearing from children and young people and their families is vital if we’re to focus on what really matters most to them. Importantly the system needs to recognise the positive feedback children, young people and families/carers are giving to care givers and acknowledge that ongoing improvement continues to evolve thanks to the commitment of teams.
Through the 2016 Children and Young Person’s Survey, the Care Quality Commission have provided a rich analysis of the data mapped against current policy that is worth dipping into. This raises the question;
We can always work towards improvements, but what should we focus on?
As a Children’s Nurse working within child health, these were the things that struck me:
We need to keep working at involving children and young people more in their care.
The 2016 data is telling us that children and young people are still not feeling consistently involved in decisions about their care. We are making progress with young people (46% of 12-15 year olds felt involved in decisions about their care) but we’ve more to do with younger children (39% of 8-11 year olds felt involved in decisions about their care).
Kate Martin who developed ‘CYP Me First’ with young people reflects:
“we can’t underestimate the importance of communication as the interface with how we experience healthcare; it’s the difference between simply ‘being treated’ and experiencing good care. It’s particularly importantly for young children who can often feel out of control and anxious because they haven’t been fully involved in decisions about their care. Children are never too young to engage, it’s more about our skills as healthcare professionals about how we engage with them”.
Is communication part of our continuous professional development? Is it given the attention that we give to clinical skills development such as intravenous medication administration? Communication skills development and enhancement deserves real attention.
We need to ensure staff in general paediatric areas are trained in mental health as well as physical care.
Robin Barker, Senior CAMHs Nurse and Project Lead for ‘We Can talk’ shares;
“we hear time and time again from young people that its often one person that made a difference to their stay, the person whoever that is, regardless of position or specialism took it on themselves to connect with the young person on a human level. Communication about mental health is more about effort and attitude than expertise. Giving staff time to reflect and consider the difference they make to a young person is a vital part of the training provided by the ‘We can talk’ programme.”
Are staff in general paediatric areas receiving support and education to care for children and young people with mental health needs? It’s only by building the competence of staff in this area will we improve experiences of care in this area.
A continuous focus on pain management, particularly for those with complex needs, is important
We cannot be complacent about the effective assessment and proactive management of children and young people’s pain and this requires ongoing attention.
Professor Alison Twycross, of London South Bank University, confirms this:
“Assessing and managing children and young people’s pain effectively is an important part of quality care. Not managing pain effectively can have detrimental short and long-term consequences for children, for example, through increased sensitivity to later pain events.’”
Professor Bernie Carter, Edge Hill University adds; “Children with profound cognitive impairment are particularly at risk if pain assessment is not effective. Take notice of what parents say.”
Play is the business of childhood, but as child health professionals are we giving it the priority children are asking for?
Sian Spencer-Little, Specialised Play and Activity Practitioner in Paediatrics at Kings College Hospital NHS Foundation Trust, reflects;
“Within healthcare, being or becoming playful is sometimes really tricky, professionals tend to focus on getting on with the day to day clinical tasks. However normalising play is such an integral part of a child or young person’s day-to-day life, having the opportunity and the space to engage in it whilst in hospital allows children the one essential element that is central to their development and provides them an overall sense of well-being. This includes gaining valuable self -calming strategies when engaged in something they love at a highly stressful time when they may feel completely out of control and really frightened (even if this is not verbally conveyed).
“Play provides opportunities for children and young people – even when they are unwell – to be creative, to ask questions and receive explanations, to explore, to process complex information and emotions and, most importantly, to experience joy, freedom and to relax.”
“By not incorporating play into our day to day activities children and young people miss out on vital opportunities to maintain their development, to access support and have a safe place to explore and effectively communicate, understand and cope with the clinically invasive procedures they experience as part of their journey through healthcare. Play is grounding, therapeutic and importantly fun, indeed it’s a vital part of our therapeutic interventions.”
As Child Health Professionals, play is part of all our roles. As children’s champions we are not only experts in physiological aspects of children’s care but in promoting childhood at every possible opportunity; every one of us has a duty to be playful in our interactions.
We need to care for the parents and carers, too
It’s reassuring to see families are reporting we’re involving them more in their child’s care. Professor of Children’s Nursing Sarah Neil of the University of Northampton reflects; “parents are the experts on their child/young person care and positive non-critical, non-judgemental approaches to collaborative working with families is key.”
It’s clearly important we get the basics right which we’re not always doing. Parents having somewhere to make a hot drink and somewhere to warm some food when caring for a sick child are fundamental aspects of securing the carers well being that we’re clearly not getting right consistently and this is something units need to address.
So, whilst there’s lots of good stuff, and there are positives to draw from the survey findings, we clearly need to retain focus and keep working to improve care for and with the children and young people that we serve.
Work with children, young people and families locally to drive your improvements, you find they give you loads of energy and you also have fun in the process too!
Why not tweet about the actions you’re taking to address your local survey results and share your good stuff to inspire others! #CYP #PatientExperience
Kath Evans is a registered general and children’s nurse and her career has included clinical, educational, managerial and service improvement roles. She is Experience of Care Lead for Maternity, Infants, Children and Young People at NHS England where she is committed to ensuring the voices of children, young people, families/carers and maternity service users are heard in their care and in the design, delivery and commissioning of services. She tweets as @kathevans2
Thank you to the professionals whose reflections are included in this blog
- Sian Spencer, tweets as @spencer_sian
- Professor Bernie Carter tweets as @CarterBernie
- Professor Sarah Neil tweets as @SarahNeill7
- Professor Alison Twycross tweets as @alitwy
- Kate Martin tweets as @_Common_Room
- Robin Barker tweets as @robinfromcamhs