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Physical and mental health for young children
Physical and mental health for young children

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2.3 Access to services for babies and young children to support health

A black-and-white photograph of two young children
Figure 5 Growing up in Birmingham

In 1971, Julian Tudor-Hart wrote about the fact that the people who were most in need of medical care or health support were the least likely to have good access to it. He called this ‘the inverse care law’. But it can be possible to design services that are more readily accessible to those who need them most. The Derby community paediatric service decided to tackle ways to improve access for children from the most disadvantaged areas (Maharaj et al., 2014). Added to this, the service monitored how well families and children from those areas were finding and using the service.

Activity 4 How well is access monitored?

Timing: 5 minutes

As you read the case study below, think about services that you run or use. How effectively do they help families living with disadvantages and how well is that access monitored? Make a note of what works and what could be improved, using the ideas below.

What makes the community paediatric service in Derby work well for those in need?

Multi-agency working: Our service has a strong ethos of multi-agency working. Unusually for a specialist health service, 50 per cent of our referrals come from agencies outside health, including education, social care, police, and voluntary agencies.

Staff awareness: One of our main objectives is to provide a service that is accessible to and used by vulnerable and deprived children. We made our focus on these children explicit by including it in staff training, including administrative staff. As a result of this all our staff are aware of and sensitive to the difficulties faced by deprived families.

Accessibility: Our service has removed many of the barriers that deprived families often find difficult to navigate: we see children in local clinics close to home; our referral and booking process is simple and inclusive as we accept referrals from all agencies and prioritise on the basis of need rather than source of referral; we offer families a choice of time and dates for appointments, and provide telephone reminders; for families who are likely to struggle to attend we enlist the help of other agencies to support attendance; we see children in non-health settings when appropriate, for example in schools and children’s centres.

Acceptability: Community paediatricians provide care that is available to all and covers a wide range of conditions, so we do not carry the perceived stigma of services aimed specifically at poor children.

Comprehensive service provision: Comprehensive services that can address many issues at once are more likely to be successful at reducing health inequalities due to poverty. Community paediatricians have broad-based training and work in multi-agency and multidisciplinary networks. Consequently, they can manage a wide range of issues across the physical, learning, emotional and psychosocial domains (meaning issues at the intersection of psychological and social life, such as anxiety, enuresis, aggression). They provide a comprehensive and co-ordinated service for their patients via local community paediatric clinics.

(adapted from Maharaj et al., 2014, pp. 224–5)
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Review your learning

Timing: 10 minutes

Look back at your earlier notes. What are your thoughts now on the two questions you considered at the start of Section 2?

  • What is meant by the term ‘inequalities in health’?
  • What does it mean for babies and children born into families in different circumstances and different geographic areas?
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‘Inequalities in health’ means differences in the expected levels of illness and death between people based on their incomes, living circumstances, geographic location (where they live) and environments. People on lower incomes, in more deprived areas and living in poorer housing conditions die earlier and have more ill-health than people with higher incomes and better living conditions.

Babies and children living with families in those poorer circumstances and areas also suffer more ill-health, lower birth weights and have higher rates of infant mortality than babies and children in wealthier circumstances.