Services for Children
Similarly, analyses of health service availability and
levels or provision at population level take an adult view. This disregards the
needs of the 20% - 25% of the population who are children – and who need to
rely on the society to ensure their needs are met.
Children do not occupy adult hospital beds – nor do
adults occupy children’s hospital cots. Yet measures of hospital bed
availability generally refer only to generic ‘beds’. It is not just the size of
the bed, but the linked services which matter. Moreover, children need their
own appropriate environment, including play facilities and relevant educational
provision. However, apart from those data which refer to neonatal intensive
care or special care baby units, there is no routine data on the levels of
hospital provision for children. And apart from inpatient care, children should
have appropriate separate faculties in trauma and accident units and in
outpatient departments. No available data show any of these separate structures.
The European Association for Children in Hospital
(EACH) seeks to promote appropriate standards and facilities for children in
hospital, as enshrined in their Charter of Leiden. So far, 16 European
countries have become members of EACH. However, there is still no data
available on the degree of concordance with the Charter. This indicates a
significant under-appreciation of the issues of appropriate hospital services
for children, let alone their recording.
Resources for Children’s Health Services
Hospital services for children – inpatient and
outpatient – should also have dedicated staff. The concept of the paediatrician
as a children’s physician is generically well-understood, but there is no
common definition. Conversely, the age-group paediatricians see varies in each
country. Good practice for surgery on children to be the domain of surgeons
with paediatric experience and further training is recognised but not reflected
in national and international data. This vital differentiation is lost in
statistics on doctors per 100,000 population, within which the interests and
needs of children are totally unrepresented.
The role of nurses varies across European states.
However, this function is discharged in children’s wards and health services,
where nurses should have specialist training in caring for children. This also
does not feature in nurses-to-population statistics. Children’s services also
benefit from other specialist personnel, such as play therapists. Overall,
though, they are not measured.
Health Care for Children
The principle of subsidiarity for health service policy
is strong and particularly clear with regard to primary health care for
children. In some countries there is a separate special system of primary care
paediatricians, ensuring specialist care. In other countries, there is a system
of generic family general practitioners, with whom the whole family registers
for primary care, ensuring continuity and understanding of the family context.
Other countries have other systems. This variation cannot easily be reflected
in an overview such as this; thus, meaningful comparative analyses of issues
such as availability, access, quality, and adequacy are hard to achieve.
188.8.131.52 School Health and Adolescent Health
A particular challenge and a policy variation across Europe, concerns advisory, preventive, and screening services for school children and
adolescents. The traditional pattern of school health service, with an
identified school nurse, or doctor, screening children on a regular basis and
also giving general advice to teachers, has dwindled in many countries.
However, lack of any health presence in schools leads to disadvantaged children
being further disadvantaged, and makes the early detection and response to
neglect or abuse more difficult to achieve.
The advisory role of the school health service is also
important. It is an accessible and free first point of contact for a child with
a health or health-related problem they wish to raise, but where the child
feels that progressing it though their parents is not appropriate or effective.
This may include cases where the parent, or the family context, is perceived by
the child as the source of the problem. In cases of mental health, anxiety or
depression, a school health professional may be an available and accessible
first point of contact.
With the onset of puberty and sexual maturity, many
children need advice. In cases where the child has decided to become sexually
active or fears they may be pressured into this, a confidential source of
reproductive health advice is needed. Effective, accessible and confidential
adolescent health services are vital, though provision is very varied.
Health Service Quality
Measurement of service quality for child health
services is problematic. For the majority of their childhood, children do not
answer satisfaction surveys. Outcome measures are difficult to define and
measure. Screening services and immunisation, uptake rates are, however, a good
outcome measure. But in general, assessing the quality of these services is
challenging, and under-addressed, as exemplified in the previous sections which
have highlighted the lack of data on appropriateness of facilities and
manpower. The more the development of health service quality measures advances
on an adult-centric model, the more children are disadvantaged – and are not
able to speak up for themselves.
Pharmaceuticals for Children
A long-standing problem, hitherto poorly addressed, has
been that of pharmaceuticals and dosages for children. This is of course
exacerbated by the ethical challenge of clinical trials where children are
concerned. However, this is an area where the European Community is starting to
take effective action.