The Integrated Care Programme for Children has been established to ensure that children and their families can access safe, high quality services in an appropriate location, within an appropriate timeframe, irrespective of their geographical location or social background without duplication or fragmentation of services. Its purpose is to place children and their families at the centre of service design. The Integrated Care Programme for Children will work with and build on the work of the National Clinical Programme for Paediatrics and Neonatology.
Context
The 2011 Census (CSO, 2011) report shows that there are over 1 million (1,035,817) children under 16 years in Ireland. Children 0-15 years now account for 23% of the total population, one of the highest in Europe. Overall, there has been a 16% increase in the 0-15 years age group since 2000, however, within the age groups, the increases vary quite a lot with the 0-4 year age group showing a 34% increase, the 5-9 year age group has increased by 20% and the 10-15 year age group has increased by just 1%.
The rapid rise in the number of children under four years in this country is particularly striking. It has important implications for child health and acute paediatric services, for example, the numbers of children requiring immunisation and screening, the potential to have increased numbers of children seeking care from general practitioners through the ‘under six contract’ and a resultant potential increase in referrals to secondary care. Children’s healthcare needs are becoming increasingly complex and are changing due to, for example, increased survival of extreme prematurity, increased numbers of children with chronic health issues, obesity, and a sharp rise in allergic disease. Health care provision to children in Ireland is often fragmented. A child with a complex condition encounters numerous healthcare professionals, often with no one individual taking responsibility for the coordination of their care. Meeting the healthcare needs of children and young people in Ireland requires a coordinated approach to service planning and delivery.
The importance of child health
A vital and productive society is built on the foundation of its children’s health and development. Health in the earliest years – beginning with the future mother’s health before she becomes pregnant – lays the groundwork for well-being not only in childhood but also throughout adult life.
Healthy children need strong community paediatrics with immunisation, screening, nutrition and developmental/cognitive assessment. Ill children need a seamless acute hospital service. Children with care and support needs should be provided with a continuum of services such as primary, community and ambulatory care to avoid unnecessary hospital admissions, and have their required treatments and supports delivered within their local community as much as possible. Developing health services for children with illness, disability or child protection issues as well as the well child requires an adequately and appropriately resourced workforce. There is a need to appropriately plan for new morbidities such as increasing incidence of obesity, diabetes and inflammatory bowel disease, the surge in atopic disease and allergy, and a growing need for childhood disability and child and adolescent mental health services.
Opportunities
There is now a unique opportunity for health services for children in Ireland with the establishment of a new children’s hospital, implementation of the National Model of Care for Paediatric and Neonatology Healthcare Services, introduction of a new child health model of universal screening with additional support for vulnerable families, and further extension of the ‘under six’ contract with general practitioners. The Integrated Care Programme for Children aims to capitalise on these significant developments. The future direction should be to provide as much care as close to home as possible, and to achieve this both primary and community care of children and adolescents must be strengthened. There is a need to strengthen links between primary and secondary care, and provide additional support to general practitioners to manage childhood illness closer to home. The concept of an integrated service will eliminate the previous fragmentation and duplication that has frequently been encountered in the delivery of clinical care to children.
Essentially, all children should be able to access safe, high quality services in an appropriate location, within an appropriate timeframe, irrespective of their geographical location or social background. At its core, health care design, planning and delivery should be child and family centred and based on best practice and proven benefits.
