13.6.2 Health 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.

 

13.6.2.1 Hospitals

 

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.

 

13.6.2.2 Human 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.

 

13.6.2.3 Primary 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.

 

13.6.2.4 School Health and Adolescent Health Services

 

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.

 

13.6.2.5 Child 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.

 

13.6.2.6 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.