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A LEADING Australian paediatrician has called for the appointment of a federal chief paediatrician to advise the government on strategies needed to meet the first national standards on the health care needs of children and adolescents, released this week.
Professor Dominic Fitzgerald, a member of the Royal Australasian College of Physicians (RACP) Paediatric Policy and Advocacy Committee, said Australia needed a federal response to paediatric health challenges.
He has also called on medical practices and hospitals to implement the improvements needed to meet the standards.
“Despite the fact that we are an affluent nation, seemingly able to largely outsmart the global recession, there is no doubt that the money available in the heath care system remains way below what is needed,” he said.
“Children don’t vote and so perhaps their needs do not reach the same priority when largely political decisions are made about the priorities for health care funding.”
Consensus standards for the care of children and adolescents in Australian health services were published in the MJA this week. (1)
They state that in a health care setting children and adolescents must be accommodated separately to adults, facilities must be provided for parents and carers to stay near their child, child- and adolescent-specific equipment and education are essential, and appropriately trained staff should be available.
The standards, aimed at all health services, were developed by a multidisciplinary working group of clinicians, health service providers and consumer advocates, convened by the RACP, and underwent pilot testing in six metropolitan, rural and regional hospitals.
Professor Fitzgerald, who had no direct input into the standards, said medical practices and hospitals must make funds available to meet the standards.
“As a society can [we] afford not to?”
Dr Paul Bauert, chair of the AMA Child and Youth Health Committee, welcomed the standards and also agreed that a federal chief paediatrician was needed in Australia.
Dr Bauert said larger hospitals, particularly general hospitals, should aspire to the standards.
However, he said while bigger general practices attempted to set aside play areas for children, he believed the main thrust for improvements should be on general hospitals to implement the standards.
Professor Susan Sawyer, a member of the RACP Joint Adolescent Health Committee and the working party that developed the standards, said the standards were critical in ensuring that the health and welfare of children were fully protected in the medical setting.
Standards should not simply be “add-ons” but should underpin wider practices, Professor Sawyer said.
“Children and young people should not be viewed as second-class citizens in terms of their health,” she said.
“For the Australian health community to suggest it couldn’t afford such standards would be a sorry state of affairs.”
The closure of a number of paediatric wards, especially in country hospitals, had resulted in the dilution of expertise in paediatric nursing in particular but it also risked children being exposed to potential harms from much older patients, Professor Sawyer said.
Another problem was that most paediatric services struggled to provide age-appropriate pain management.
“We are increasingly aware of the risk of children and adolescents developing post-traumatic stress disorder as a result of painful procedures they were exposed to in hospitals,” she said.
“The notion of ‘just grin and bear it’ is simply not appropriate for children.”
Professor Fitzgerald said a lack of resources in hospitals meant that nurse-to-paediatric-patient staff ratios were inappropriate, there were insufficient beds to meet the needs for semi-elective surgery, and insufficient resources in overcrowded emergency departments where the waiting time could be 4‒5 hours.
“There is a huge unmet need for community allied health resources, which are necessary to supplement and complete the care of children following hospitalisation, and there is a frightening gap between the level of specialist and sub-specialist care for paediatric patients in regional and urban Australia, whether this be in mental health, substance abuse, surgery or medical specialties,” Professor Fitzgerald said
Posted 17 January 2011
The importance of leadership and coordination of services relating to the health and wellbeing of children and youth is not limited to competing priorities within the hospital sector. The most effective model is a comprehensive network across the entire health services spectrum and in close partnership with a range of other agencies, both government and non-government. As stated in comments above, this population does deserve and require particular priority and a cohesive approach is essential.
Les White, Chief Paediatrician, NSW Health
In response to Sue Ieraci, I wonder if the same can be said for young people’s health care (12-24 yr olds), as highlighted by Susan Sawyer’s inclusion of young people in her comments. From a youth health service perspective, challenges still exist in young people’s access to health care, especially among marginalised and at-risk young people who are paediatrically aged, but engaging in risky adult and health compromising behaviours. They are easily alienated from both paediatric and general services.
It is important for a Federal Chief Paediatrician to include in their scope the health of young people up to 24 years of age. While this is beyond the age range of many paediatric servces, it is synchronistic with youth health policy, as in NSW (http://www.health.nsw.gov.au/policies/pd/2010/pdf/PD2010_073.pdf)
My experience, working in a busy mixed ED that sees about 25% children, is that children generally get a better deal in our hospitals than old people. They have shorter waiting times, dedicated treatment and procedure spaces that are decorated appropriately. We are aware of the importance of analgesia and sedation for procedures. The specialist children’s hospitals are generally far better resourced than the general hospitals – both physically (structure, equipment) and in terms of staffing levels.
Of course, children are our future and our responsiblity, and should receive all the benefits of the best that our health system can deliver. But is there some other group that shouldn’t receive all those benefits?
If there is any group that is probably under-served, maybe it would be patients with mental health problems in the public system. Should we therefore have a chief psychiatrist? Or, given that EDs are overburdened and carry a large proprotion of the community’s risk, we should have a chief emergency physician.
The importance for standards in Childrens and adolescent health care settings cannot be overstated. Whilst the standard present many problems for hospitals and services that are part of adult institutions it should not be possible to ignore them or shrug off change becuase it is too expensive. Child and adolescents have as much right to appropapriate health care as others in the community and this document should be considered alongside the recently published Charter on the Rights of Children and Young People in Healthcare Services in Australia.
In the current health care reform process, the government is considering clinical leadership and developing “lead Clinican Groups”. Clearly a lead clincian group for children and young people would be not only desirable but essential. State and Territories are currenlty developing Children’s Health networks within each jurisdiction. Leaders of these networks are already meeting under the auspices of Children’s Hospitals Australasia (CHA) and are well placed to provide a voice to the national health needs of Australian Children and Young people that current commentators seek within the office of a chief paediatrician. National leadership for advice and counsel Children’s and Young people health is within our grasp and it would be useful for commentators to support the notion of a National Clinician leadership group for children and young people alongside other national lead clinicians groups that will be obviously focussed on other areas and perhaps less interested in children’s health.
Children’s and young peoples health is too important for this nation not to have a leadership group independent of other groups and perhaps the chair being identified as the Chief Paediatrician.
Associate Professor Graham Reynolds
President
Children’s Hospitals Australasia