Dr Louise Kyne
Dean of the Faculty of Paediatrics, Royal College of Physicians of Ireland
Investment in early childhood is proven to be highly cost-effective. Knowing the challenges will help focus resources and treatment initiatives.
Among the greatest challenges affecting children’s health in Ireland today are poverty and unequal access to care, further exacerbated by significant increases in the cost of living. Presently, 3,137 children are homeless, and many more cannot access the care they need.
Limited access to healthcare
There has been a significant increase in children seeking asylum in Ireland compared to 2021. The issue of children from vulnerable or marginalised backgrounds encountering obstacles when engaging with the Irish healthcare system is all too familiar.
Mental health issues have increased since Covid-19, and services are overstretched. Anxiety, eating disorders and functional disorders are all on the increase and waiting lists are challenging. The childhood obesity surveillance initiative (COSI) reports that one in five Irish school children are either overweight or obese. Significant numbers of these children also suffer from associated physical and psychosocial challenges.
Paediatric workforce issues
Long waiting lists for outpatient appointments have soared with the pandemic, particularly for children with developmental needs. Recruiting multidisciplinary teams has been challenging, and access to vital care for children with complex care or mental health needs in hospital and community settings is a growing concern. Integration with other healthcare services is essential.
It is becoming more difficult to recruit and retain paediatric trainees. Inequitable remuneration needs to be addressed to ensure we continue to attract the best quality trainees and retain our wonderful young paediatricians.
Developing the local and regional paediatric departments so that paediatric trainees can learn within the planned hub and spoke model of the New Children’s Hospital and being European Working Time Directive-compliant is of paramount importance. The increasing number of female doctors in paediatrics requires appropriate workforce planning to accommodate increased flexible training and job sharing as normal practice.
It is becoming more difficult to recruit and retain paediatric trainees.
How to address the challenges
There are signs of positive change to advance paediatric services in Ireland, and we begin to address some of these challenges.
The Lynn clinic at Children’s Health Ireland, established in October 2020, provides Paediatric Inclusion Health (PIH) care to children experiencing social adversity. Named in honour of Dr Kathleen Lynn, The Lynn Clinic has already shed much-needed light on important health and social metrics for various groups at risk of marginalisation.
The Irish Paediatric Acute Transfer Service (IPATS) is also making a difference to children, their families and paediatricians. Established in 2014 as part of the National Ambulance Service, IPATS brings the Paediatric Intensive Care Unit level of care to peripheral hospitals.
Accommodating more children
In Ireland, approximately 1,500 children per year will require critical care. Around 450–500 of them will present to paediatric units outside of the two main paediatric hospitals. In 2021, IPATS saw a 160% increase in transports as paediatric respiratory illnesses rebounded post-lockdown. Currently operating seven days a week during daytime hours, additional HSE resourcing will see IPATS extended to a 24/7–365 service. Once a 24-hour service is established, it will be welcomed by all units to safely transport critically ill children.
We must continue to build on such initiatives to guide future developments that will at least start to address the challenges facing our nation’s children and their families.