Catherine Powell

Children and young people’s missed health care appointments: reconceptualising ‘Did Not Attend’ to ‘Was Not Brought’ – a review of the evidence for practice

The issue of wastage caused by missed appointments features prominently at a time when cost-saving measures become ever more important in the health care economy. Missed appointments are said to cost the NHS in the region of £600 million per annum. Various strategies are being tried and tested to ensure that people attend their appointments (or are in for domiciliary visits) including texting and phoning reminders. Clearly, attending for health care is generally in a person’s best interests. However, in the UK, if appointments are missed, then the usual outcome is a ‘three (or even two) strikes and you are out’ approach with a notification to the General Practitioner. In this paper we will argue that the seemingly widespread ‘Did Not Attend’ (DNA) routine described above is not appropriate where children and young people are concerned. The issue here is that the child or young person ‘Was Not Brought’ (WNB) to their appointment, rather than the fact that they DNA. This is important, because not only is access to health care their fundamental right (United Nations Convention on the Rights of the Child, 1989: Article 24), but failure to attend for health care is recognised as a child protection issue within statutory definitions of neglect. Failings in presenting children for health care is also known to feature prominently in cases that have reached the threshold for Serious Case Reviews, and this paper summarises the evidence in this respect. We conclude the paper by suggesting that reconceptualising child and young person DNA as WNB will lead to positive interventions to safeguard and promote the welfare of children that go beyond the missed appointment to a move towards the child-centric practice described in recent key reviews.

Why was this child not brought

How do we react to the missed appointment? It is a busy clinic (is there any other type?) and the first reaction is likely to be relief. Then there is the realisation that some thought may need to be applied to the child who was not brought. Then there is the remembrance that there is a policy to be followed. Perhaps, it would have been easier if the child had come to the clinic… There are a multitude of issues that derive from a missed appointment. It has implications for the child or young person, the parent/carer, the health practitioner for whom the child had the appointment, the referrer, the Trust or other health provider, for Commissioners and possibly for the Care Quality Commission and Local Safeguarding Children Boards among others. It is easy to lose sight of the child or young person in all these. Even the terminology is open to debate. We have previously argued that ‘Was Not Brought’ (WNB) was a more appropriate nomenclature to use than ‘Did Not Attend’ (DNA) when applied to children and young people1 and that the reconceptualisation of the DNA as WNB would lead to positive interventions to safeguard and promote the welfare of children.2 Munro has also commented that the change from DNA to WNB is a simple mechanism for triggering a different reaction.3 These three articles stress the need …

Review: ‘Opening the door’: A qualitative interpretive study of women’s experiences of being asked about intimate partner violence and receiving an intervention during perinatal home visits in rural and urban settings in the USA

The study reported here is of particular relevance to practitioners and researchers with an interest in perinatal healthcare. However, given the importance of domestic violence and abuse/intimate partner violence (DVA/IPV) as a contemporary public health issue impacting on the physical, mental, emotional and sexual wellbeing of victims and their families, then arguably an understanding of the interventions that may help to prevent, recognise and respond positively to disclosure is pertinent to the broader readership of the journal. Furthermore, in recognition of the gendered nature of DVA/IPV, and of the nursing workforce, it is highly likely that this paper touches on the personal, as well as the professional, lives of significant numbers of its readers. The strength of this qualitative study lies in the presentation of participant narrative. Key here, and worthy of reiteration, are reports of perpetrators’ control over their victims. This important and highly damaging element of DVA/IPV has not always been well recognised, despite being an important risk factor for domestic homicide (Home Office, 2013). As the author(s) of the paper presented here note, safety planning is a crucial element of the response to disclosure, but this needs to be undertaken with care and in partnership with the victim. Whilst an effective response is dependent on professional confidence in ‘asking the question’, awareness of specialist domestic violence and abuse services form a critical element of the response.

Research proposal: using the Delphi technique to develop a consensus on appropriate and timely referral of cases of child abuse and neglect

Child abuse and neglect, alongside other childhood psychosocial problems, have been described as a new morbidity in paediatrics (Dubowitz & King, 1995). Although the provision of statistical evidence is hindered by difficulties in defining and reporting, child maltreatment is by no means a rare event. A conservative estimate is that at least one in ten children in the UK are likely to encounter physical, emotional or sexual abuse or neglect during the course of their childhood (National Commission of Inquiry into the Prevention of Child Abuse (NCIPCA), 1996). Health professionals working with children and their families are in a key position to identify and refer children at risk of, or suffering from, abuse and neglect (Powell, 1997). Such referrals need to be both appropriate and timely. This paper discusses the proposal to use the Delphi technique in the development of criteria that will aid health professionals in the early identification and referral of children who may be suffering from abuse and neglect.

Getting there by degree … a personal view of undertaking a part-time degree course

Nine months ago the author became a student on a part-time Bachelor of Nursing Sciences Course. The author shares her experience in order to encourage nurses to consider undertaking this type of study and at the same time persuade course selector that part-time workers with domestic commitments can cope.