The Platt Report, officially known as Welfare of Sick Children in Hospital (Ministry of Health, 1959), was a report that was the result of research into the welfare of children who were undergoing medical treatment within the UK and to make suggestions that could be passed on to the hospital authorities that would improve their welfare during hospital visits. The report was named after Sir Harry Platt, who was the President of the Royal College of Surgeons. Platt produced the report at the behest of the Ministry of Health in the UK government. The recommendations in the Platt Report, provided the means by which a child trauma ward of a hospital should be planned for children. Established on 12 June 1956, the committee that was to produce the report defined their remit as: To make a special study of the arrangements made in hospitals for the welfare of ill children – as distinct from the medical and nursing treatment – and to make suggestions which could be passed on to hospital authorities.
The findings of the report by the committee was that hospitals were miserable places for children, and while in hospital, they had to follow strict ward routines, and were not allowed to play. Moreover, the most grievous of the findings, was that parents were under no circumstances, allowed to visit their children outside visiting hours.
Function Membership of the report committee included two surgeons, two physicians, one nurse, and one Registered Sick Children Nurse. From its lifetime of 1956 to 1958, the committee met 20 times to consider both written and oral evidence, taken from a number of organisations including the Royal College of Physicians and Surgeons of Glasgow, Royal College of Physicians, Royal College of Nursing, the Tavistock Institute and the National Association for Maternal and Child Welfare.
The British Medical Journal confirmed in an article on 18 November 1961, that on the previous 9 November, that in reply to a question, in the House of Commons, the Minister of Health, Enoch Powell, accepted the report: The government, with the agreement of the medical profession, accept the main principles of the report.
Summary The Platt Report recommended that children should have unfettered access to their parents while ill. The National Association for the Welfare of Children in Hospital (NAWCH) had consistently campaigned over many years for the same position, and conducted ongoing monitoring of the effects of the report. In 1982, the NAWCH conducted a survey throughout England. The survey found that progress was slowly being made and 49% of wards studied allowed unrestricted access for parents. The survey also looked at where children were being nursed and found that despite the recommendations of the Platt Report being broadly accepted by the government in 1959, 28% of children were still being nursed on adult wards. Whilst it may have been anticipated that the parents denied open access to children were those whose children were being nursed on adult wards, the survey shows that 48% of children's wards still did not have open access. The children who fared worse were children on ear, nose and throat wards with 24% being denied visits on the day of operation and with many spending up to 36 hours away from their parents.
Changes occurred rapidly from the 1980s onwards, due to a new generation of doctors and nurses who were sympathetic to the recommendations of the report. A follow-up study by NAWCH during 1986 showed great improvement, although a detailed look at changes in the interim year showed a few instances where small children's units had closed and children transferred to adult wards. The second survey was, however, on the whole very encouraging with 85% of parents having open access and another 4% of parents on open access except on operating day.
With the introduction of the Leiden charter in 1988 from the European Association for Children in Hospital that became a working framework for national paediatric organisations in Europe and the creation of the Convention on the Rights of the Child formalised the Platt report recommendations at the international level.
By 1993, a report by the Audit Commission, called Children First showed further improvements had been made, but highlighted the needs of adolescents, indicating that the Platt report recommendations had not been fully implemented.
During the first two decades of the 21st century, the re-framing of the idea of family centred care to a child-centred care approach was taking place. This approach was directly influenced by the UN convention, which in turn was driven by the Platt Report recommendations. Without the Platt Report directing policy at the national level within the United Kingdom from the 1950s onwards, it would have been unlikely these changes would have taken place. Even now, the Platt report is still considered relevant to the forming of policy that aims to improve childcare and associated services.
Hospital visiting of sick children 1850–1910 To understand why the Platt Report was produced and put into effect, an examination of the hospitalisation of children, leading up to the mid-1950s must be made. From the 1850s to around 1910, most of the cities in the UK had built their own children's hospitals, which included a large number of prestigious hospitals, e.g. Royal Hospital for Sick Children, Glasgow, Great Ormond Street Hospital and the Royal Manchester Children's Hospital. These were independent institutions funded by voluntary donations, and from research, were shown to be designed for the "deserving poor" largely reflecting Victorian values. Children could only be admitted, if they were sponsored by a letter of recommendation, from a hospital affiliate. The "undeserving poor" were sent to workhouse infirmaries, whilst middle class children were generally cared for, and indeed operated on, at home. These hospitals set their own rules and had their own way of working, including regulating admissions, that often excluded infants and children under the age of two on humanitarian and pragmatic grounds.
