Editorial
Unicef/NYHQ2012-0218/Romenzi
Protecting children in conflict
For the full UN report see http:// www.un.org/ga/search/view_ doc.asp?symbol=S/2014/31
The UN Convention on the Rights of the Child states that children have rights to protection, health, education, and fair treatment. For the children killed, tortured, raped, and abused in conflicts, these rights are far beyond reach. Last week, a report of the UN Secretary-General on the situation of children and armed conflict in Syria detailed grave violations against children, committed by all parties. More than 10 000 children are estimated to have been killed since March, 2011, many more injured, and countless psychologically affected. The document contains reports of the imprisonment, torture, and murder of children, and their exposure to unthinkable cruelties. Sexual violence is used to harm, humiliate, and intimidate young victims and those forced to witness. Children have been recruited into warfare, abducted for ransom, and used as human shields. They have lost families, homes, schools, and health care. Tragically, similar reports have surfaced from other nations gripped by conflict. Brutality against children in the Central African Republic is said to be at unprecedented levels; children are being beheaded and maimed amid
widespread sexual violence, and an estimated 6000 are associated with armed groups. For children who escape conflict, the psychological scars from witnessing horrific events endure. In South Sudan, orphaned and displaced children will struggle to find their emotional needs met in a country battered by decades of civil war, many living in camps where their security and health are threatened. Children born as refugees might not have birth certificates, crucial to ensure they can access their rights. By committing atrocities to children, fighters destroy their nation’s future. Damage to children’s health, education, and psychological wellbeing will delay a country’s recovery; without decisive action, a generation in every war zone could become the lasting casualties. Better protection of children is paramount. The Syrian Government has legislated greater child protection, but violations threaten to continue while war lasts. During the conflicts and the aftermath, international communities must seek to heal emotional wounds and safeguard children’s rights. The Lancet
Getty Images
The Francis report: a year on
For the Nuffield Trust report see http://www.nuffieldtrust.org.uk/ sites/files/nuffield/ publication/140206_the_ francis_inquiry.pdf
576
In February, 2013, the second and final report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, chaired by Robert Francis QC, was damning in its conclusion: “failings at every level” of the NHS had allowed appalling cases of care to continue at the hospital for nearly a decade. The Francis report made 290 recommendations for change to put the patient at the heart of everything the NHS does. A year on, what progress has been made? In a new report, the Nuffield Trust assesses changes at the hospital level based on a survey of a third of England’s acute care trusts and in-depth interviews with senior members of staff. The report found many trusts engaging in internal and external initiatives to understand and improve the quality of care in response to the Francis inquiry and several other linked reports that followed (eg, Bruce Keogh’s mortality review). Trusts reported using different data sources and sources of intelligence to track the quality and safety of care, including internal peer review of specific wards and specialties, meetings with complainants and their families, and use of a wide
range of metrics to monitor basic aspects of care such as falls, pressure ulcers, and staffing levels. However, the trusts noted that the tensions between financial performance and quality of care that were, in part, responsible for the Mid Staffordshire care scandal still existed, and had even intensified since funding for the NHS has been frozen in real terms since 2011–12. Trust leaders felt that the multiple sources of external scrutiny they faced along with financial and performance targets (eg, waiting times) were leading to pressure on their teams, which could undermine work to improve and manage services. The lessons learned from Mid Staffordshire have resulted in clear actions in acute trusts. Whether these activities lead to better patient care needs to be monitored closely, as does the existence of genuine cultural change among staff and the wider NHS system. The need to continue to strive for improvement comes at a time of massive service reorganisation and increasing financial difficulty. The challenges are immense but the overriding aim—to value the patient first and foremost— must never be forgotten. The Lancet www.thelancet.com Vol 383 February 15, 2014
Unicef/NYHQ2012-0218/Romenzi
Protecting children in conflict
For the full UN report see http:// www.un.org/ga/search/view_ doc.asp?symbol=S/2014/31
The UN Convention on the Rights of the Child states that children have rights to protection, health, education, and fair treatment. For the children killed, tortured, raped, and abused in conflicts, these rights are far beyond reach. Last week, a report of the UN Secretary-General on the situation of children and armed conflict in Syria detailed grave violations against children, committed by all parties. More than 10 000 children are estimated to have been killed since March, 2011, many more injured, and countless psychologically affected. The document contains reports of the imprisonment, torture, and murder of children, and their exposure to unthinkable cruelties. Sexual violence is used to harm, humiliate, and intimidate young victims and those forced to witness. Children have been recruited into warfare, abducted for ransom, and used as human shields. They have lost families, homes, schools, and health care. Tragically, similar reports have surfaced from other nations gripped by conflict. Brutality against children in the Central African Republic is said to be at unprecedented levels; children are being beheaded and maimed amid
widespread sexual violence, and an estimated 6000 are associated with armed groups. For children who escape conflict, the psychological scars from witnessing horrific events endure. In South Sudan, orphaned and displaced children will struggle to find their emotional needs met in a country battered by decades of civil war, many living in camps where their security and health are threatened. Children born as refugees might not have birth certificates, crucial to ensure they can access their rights. By committing atrocities to children, fighters destroy their nation’s future. Damage to children’s health, education, and psychological wellbeing will delay a country’s recovery; without decisive action, a generation in every war zone could become the lasting casualties. Better protection of children is paramount. The Syrian Government has legislated greater child protection, but violations threaten to continue while war lasts. During the conflicts and the aftermath, international communities must seek to heal emotional wounds and safeguard children’s rights. The Lancet
Getty Images
The Francis report: a year on
For the Nuffield Trust report see http://www.nuffieldtrust.org.uk/ sites/files/nuffield/ publication/140206_the_ francis_inquiry.pdf
576
In February, 2013, the second and final report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, chaired by Robert Francis QC, was damning in its conclusion: “failings at every level” of the NHS had allowed appalling cases of care to continue at the hospital for nearly a decade. The Francis report made 290 recommendations for change to put the patient at the heart of everything the NHS does. A year on, what progress has been made? In a new report, the Nuffield Trust assesses changes at the hospital level based on a survey of a third of England’s acute care trusts and in-depth interviews with senior members of staff. The report found many trusts engaging in internal and external initiatives to understand and improve the quality of care in response to the Francis inquiry and several other linked reports that followed (eg, Bruce Keogh’s mortality review). Trusts reported using different data sources and sources of intelligence to track the quality and safety of care, including internal peer review of specific wards and specialties, meetings with complainants and their families, and use of a wide
range of metrics to monitor basic aspects of care such as falls, pressure ulcers, and staffing levels. However, the trusts noted that the tensions between financial performance and quality of care that were, in part, responsible for the Mid Staffordshire care scandal still existed, and had even intensified since funding for the NHS has been frozen in real terms since 2011–12. Trust leaders felt that the multiple sources of external scrutiny they faced along with financial and performance targets (eg, waiting times) were leading to pressure on their teams, which could undermine work to improve and manage services. The lessons learned from Mid Staffordshire have resulted in clear actions in acute trusts. Whether these activities lead to better patient care needs to be monitored closely, as does the existence of genuine cultural change among staff and the wider NHS system. The need to continue to strive for improvement comes at a time of massive service reorganisation and increasing financial difficulty. The challenges are immense but the overriding aim—to value the patient first and foremost— must never be forgotten. The Lancet www.thelancet.com Vol 383 February 15, 2014
