What impact do NHS reforms have on the provision of children's services in England? The views of senior UK children's nurses

At the summer 2006 meeting of the Association of Chief Children’s Nurses (ACCN) held at The Evelina Children’s Hospital, London, the group were asked by a senior government advisor at The Department of Health to consider what impact NHS reforms have had on the provision of children’s services in England. Because of time restraints it was decided to address the issue through a Delphi study in which the first round to develop the initial criteria was ascertained through a focus group activity at the meeting. Nineteen senior children’s nurses attending the meeting participated in the focus group activity. Forty items were generated at this initial focus group meeting and which afterwards formed the basis of the Delphi instrument. Two subsequent Delphi rounds were conducted by email to endorse or reject the initial findings compiled from the focus group meeting. The Delphi study was conducted over an eight week period and 11 chief children’s nurses from children’s hospitals and units in Wales, Scotland and England responded to rounds two and three. The second and third rounds of the Delphi study utilized a five-point Likert scale in which respondents were able to strongly agree, agree, disagree, strongly disagree or express neutrality to each of the 40 focus group generated statements which became the Delphi instrument. Consensus in this study was defined as 70% of the Delphi panel study (8/11) strongly agreeing or agreeing after round three with a statement describing the impact of NHS reforms. A number of themes in which more than 70% of the respondents agreed or strongly agreed that the NHS reforms have had an impact on the provision of children’s services in England emerged from the data. These included the questionable benefits and long-term value of audits, the sensitivity of payment by results tariffs, the adverse effects of the reconfiguration of clinical services, the vulnerability of the role of the clinical nurse specialists whose added value is not recognized in the tariffs and the difficulties in implementing the common assessment framework among others.