Only around 15% of hospital children’s services are backed up by a full-time community nursing service, creating difficulty in discharging children early, the authors of an audit report have warned.
The report of the Facing the Future Audit 2017 found 14.9% of acute general children’s services were supported by a community nursing service that operates 24 hours a day, seven days a week.
In addition, just 11.2% of GP practices were linked with a community children’s nurse, according to the report published by the Royal College of Paediatrics and Child Health.
The audit analysed data submitted by trusts on two sets of standards drawn up by the college in partnership with children, young people and families.
For example, one of the standards states that every acute general children’s service should be supported by a community children’s nursing service that operates 24 hours a day, seven days a week, for advice and support, with visits as required depending on the needs of patients.
The report highlighted that children’s community nursing teams were a “key component” of integrated services and sites visited during the audit “overwhelmingly reflect the value” they brought to caring for children using the “whole-pathway approach”.
It also highlighted that Department of Health guidance had “clearly stated” that children should have access to visits from a community nursing team at home between 8am and 10pm, with 24-hour telephone advice available.
“Nurses have described examples where services have been decommissioned”
However, it said its site visits showed “great variability” in the types of children’s community nursing teams available – both in relation to their role and the hours they provided services.
For example, it said respondents to the audit reported that the majority of children’s community nursing services operated less than 12 hours per day.
“Anecdotally, nurses have described examples where services have been decommissioned as a result of low use during out of hours. Nurses are therefore providing duties to their patients out of goodwill, that are not recognised in service specifications and workforce planning,” said the report.
The audit found geographical service boundaries often had an impact on what services were available, especially if the nursing service covered several catchment areas.
In addition, the “financial viability” of meeting the standard was raised as an issue by most units visited and nurse shortages had “made it difficult to recruit, which may indicate why services are in the majority of cases operating a service between 9am and 5pm”.
“The severe lack of nurses means that children and young people are missing out on the vital care they need”
However, the audit said that, while workforce issues had been recognised as a “huge challenge”, there has been a 15% increase in full time equivalent numbers for children’s nursing in 2017.
Creating networks or collaborative working between commissioners and health boards could be a potential solution to tackle the catchment area issue with crossing boundaries, suggested the report.
The RCPCH said it would now be working closely with the Royal College of Nursing to better understand and recommend how services can meet this standard.
Regarding the linking of GP practices with a community children’s nurse, the report authors warned there were “numerous challenges”.
It said community nursing teams lacked the resources “stemming primarily from the shortage of children’s nurses”, meaning that many lacked the time to build key relationships with GP practices.
Meanwhile, pressures on GPs in primary care could “often result in poor opportunities” for children’s community nursing services to engage with general practice.
The report said service planners must ensure GPs were aware of the services that children’s community nurses could provide as support, particularly on avoiding unplanned admissions.
“There are no second chances for children and young people’s health”
Nurses and GPs spoken with during site visits felt it would be “more realistic” to link children’s community nursing teams with a “hub” of GP practices, rather than individually, said the report.
“A central point of access or a children’s community nursing team email address would be a sufficient means of contact for GPs,” it said.
The report also discussed the role of advanced nurse practitioners in terms of children having their case discussed with an “appropriately competent” health professional before they were discharged.
It noted that RCPCH standards and guidance recommended that advanced children’s nurse practitioners were competent to lead care in paediatric assessment units with co-located consultant support.
But it warned that audit visits showed that in some areas the ANP role was “not clearly defined”, resulting in “some confusion around the ability for ANPs to provide clinical decision making”.
It highlighted that RCN guidance “clearly outlines” the role and competencies expected of ANPs and should be consulted by units seeking to develop nursing roles.
The training and funding of ANPs to fill tier 2 paediatrician rotas was offered as a “viable solution” for many paediatric services struggling to provide sufficient workforce, stated the report.
However, the audit authors said sites had reported to them that “recruiting ANPs into service has been difficult due to an overall shortage of registered children’s nurses”.
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Fiona Smith, RCN professional lead for children and young people, said the report revealed the “overstretched and understaffed” state of children’s and young people’s healthcare services.
“The severe lack of registered children’s nurses means that children and young people are missing out on the vital care they need,” warned Ms Smith.
“The report highlights that children’s community nursing services are critical for ensuring timely discharge from hospital and for preventing readmissions,” she said. “Yet these essential services are being decommissioned – disadvantaging children and young people who are cared for at home.
“Greater collaboration is needed between all children’s services and the RCN welcomes the opportunity to work with RCPCH and RCGP to help improve standards,” stated Ms Smith.
She added: “There are no second chances for children and young people’s health – the government must adequately fund and properly resource their healthcare or risk storing up problems for the future.”