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A forward view for child health: integrating across the system to improve health and reduce hospital attendances for children and young people
  1. Russell M Viner1,2,
  2. Dougal S Hargreaves1
  1. 1 Population, Policy & Practice Research Programme, UCL Institute of Child Health, London, UK
  2. 2 Children & Young People’s Programme, Healthy London Partnerships, London, UK
  1. Correspondence to Professor Russell M Viner, Population, Policy & Practice Research Programme, UCL Institute of Child Health, London WC1N 1EH, UK; r.viner{at}

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In complex health systems, the highest quality of care occurs when different elements of the system are joined up in a transparent way in order to meet patients’ needs. In a primary-care focused system such as in the UK, the majority of care for children and young people (CYP) is provided in primary care, while most specialist expertise resides in secondary care organisations. Pathways for both acute care and long-term conditions must therefore necessarily cross institutional borders, often multiple times. This can be a source of adverse outcomes and poor patient experience.

In England, health system changes over the past 30 years have acted to fragment the system into multiple smaller institutions and strengthen barriers. The 2012 Health and Social Care Act contributed to fragmentation of the health system for children.1 Breaking down these barriers through better integration of care across the primary–secondary care interface has therefore become a key aim for the National Health Service (NHS) in England2 and the focus of much quality improvement work by paediatricians across the UK.3

There has been a dramatic take-off of interest in ‘integrated care’ over the past 5 years across many countries.4 Integration may be across institutional borders/barriers in the health system or across life course barriers, such as the transition from CYP health to adult health systems. There has also been growing interest in system integration, across borders/barriers between health and other systems such as social care and education.

Much has been written, including in this journal, on the benefits of integrated care.3–5 The benefits of more integrated care include the potential to improve safety, outcomes and patient experience and the potential also to reduce costs. One potential benefit of greater integration for …

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  • Contributors RV wrote the first draft. DH edited the draft. RV and DH finalised the submitted editorial.

  • Competing interests RV is clinical director for children and young people at Healthy London Partnerships.

  • Provenance and peer review Commissioned; internally peer reviewed.

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