The Scottish paediatrician George Armstrong, who established the first British dispensary, in 1769, was against in-patient care, i.e. hospitals for sick children. Armstrong stated: But a very little reflection will clearly convince any thinking person that such a Scheme as this can never be executed. If you take away a sick child for its Parents or Nurse, you break its heart immediately.
Objections to admission were sometimes based on pragmatic reasons, e.g. reducing the threat of cross infection from children with diseases such as typhus, diphtheria and measles, that were a major cause of infant mortality. The voluntary nature of hospitals meant that such outbreaks were very costly. Babies and small children required more nursing care. However, by the 1880s more and more hospitals were accepting children. By the 1870s, the prevalent view among doctors and nurses was that children were better off by being removed to hospital, away from the often poor, unsanitary conditions at home.
There were enlightened people like surgeon James Henderson Nicholl of the Glasgow Hospital for Sick Children, who pioneered day surgery procedures such as Hernia and cleft palate and who stated in 1909 that: [I]n children under 2 years of age, there a few operations indeed that cannot be as advantageously carried out in the out patient departments as in the wards.
Nicholl believed that hospitalisation wasn't necessary, and children were better cared from in their own home, both by their parents and by nurses who made daily visits to the children. Nicholl recognised that "separation from mother is often harmful". However, Nicholl's views were in the exception. For almost 50 years, whether children were in a workhouse infirmary, sanatorium or a hospital, they separated from the mothers and families and only visited, on a very strict visit schedule. By the end of the 20th century, children's hospitals had become depersonalised scientific institutions dominations by both male and female professionals.
1910–1950 With the rise of behaviourism from the 1900s to the 1950s, children were rarely seen as individuals, and they became more of a collective problem to be solved. Behaviourism had many advocates, and amongst the strongest proponents of the philosophy were John B. Watson and Truby King. Watson stated the following advice regarding children: Treat them as though they were young adults. Never hug and kiss them, never let them sit on your lap. If you must, kiss them once on the forehead when they say goodnight. Shake hands with them in the morning ... try it out ... In a week's time you will be utterly ashamed of the mawkish, sentimental way you have been handling it.
King, who promulgated a specific kind of child rearing, advocated that the child had to be breastfed, based on a strict schedule every 4 fours, not to cuddle them, and not to feed babies or children at night, lest they cried and became spoiled. King had become well known, as a child rearing expert during the interwar period, and his advice was widely accepted by the medical community. By the 1920s, hospitals were grim places for children, and only addressed the physical needs of the child, never noticing the emotional and psychological needs.
However, there were dissenting voices, both for those who had started to question the tenets of behaviourism, and those who already recognized the unique link between the child and their mother, who would nurse them in times of ill health and who always felt responsible for the child's recovery. Sir James Calvert Spence began the practice, then unique in Britain, of admitting mothers to hospital with their sick children, so that they might nurse them and feel responsible for the child's recovery. However, as a visionary, Spence was unique in this position, during that period in the 1920s, when he established his resident mother and baby unit in 1926. By the 1930s there were physicians who recognised the need, including Agnes Hunt, who introduced open visiting.
During the interwar period, leading up to World War II, research conducted by people like Harry Edelston and John Bowlby further eroded the importance and veracity of behaviourism. Edelston, a psychiatrist in Leeds, detailed that children were emotionally damaged by their stay in hospital. In 1939, John Bowlby wrote an open letter to the British Medical Journal which criticised government plans to evacuate a million children from towns and cities to the safety of the countryside. Controversially, Bowlby and his co-signatories pointed out in a letter that the psychological danger of removing children under the age of five years, from their mothers far outweighed the dangers of leaving them in cities.
Despite L.A. Perry's 1947 Lancet article, that vigorously protested the restrictions of parental visits on hospitalized children, Edelston wrote in 1948, that many of this colleagues still refused to believe in hospitalisation trauma. Bowlby would later study 44 juvenile thieves and found that a significantly high number had experienced early and traumatic separation from their mother. Bowlby would use the data in 1949 on the delinquent and affectionless children and the effects of hospitalised and institutionalised care in the commission to write a report for the World Health Organization's on the mental health of homeless children in post-war Europe.
In the late 1930s, work by René Spitz, an Austrian-American psychoanalyst, confirmed the findings by Edelston, Bowlby and Perry, specifically deleterious effects of hospitalisation, based on his research with institutionalised children.