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Integrated care: a solution for improving children's health?
  1. Ingrid Wolfe1,2,
  2. Claire Lemer3,
  3. Hilary Cass3
  1. 1Department of Primary Care and Public Health Sciences, King's College London, London, UK
  2. 2Evelina London Children's Hospital, London, UK
  3. 3Evelina London Children's Healthcare, London, UK
  1. Correspondence to Dr Ingrid Wolfe, King's College London, Department of Primary Care and Public Health Sciences, 5th floor Addison House, Guy's Campus, London SE1 1UL, UK; ingrid.wolfe{at}kcl.ac.uk

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There is growing concern that the UK is not performing as well as it should in securing and promoting health for children and young people.1 The reasons behind the UK's child health problems are complex, including socioeconomic conditions and other upstream determinants of health, and health systems and healthcare factors, as shown in figure 1. A comprehensive strategy to improve UK child health should therefore include action across all the domains and determinants of health. Integrated care is about joining things up in order to meet health needs, and in ways that make sense to children and families. Therefore, it should make an important contribution towards improving child health. Although this hypothesis is plausible, and is the basis of a great deal of policy, evidence is still indirect and limited. A concerted effort towards improving healthcare and child health must be supported by a strong drive to improve children's health services and systems research.

Figure 1

Determinants of child health.

Why is integrated care needed?

Currently there is a mismatch between health needs, which are increasingly about chronic conditions (physical and mental), and the health system that exists to meet health needs. Problems in healthcare partly explain the mismatch. Services are still largely centred around urgent care, but despite the focus on these services quality is variable and sometimes poor, and demand continues to rise.2 ,3 Planned care for children with long-term conditions often takes second place, and management of children with long-term conditions is suboptimal, leading to reduced quality of life and increased costs as these young people move into adulthood. Furthermore, workforce data suggest that our model of healthcare for children is not sustainable, but more importantly it is not fit for purpose in terms of outcomes.4 The resultant combination of poor health, suboptimal care outcomes and inefficient services is …

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