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National clinical director for children Appointed: July 2001 |
I have been successful at increasing awareness among the top team at the Department of Health about deficiencies exposed by the Kennedy inquiry into deaths of babies at Bristol and the Laming inquiry into Victoria Climbié’s murder. I have a seat at the top team, so for the first time there’s someone who can speak as an authority on the needs of children and young people and on maternity services.
Concerning the development of the children’s national service framework, "Getting the right start," I have led a team of well over 300 people from across the country in eight expert working groups. The first part of our framework, published in April 2003, set standards for children in hospital. The rest of the framework is due for publication early in 2004.
The best accolade we have had so far is that the field tells me there are no surprises in what we’ve published. It reflects the whole way we have gone about it: through a massive consultation with people working with children and in children’s services.
I have been involved in the green paper Every Child Matters (published in September 2003). Now the role for the children’s national service framework is to deliver the policies outlined in the paper. This reflects the inter-departmental working between the Treasury, the Department for Education and Skills, and the Department of Health.
For the first time the framework has given clear standards for the care of children in hospital. I’m proud of the way it looks at the holistic approach to the care of children. The three key principles are child centred services, the whole child, and needs led services. The standards will define the care that children will receive in hospital, the service received, and the quality of the environment. It’s all about the child actually becoming much more involved in its management and about making sure that every trust has a written policy for the management of pain and use of medicines in children. It’s putting children on the radar—children don’t have the vote that older people do.
What others say
Professor Sir David Hall, professor of community paediatrics, University of Sheffield, and former president of the Royal College of Paediatrics and Child Health: Being a tsar used to be a dangerous job, with a high risk of a violent and untimely end. The hazards for the new generation of health tsars are more subtle. They walk a tightrope. They need to understand and respond to the aspirations of the discipline of which they are a member, and yet they are not appointed to represent their profession but rather to think about and argue for the needs of the users—the needs of children and young people, in the case of Professor Aynsley-Green.
Our children’s tsar spent much of his career as a medical scientist and is an international authority on hypoglycaemia. In an extraordinary and rapid metamorphosis he has acquired extensive knowledge and insight into child poverty, public health, and community development, as well as extending his knowledge of mainstream health services, all of which are being deployed in developing the children’s national service framework.
But the proof of the pudding is in the eating. Do tsars really bring about change? Many of the determinants of health lie outside the health service and indeed outside the health department. So every tsar has a dilemma: to focus on health care in the narrow sense and aim to get that right; or to address the bigger picture and argue the case for reducing social ills, poor education, and so on. Perhaps this is particularly a challenge for the children’s tsar. Can one person tackle all these issues? I will reserve judgment—after all, the extent to which the framework is implemented depends on our politicians. But Professor Aynsley-Green’s commitment to both tasks is beyond dispute, and he deserves the support of everyone who worries about the health of the nation’s children.
Francine Bates, chief executive officer of Contact a Family, member of the Children’s NHS Task Force, and chairwoman of the External Working Group on Disabled Children: Al has set about the task of developing the children’s national service framework with incredible energy and commitment, working with over 250 experts in the field of child health to develop standards for children in health and social care. I am particularly pleased that over the last couple of years he has really understood the importance of fully including disabled children within our society. He has moved away from a narrow "medical" view of disability and now recognises that disabled children have social and emotional needs that must also be met within the framework.
He is not seeking any personal glory. I have seen him speak on many occasions, and I never fail to be moved by his determination to bring about real change in the health service and improve outcomes for all children. He has handled the transition to Whitehall civil servant well—against a background of continuing structural upheaval within government. He has already established good relations with the new minister for children, Margaret Hodge, who will now be jointly responsible for signing off the framework. He is not afraid to speak his mind to ministers when necessary. He has been travelling up and down the country, talking to healthcare and social care professionals, parents, and, most importantly, children and young people. He will ensure that the final framework, when it comes out in 2004, is evidence based and practically focused. Of course, there are challenges ahead for him. Funding the framework and finding the trained and competent staff to implement it is going to be a struggle. But whatever happens he has brought the child health community, including the voluntary sector and parents’ groups, together for the first time. This powerful alliance will continue to work together and press for change long after Al returns to his former life. I think this will certainly be one of his lasting achievements.
Professor Bernard Crump, chief executive officer, Shropshire Strategic Health Authority: Only part of the national service framework for children has been published so far, the part focusing on the acutely ill child. So far I think the most practical evidence of Al’s contribution has been to have published this standard for what children can expect from hospital care and to be a tireless and persuasive advocate for it.
I don’t know whether Al had a role in the decision to shift the lead responsibility for children’s social care to the Department for Education and Skills. My chair is a visiting chair in public health at Leicester, and I am a public health doctor by training. Currently I am chairing a task group on extending choice in the provision of health care to children and young people, as part of the "choice, responsiveness, and equity" consultation. (Francine Bates is one of the members of the group.)
No one who meets and talks to Al can fail to be impressed by his boundless enthusiasm for his role and his passionate interest in improving the health of children. For me, this speaks to one of the real values of the role of the national clinical director: that of a highly informed interlocutor between, on the one hand, the health department and the NHS at national level and, on the other, the clinicians in the field. Some of the best debates that we have at the monthly meeting of the chief executives of the 28 strategic health authorities and the departmental board are those in which the national clinical directors are fully engaged in debating improvement. In my view they are effective jointly and severally.
I sense that Al is frustrated at times by the rate of progress. His
framework has had a long period of gestation, and the changes in departmental
responsibility for children will take time to bed in. In many ways his
role will be even more significant with these changes. I hope both departments
listen to his advice, for the sake of all our children.