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annex 2: health for all children, fourth
edition
Executive Summary, Fourth Edition of
Health For All Children
Edited by David M B Hall and David Elliman
(2003)
Reprinted by permission of Oxford University Press
- The 2002 programme sets out proposals for
preventive health care, health promotion and an
effective community-based response to the needs of
families, children and young people. It takes account
of, and is in line with, Government policies and
initiatives. The report does not address issues of
hospital or acute care but provides links to other
sources of information on these topics.
- Primary care organizations (
PCOs) working in partnership with
other agencies will need to ensure that the programme
is available and accessible to all families within
their boundaries, including socially excluded and
hard-to-reach groups.
- In the light of growing evidence that communities,
relationships, and the environment are important
determinants of health, investment in community
development and social support networks is increasingly
important; health professionals should contribute to
and sometimes lead in these aspects of health
care.
- PCOs should ensure that allocation
of resources between and within areas reflects the
greater needs of neighbourhoods that are challenging by
reason of deprivation, violence, language barriers,
lack of facilities, hostility, etc. Staff recruitment
and support should take account of the difficulties of
working in such areas.
- The holistic approach of family medicine is
commended and the importance of considering the impact
on children of parental mental and physical illness,
domestic violence and substance misuse is stressed.
Health professionals working with adult patients should
enquire about their children and liaise closely with
paediatric services where needed.
- Every child and parent should have access to a
universal or core programme of preventive pre-school
care. The content of this is based on three
considerations: the delivery of agreed screening
procedures, the evidence in favour of some health
promotion procedures, and the need to establish which
families have more complex needs.
- Formal screening should be confined to the
evidence-based programmes agreed by the Child Health
Sub-group of the National Screening Committee. The
agreed screening programmes are given in the table on
page 351. Screening activities outside this framework
are important in order to ensure continuing refinement
of the evidence base, but should be treated as
research, reviewed by an ethics committee, time
limited, and reported for peer review.
- There is good evidence to support health promotion
activity in a number of areas including prevention of
infectious diseases (by immunization and other means),
reducing the risk of sudden infant death, supporting
breastfeeding, encouraging better dental care, and
informing and advising parents about accidental
injury.
- There is as yet no single health promotion measure
to reverse the emerging problem of obesity, but the
importance of the problem and the need to address it as
a public health issue are stressed.
- There is growing evidence that language
acquisition, pre-literacy skills, and behaviour
patterns are all amenable to change by appropriate
patterns of child management. These insights can be
incorporated into programmes like Sure Start but can
equally well be provided in non-Sure Start areas.
- Many illnesses, disorders, and disabling conditions
are identified by means other than routine preventive
care programmes, but health professionals must respond
promptly to parental concerns. Reluctance to carry out
appropriate assessment or refer for more expert advice
remains an important cause of delays in diagnosis in
both primary and secondary care. Clear pathways of care
are vital to facilitate prompt and appropriate
referrals and need to be developed at local level.
- Formal universal screening for speech and language
delay, global developmental delay, autism, and
postnatal depression is not recommended, but staff
should elicit and respond to parental concerns. An
efficient preliminary assessment or triage process to
determine which children may need intervention is
vital.
- The core programme includes antenatal care, newborn
examination, agreed screening procedures, support as
needed in the first weeks with particular regard to
breastfeeding, review at 6-8 weeks, provision of health
promotion advice either in writing (where appropriate)
or by face-to-face contact, the national immunization
programme, weighing when the baby attends for
immunization, and reviews at 8 or 12 months, 24 months,
and between 3 and 4 years. However, it is expected that
staff will take a flexible approach to the latter three
reviews according to the family's needs and wishes, and
face-to-face contact may not be necessary for all
families.
- The Personal Child Health Record is commended.
There should be a basic standardised format for
universal use, which should be used to gather a core
public health dataset.
- Children starting school should receive the agreed
screening programmes and their
pre-school care, immunization record, and access
to primary health care schedule should be
reviewed. - There is an evidence base for the health care of
school-age children derived from a range of interview
studies with teachers and children designed to
establish what they perceive as their main needs. It
should include the following: support for children with
problems and special needs; participation in Health
Schools programmes designed to improve the school
environment and social ethos, promote emotional
literacy, exercise opportunities and healthy eating,
and reduce bullying; health care facilities for young
people in line with their clearly stated and
well-established requirements for privacy and
confidentiality.
- There is an urgent need to secure the provision and
the quality of a range of more specialized services to
back up those working in primary health care, education
and social services.
- Access to a child development centre or team and a
network of services, including referral to tertiary
units when needed, is essential for the assessment of
children with possible or established disabilities.
There is ample evidence as to what parents expect, in
terms of quality, from those services. The care of
children with disabilities involved all the statutory
agencies and, in many cases, the voluntary sector as
well.
- Emotional and behavioural disorders are common, but
service provision is often inadequate and fragmented. A
substantial investment involving all statutory agencies
is needed, both in preventive programmes at community
level and in managing both straightforward and complex
problems.
- There are statutory duties in respect of child
protection, looked after children, and adoption
procedures. The requirements for staffing are set out
in the body of the Report. Child abuse in all its forms
is a major but often unrecognized problem, and there is
an urgent need for better multi-agency training of all
staff and for improved support for those working in
this difficult area.
- There are also statutory duties in respect of
liaison work with education authorities with regard to
children who have special educational needs. In
addition, the development of health promoting policies
and programmes for school age children, in
collaboration with education professionals, parents,
and young people, requires staff time and
expertise.
- The report stresses the importance of leadership
and management of the whole programme. A coordinator is
needed to develop and sustain an overview of the health
of all children within the district for which the
PCO is responsible.
- It must be clear who is responsible for screening
programmes, maintenance and reporting of immunization
uptake, introduction of new immunization programmes,
health promotion, care pathways for children with
health or development problems, socially excluded
groups, child protection, looked after children, links
with education, staff training, and data
management.
- Since all these activities are interlinked, there
is a need for a multi-agency steering group to ensure a
focus on desired objectives and outcomes.
- All staff in contact with children should be
appropriately trained and take part in regular
continuing professional development.
Health for all children, edited by David M B Hall
and David Elliman (2003)
Published by Oxford University Press (
www.oup.com )
ISBN
0-19-851588-X
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