Emergency and urgent care for children and young people

Sheila Shribman, National Director for Children, Young People & Maternity Services ‘Children and young people in England require high quality emergency and urgent care when they are ill or injured. Prompt access to face to face consultation with a skilled competent and confident professional is expected by all families'

Emergency and urgent care for children and young people is one of the high volume care pathways focused on by the NHS Institute for Innovation and Improvement in its Delivering Quality and Value programme.

A system approach across primary and secondary care is required, and therefore system applications (acute trusts and PCTs) from each SHA region in England were invited to join the Rapid Improvement Programme to work with the NHS Institute’s emergency and urgent care for children and young people team.

Selected trusts

Thirty-nine applications were received and ten were successful, one in each SHA region. Each one of these trusts is also required to test a product specifically aimed at engaging with children and young people in their local health services. This will be done in partnership with 10 secondary schools (one per local authority). This product has been developed by children and young people and is planned to be tested through the existing curriculum. Over the next twelve months the emergency and urgent care for children and young people team will be working with the successful trusts to improve the quality and value of care provided to children and young people, by taking a system approach to transform care pathways and processes.

For a list of successful trusts please click here.

A short summary of what we have achieved to date

  • Getting departments around a table together from across the health system including - Accident & Emergency (A+E) and Paediatrics departments, as well as the ambulance service, GPs', Community Children's Nurses and NHS Direct - to work together and highlight opportunities for effective collaboration.  Chief Executive support and engagement is crucial
  • Getting teams out to look at what works well in other places, e.g. integrated children's A&E and Paediatric assessment units - making best use of the skills of children's trained nurses (Registered Nurse (RN) child nurses)
  • Seeing 'front of house' triage services staffed by children's trained nurses, directing to primary care where appropriate
  • Focussing on high volume pathway development.  So far sites are working on whole system pathways for the managment of bronchiolitis, feverish illness in children, asthmatic/wheezy children, head injury and diarrhoea and vomitting
  • Engaging with children and young people using a lesson plan in primary and secondary schools getting them to find out more about their local emergency health services and testing a tool to support that engagement (DVD available)
  • Importantly the programme has facilitated rapid improvements, supporting very practical interventions, for example:
    • Access to a Consultant Paediatrician hotline to prevent avoidable admissions
    • Putting a paediatric nurse front of house to ensure children are assessed by a competent and experienced practitioner to get safe, high quality care
    • Establishing service level agreements between walk in centres and paediatricians to ensure that there is the professional leadership and support for those staff managing children within the community setting

Key ingredients identified for success so far:

  • PCT Commissioner engagement and support (support at Chief Executive Level)
  • Independence of NHS Institute providing high level feedback on the system helps to validate concerns and pull together the local teams to work to find joint solutions
  • Clinical leaders across departments dedicated the time to work as a Whole System
  • Project management support and improvement expertise to assist with pulling the local team together across organisational boundaries


4th November 2009 – Event fo PCT Children's Commissioners at University of Warwick – jointly hosted by the NHS Institute, DoH, CHIMAT, RCPCH and NPSA

In addition, each of the ten sites are holding local health professional events to engage their wider health system to provide high quality emergency care.

For further information please contact sheryl.cox@institute.nhs.uk*

Papers have been presented at:

  • A celebration of 25 years of Children’s Nursing, RCN, Liverpool, 11 and 12 September 2009

  • Best Practice Consultation with Children and Young People, London, 30th September 2009 

  • Primary Care Live - Annual Conference and Exhibitions, London - 30 Setpember and 1 October 2009 and Manchester - 4 and 5 November 2009

Please keep visiting the website for information about new events.

Site visits

Teams participating in the programme have visited Homerton NHS Foundation Trust, East & North Hertfordshire NHS Trust & Smith Down Walk in Centre for Children (all are case studies in the Focus on document).  They have also visited the Wirral (Arrowe Park Hospital) to see their integrated Children's Emergency and Paediatric Assessment Unit in action. Click here to see the photos.

Sharing Resources

Networking is one of the key aims of the Children and Young People’s Emergency and Urgent Care Programme across England. The resources in this section have been developed by our collaborating sites and are displayed here so that other health systems/teams can share and learn from their ideas. Please feel free to use and adapt the ideas liberally.

Contact details of our ten participating sites are also included if further discussions are required with any of our sites who are most happy to share in their experience of planning and working towards a high quality whole system pathway of care for children in need of emergency and urgent care. For further information click here.


Mrs Sarbjit Purewal, Associate sarbjit.purewal@institute.nhs.uk*

Dr Venkat Reddy, Consultant Paediatrician venkat.reddy@institute.nhs.uk*

Christine McDermott, Clinical Pathway Improvement Facilitator  christine.mcdermott@institute.nhs.uk*

Kath Evans, Clinical Pathway Improvement Facilitator

* Please note that the NHS Institute is an innovation and improvement organisation and is unable to give medical advice to patients or their carers