Referral and access to children's health services.

T he Children’s National Service Framework has identified access as a core theme and aims to develop standards to ensure better access and smoother progression in the provision of services. The need for better coordination was highlighted by the Bristol Children’s Enquiry which recommended that ‘‘there must be a greater integration of primary, community, acute and specialist health care for children ... so that services for children in the future are better integrated and organised around the needs of children and their families’’ (recommendation 177). This theme also underpins the development of managed clinical networks which aim to ensure that high quality effective services are equitably provided and coordinated around the needs of the child rather than being constrained by organisational or professional boundaries. 4 At present children’s health services may be hosted and managed by different organisations. Comprehensive commissioning and service development can be problematic, as it is often difficult to create an overview of local health needs and service utilisation. Information is held in different forms, in different databases, and by different services. The provision of children’s services is also complex, being delivered by a number of different professionals, at a range of levels and in different locations. Access to these services is often by a number of independent referral routes which may differ in terms of entry and urgency criteria, who is eligible to refer, and work to different geographical boundaries. Poor communication and coordination between services can lead to duplication of work or confusion about who is responsible for meeting which particular part of a child’s or family’s needs. From a referrer’s perspective a range of referral pathways can be a source of confusion; particularly where there are multiple needs or where the most appropriate service to address a child’s needs is not clear. Navigating such a complex system can be both frustrating and time consuming for referrers, children, and their families.