Nav: Home

Government and NHS leaders could do more to encourage collaborative relationships between healthcare

April 03, 2019

The Nuffield Council on Bioethics has published a briefing note outlining the factors that can contribute to disagreements between parents and healthcare staff about the care and treatment of critically ill babies and young children. It concludes that the Government and NHS leaders could do more to foster good, collaborative relationships between parents and healthcare staff across the UK.

The care and treatment of critically ill children often involves complexity and uncertainty. Disagreements can arise between parents and healthcare staff about the best course of action, and sometimes these become entrenched. Recent high-profile court cases in the UK have highlighted the damaging effects that these kinds of disagreements can have on everyone involved.

The reasons why disagreements develop are wide ranging, but include poor communication - such as conflicting messages being given to families by different members of staff, or the use of insensitive language - and delays in seeking resolution interventions, such as mediation.

The Nuffield Council has highlighted areas of action for healthcare policy-makers and NHS leaders that could help to prevent prolonged and damaging disagreements developing in future, or to resolve them more quickly. Overall, the aim should be:
  • good communication between families and staff and an understanding of differing perspectives
  • appropriate involvement of parents in discussions and decisions about the care and treatment of their child
  • timely use of resolution interventions, such as mediation, in cases of disagreement
  • attention to the profound psychological effects that disagreements can have for families and staff.
Professor Ann Gallagher, member of the Nuffield Council on Bioethics, and Professor of Ethics and Care at the University of Surrey says:

"Disagreements about the care and treatment of critically ill children can be extremely distressing for parents and for everybody involved, particularly if the case is referred to the courts. Every situation is different, but we have tried to understand some of the common causes of disagreements by talking to parents, healthcare staff and range of other people with expertise in this area.

"We heard that problems can start early, with poor communication leading to a breakdown of trust, or parents feeling they are excluded from medical conversations about their child. Healthcare staff can feel they are not adequately supported to deal with conflict.

"Although there is a lot of good practice already out there, we think more could be done at a national level to support good, collaborative relationships between families and healthcare staff leading to shared decision-making. We want to prompt policy makers and NHS leaders to think carefully about how the damaging and protracted disagreements that we have seen in recent years can be avoided in future."

Areas of action

The Council suggests that, amongst other measures, those responsible for national policy making in relation to healthcare practice should consider:
  • supporting hospital trusts across the UK to develop processes for recognising and managing disagreements between parents and healthcare staff, such as introducing conflict management frameworks and increasing timely access to resolution interventions
  • making ethics, communication and conflict management training for paediatric healthcare staff more widely available, or even compulsory
  • improving access to and awareness of children's palliative care services.
Amongst other measures, those involved in leading NHS trusts and hospitals should consider:
  • providing parents with a trusted and appropriately trained healthcare professional as a central point of communication
  • exploring ways in which those parents who want to can be more involved in discussions and decisions about their critically ill child, including having access to their child's medical records
  • ensuring healthcare staff involved in disagreements are better supported by, for example, developing conflict management frameworks, providing more psychological support, and protecting them from abuse and intimidation.
-end-
Notes to editors


  • The Nuffield Council on Bioethics is an independent body that has been advising policy makers on ethical issues in bioscience and health since 1991. We are funded jointly by the Nuffield Foundation, Wellcome, and the Medical Research Council.

  • The NHS Long Term Plan, published in January 2019, includes commitments to increasing training and welfare for NHS staff. The summary document states: "We will continue to increase the NHS workforce, training and recruiting more professionals (.....) We will also make the NHS a better place to work, so more staff stay in the NHS and feel able to make better use of their skills and experience for patients.



Nuffield Council on Bioethics

Related Children Articles:

Do children inherently want to help others?
A new special section of the journal Child Development includes a collection of ten empirical articles and one theoretical article focusing on the predictors, outcomes, and mechanisms related to children's motivations for prosocial actions, such as helping and sharing.
Children need conventional CPR; black and Hispanic children more likely to get Hands-Only
While compressions-only or Hands-Only CPR is as good as conventional CPR for adults, children benefit more from the conventional approach that includes rescue breaths.
Cohen Children's Medical Center study: Children on autism spectrum more likely to wander, disappear
A new study by researchers at Cohen Children's Medical Center of New York suggests that more than one-quarter million school-age children with autism spectrum disorder or other developmental disorders wander away from adult supervision each year.
The importance of children at play
Research highlights positive strengths in developmental learning for Latino children in low-income households based on their interactive play skills.
Racial disparities in pain children of children with appendicitis in EDs
Black children were less likely to receive any pain medication for moderate pain and less likely to receive opioids for severe pain than white children in a study of racial disparities in the pain management of children with appendicitis in emergency departments, according to an article published online by JAMA Pediatrics.
More Children News and Children Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Erasing The Stigma
Many of us either cope with mental illness or know someone who does. But we still have a hard time talking about it. This hour, TED speakers explore ways to push past — and even erase — the stigma. Guests include musician and comedian Jordan Raskopoulos, neuroscientist and psychiatrist Thomas Insel, psychiatrist Dixon Chibanda, anxiety and depression researcher Olivia Remes, and entrepreneur Sangu Delle.
Now Playing: Science for the People

#537 Science Journalism, Hold the Hype
Everyone's seen a piece of science getting over-exaggerated in the media. Most people would be quick to blame journalists and big media for getting in wrong. In many cases, you'd be right. But there's other sources of hype in science journalism. and one of them can be found in the humble, and little-known press release. We're talking with Chris Chambers about doing science about science journalism, and where the hype creeps in. Related links: The association between exaggeration in health related science news and academic press releases: retrospective observational study Claims of causality in health news: a randomised trial This...