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Lack of focus on children in majority of STPs a “major cause for concern”

The majority of Sustainability and Transformation Partnerships (STPs) are failing to take into account the needs of children, the Royal College of Paediatrics and Child Health (RCPCH) has warned.

The report says that while most STP set out the case for change covering themes such as prevention, early intervention, more care delivered in the community, better mental health services and integrated working, there is a lack of detail underpinning the vision.

It concludes that the lack of profile given to infants, children and young people (who comprise 25% of the UK population) by the majority of STPs, is a major cause for concern.

The RCPCH report is based on a review of the 44 published STPs plan, and reveals major deficiencies including:

  • Lack of a life course approach: The majority of STPs do not demonstrate appreciation of the life-long impact of poor health in childhood.
  • Lack of recognition of the needs of infants, children and young people: The majority of STPs contain little mention of the health and wellbeing needs of children, except in relation to Child and Adolescent Mental Health Services; though notable exceptions are Birmingham and Solihull, and Greater Manchester, where children are considered a priority, and have set out in detail how they will improve care over the next five years. Cheshire and Merseyside STP hosts the only Acute Care Model Vanguard for women and children and is developing a dedicated work-stream.
  • Limited engagement with clinicians and the public: To date, STPs have not demonstrated that they have met their statutory duties to engage with children, young people and their families, including vulnerable and hard to reach groups, and those with complex needs and disabilities. There has also been limited engagement to date with paediatricians and other child health clinicians.
  • Workforce shortages: Demand for children’s healthcare is increasing, with the number of hospital admissions for children in England rising by 25% between 2013/14 and 2015/16 and an estimated 241 whole time equivalent (WTE) career grade vacancies (i.e. consultant level paediatricians). STPs do not make clear how these serious workforce shortages will be addressed.

Professor Neena Modi, President of the Royal College of Paediatrics and Child Health, said: “We’re disappointed at the lack of focus on the health and wellbeing needs of infants, children and young people. It is short sighted and a major cause for concern, that they appear to have been forgotten.

“We’ve found a real lack of clarity around strategic direction, oversight, accountability and responsibility for STP as they evolve. Furthermore, it is highly unlikely that STPs, or any new models of care, will be successful given the substantial workforce shortages and major funding constraints that the NHS is currently experiencing.”

The report calls on NHS England and NHS Improvement to:

  • Ensure that all STPs, develop, implement and evaluate a strategic plan which meets the needs of infants, children and young people within their respective geographical footprints
  • Define a core set of nationally consistent metrics to be captured by STP, that encompass processes, outcomes and patient experience relevant to infants, children and young people, and set out plans for nationally consistent evaluations of these metrics in order to assess the impact of the new models of care.

The report also calls on STPs to have a named, accountable lead for infants, children and young people, and have local paediatricians and child health or sector professionals involved in the development and implementation of its plans.

STPs must also have a strategic plan for infants, children and young people; which includes compliance with the NHS England’s digital child health strategy.

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