The experience of paediatric care closer to home: a place and space perspective

摘要

NHS reforms have sought to ensure that children and young people who are ill receive timely, high quality and effective care as close to home as possible (DH, 2004). This study examined the experience and impact of introducing new, ‘closer to home’ community-based paediatric outpatient clinics from the perspectives of NHS service-users and providers. Twenty-seven interviews conducted with parents and patients (aged 8-16), were analysed using a descriptive phenomenological approach. Thirty-seven interviews conducted with healthcare professionals, were analysed using a thematic framework method. Findings reveal that paediatric outpatient ‘care close to home’ is experienced in ways that go beyond concerns about location and proximity. For families it means care that ‘fits into their lives’ spatially, temporally and emotionally; facilitating a sense of ‘at-homeness’ within the self and within the place, through the creation of a warm and welcoming environment, and by providing timely consultations which attend to aspects of the families’ lifeworld. For service-providers, place and professional identity were closely related, with implicit assumptions made about where high quality of care and clinical expertise were located. Place, time and human relations were thus shown to be meaningful constituents of the experience of paediatric outpatient care. These previously ‘taken-for-granted’ nuances of healthcare delivery have implications for the design and implementation of effective ‘closer to home’ services.