16.06.20
NICE recommendations to improve the lives of children, young people
Judith Richardson, Acting Director for Health and Social Care at the National Institute for Health and Care Excellence (NICE), discusses her views on the latest NICE impact report on children’s and young people’s healthcare.
Children and young people make up 21% of the population of England, account for 23% of accident and emergency department attendances and up to 30% of GP visits. The NHS Long Term Plan prioritises ensuring a strong start in life for children and young people. Many of the commitments laid out in the NHS Long Term Plan are underpinned by NICE guidance. In this report, we look at what we know about how some of these recommendations are being put into practice, and where there’s room for improvement. Children deserve a health system that focuses on prevention, early detection, evidence-based intervention and high-quality care delivered by strong and efficient local services.
NICE’s earliest publications include recommendations about the care of children and young people, such as our guidelines on eating disorders and type 1 diabetes which were published in 2004. Since then, NICE has published an extensive suite of guidance and advice on children and young people.
Within the last decade we have seen improvements in services including maternity and neonatal care, which were the focus of previous NICE impact reports. In this report, we look at NICE recommendations that have played a part in improving the quality of children’s and young people’s services. We also consider areas where further improvement is necessary.
READ THE NICE IMPACT REPORT HERE
One area of focus is the continuing discussion around responsible antibiotic prescribing. Data show that in children 5 years old and under, the rates of antibiotic prescribing are higher than for children and adults from 5 years up to 64 years. This is worrying, given the risk of developing antimicrobial resistance. It is therefore important that antibiotics are not prescribed unnecessarily. To support this, NICE has been commissioned by the Department of Health and Social Care (DHSC) to develop antimicrobial prescribing guidance, based on thorough evidence to help healthcare professionals manage common infections. We have seen an encouraging decrease between 2016 and 2018, in primary care antibiotic prescribing, across all age ranges under 65. The most significant decrease is in those 0 to 4 years, from 0.71 prescription items per 1,000 people, per day in 2016 to 0.59 in 2018.
Another area of encouraging improvement is the reduced emergency hospital admission rates from long-term conditions; asthma, diabetes and epilepsy. NHS Digital data, part of the Clinical Commissioning Group (CCG) Outcomes Indicator Set, have shown that in 2014/2015 there were 324 annual emergency admissions per 100,000 population. During 2018/2019 this has reduced to 277, which is good news. It is important that the NHS is able to provide better, more structured and integrated support for children and young people who live with long-term conditions, within their local communities. The NHS is behind similar countries in this area and there is still variation in emergency admission rates across England. While some of this variation is because of differences in prevalence, it suggests that more could be done to manage these conditions in many parts of the country.
Judith Richardson, Acting Director for Health and Social Care at the National Institute for Health and Care Excellence (NICE), discusses her views on the latest NICE impact report on children’s and young people’s healthcare.
According to the Royal College of Paediatrics and Child Health, data they collect for the National Paediatric Diabetes Audit show that there has been an increase in children and young people with type 1 diabetes receiving NICE-recommended checks. NICE recommends regular monitoring of blood glucose levels, at least 4 times a year. While we have seen an increase in this important check, in 2017/18 only 55% children and young people were monitored as often as recommended by NICE.
Similarly, statistics from the Health and Care of People with Learning Disabilities show that children and young people with a learning disability are receiving more health checks. These checks are important as people with learning disabilities are less likely to receive treatment and are more likely to have physical health problems such as epilepsy and diabetes. As a result of physical health problems, they can have a shorter life expectancy than the general population. NICE’s recommendations aim to help reduce this health inequality. We advise that all children, young people and adults with a learning disability should be offered an annual physical health check in order to identify and manage underlying physical health problems as early as possible.
Another important area of focus within the impact report is the support provided for those transitioning from child to adult services. This process can be complex and involves many different services including education and social care. This is why we produced guidelines providing best-practice advice on the support needed before, during and after a young person moves from children’s to adults’ health or social care services. We have condition-specific recommendations on transition in many of our guidelines.
The impact report discusses a number of key areas around children’s and young people’s healthcare and reveals that there have been strategies put in place and improvements which focus on NICE’s evidence-based recommendations. But the health and social care system could be doing much more to provide better, more coordinated care and support for young people’s transition to adult services. This important report should provide the basis for discussion about where further improvements to children’s and young people’s health and social care could be made.