The government has launched the Children National Service Framework, which it says is a 'blueprint to ensure personalised child-centred health and social care' across the UK, setting out eleven key standards including medicines management.

Off-label prescribing of medicines - a particular concern for all stakeholders in the wake of controversy surrounding SSRI antidepressants  - is specifically addressed with new support for prescribers.

The strategic plan is the latest in a series of National Service Frameworks (NSFs) designed to radically improve standards of care in the NHS, and covers Children, Young People and Maternity Services.

As with the last framework to be launched, the Diabetes NSF in May 2003, the new national standards must be introduced over the next ten years but carries no strict timing and implementation deadlines unlike earlier NSFs.

Instead, PCTs and counterparts in local authorities must demonstrate progress is being made towards achieving the goals across each three-year planning period, with the Health Care Commission monitoring uptake as part of its NHS watchdog role.

A wealth of guidance has been produced for the new framework, covering a wide range of areas where services can be improved for patients. These include:

• Treatment at home for children and young people who have complex health needs, so that they can manage their illness and still have a fulfilling life. Better speech and language therapy services.
• Involving children and young people as active partners in the decisions about their medicines to fit in more flexibly with their daily lives, for example, prescription regimes that fit around the school day. Computer games and text messaging could be used to remind and teach children and young people about taking medicines.

Professor Al Aynsley-Green, national director of children services said the new NSF set out a vision for improving health and well-being for children, young people and families.

"Its aim is to improve their lives in three main ways: by actively promoting good health, by ensuring that care is centred on the child's needs, and by improving the experiences and satisfaction of mothers, children and young people with their health services.

"At its heart is a fundamental change in the way that we think, with services being designed and delivered not around organisations or professionals, but around the real needs of children and their families."

One particular area of concern is the mental health of the UK children and adolescents, with research indicating that more and more are suffering from depression and behavioural problems. The government is investing over £300 million in mental health services for all age groups across the NHS and social services.

The NSF has been several years in preparation, and over that time research has shown that there are huge gaps in knowledge and clinical evidence about child health and well-being.

In particular, the effectiveness of interventions, forms of service delivery and organisation and actual health outcomes for children has been found to be inadequate - the government putting forward £2.5 million to fund a new programme of research to plug some of these gaps.

The launch of the NSF coincides with growing concern about the safety and efficacy of medicines in children, particularly off-label prescribing.

Regulators the MHRA ordered doctors to stop prescribing all SSRI antidepressants except fluoxetine (Prozac) in December 2003 because of a lack of evidence on efficacy and concerns about safety.

An FDA panel in the US has recently advised similar restrictions. In response to the concern, the UK's new NSF sets out a number of new safeguards, including 'enhanced decision support' for prescribers, including greater information and access to specialist advice.

Children, Young People and Maternity Services NSF

Standard 10: Medicines Management for Children

Children, young people, their parents or carers, and healthcare professionals in all settings make decisions about medicines based on sound information about risk and benefit. They have access to safe and effective medicines that are prescribed on the basis of the best available evidence.

Safe medication practice is enhanced through improved training, continuing professional development, the provision of evidence-based information and systems to ensure safety of practice.

The use of unlicensed and off-label medicines for children and young people complies with local safety standards and arrangements are in place to oversee and monitor this. There is also enhanced decision support for prescribers, which includes information provision and access to specialist advice.

Access to medicines is improved through health professionals being familiar with the use of medicines in children, having good information and using evidence-based guidelines, and services working collaboratively, with good multi-agency policies in place.

Clear, understandable and up-to-date information for children, young people and their parents is provided through a variety of media and formats which are appropriate to the child's development and circumstances.

There is greater support for children and young people who take medication at home, in care and in education settings. Staff working in schools and early years settings have adequate advice, support and training from local health professionals to enable them to manage the use of medicines safely. Policies are in place for the safe storage, supply and administration of medicines.

Particular arrangements are in place to ensure equitable access to medicines and to safeguard children in special circumstances, disabled children and those with mental health disorders.

The expertise of pharmacists is used in commissioning medicine management services for children and in supporting wider health promotion strategies for children and young people.

pharmafocus@pharmafile.co.uk