Healthcare must be more playful to prevent avoidable trauma for children in hospital, warns Starlight

Children are being exposed to avoidable trauma in hospital because too few health play professionals are available and too few healthcare staff are trained to use playful approaches, according to children’s healthcare charity Starlight.1
New Freedom of Information data 2 obtained by the charity shows there are just 177 full-time equivalent health play professionals 3 supporting around 3,282,910 child hospital admissions 4 each year in London – a ratio of approximately one professional for every 18,592 admissions, far below the recommended staffing levels (1:2230).
The findings come as the NHS and Government have committed, through the National Cancer Plan for England 5, to ensure uptake of the NHS England and Starlight Play Well Toolkit 6 by 2027 to improve the experience of children and young people receiving cancer care. Starlight warns that this ambition cannot be realised without increasing specialist health play capacity and investing in training for the wider multidisciplinary workforce.
Health play professionals help children understand what is happening, prepare them for treatment and procedures, reduce fear and anxiety, and support them to cope with painful or unfamiliar experiences. Research 7 8 published by Starlight has shown that positive healthcare experiences during childhood reduce distress, improve cooperation with treatment and can help prevent lifelong healthcare avoidance and mental health problems associated with traumatic childhood healthcare experiences.
Alongside the shortage of specialist staff, Starlight’s FOI also found that only 24% of NHS Trusts in London have dedicated budgets to train health play professionals, limiting the development of the workforce at a time when demand continues to grow.
Starlight is calling on Government and the NHS to invest in both:
increasing the number of specialist health play professionals working across children’s healthcare; and
ensuring doctors, nurses and the wider multidisciplinary team receive training in playful approaches, so every child benefits from child-centred care regardless of where they are treated.
The charity developed the Play Well Toolkit in partnership with NHS England, providing the first national guidance on commissioning, designing and delivering high-quality health play services. The Toolkit sets out recommended staffing levels, service standards and the importance of training all professionals who care for children in the principles of play in healthcare.
Starlight believes that embedding the Toolkit is essential not only for children with cancer, but for every child receiving healthcare. Without investment in people and training, the charity says the ambitions set out in the National Cancer Plan will remain out of reach.
Hari’s story
Hari Owen, aged nine, who lives in north east London, was diagnosed with leukaemia aged four. Hari’s mother Sarah witnessed first-hand the difference therapeutic play made to her son on the rare occasions it was available.
During a gruelling two-and-a-half-year treatment journey, Hari was immersed in a world of surgery, chemotherapy, blood transfusions and separation from family and friends. Sometimes he was completely isolated. He attended hospital 280 times as both an in-patient and out-patient, and endured 130 mostly traumatic blood tests at home, delivered via a needle into a port in his chest known as a Port-a-cath – a small medical device inserted under the skin.
Despite the scale and intensity of his treatment, he received just 17 therapeutic play sessions in hospital just 6% of his hospital visits and none at home.
Sarah recalled: “When health play was available, it had a transformative impact – helping him understand procedures, reducing his fear and distress, and brought comfort during the most frightening moments of his care. But this access was inconsistent and mostly absent, particularly when receiving healthcare at home, despite repeated invasive procedures taking place in what should have been his safest space.”
Sarah was forced to repeatedly fight for access to therapeutic play throughout his treatment – a struggle that exposed the postcode lottery facing families.
“Play was the single most important therapeutic tool for Hari. It brought him comfort, helped him cope, and protected him from some of the trauma of what he was going through,” explained Sarah. “But it was never guaranteed. We had to push for it every time, even though it made such a clear difference. No family should have to fight for something that is so fundamental to a child’s wellbeing. For the team treating him, his medical procedures came first, often to the detriment of his mental health and overall wellbeing, which are so closely linked to recovery.”

Cathy Gilman, Chief Executive of Starlight, said:
“Every child deserves healthcare that is compassionate as well as clinically excellent. Yet for too many children, hospital is frightening, overwhelming and, ultimately, traumatic. We know those experiences can stay with them for life, affecting their mental health and even whether they seek healthcare as adults.
“Play changes that. It helps children understand what is happening, gives them a sense of control, builds trust with the healthcare team and reduces fear before, during and after treatment. It isn’t entertainment and it certainly isn’t a luxury. It is an essential part of safe, effective children’s healthcare.
“The Government has rightly recognised this by committing to the uptake of the Play Well Toolkit in the National Cancer Plan by 2027. But that commitment can only become reality if there are enough specialist health play professionals and if the wider multidisciplinary team is equipped with the skills and confidence to use playful approaches every day.
“If we are serious about improving children’s healthcare, preventing avoidable trauma and giving every child the best possible experience, we must invest in the people and training that make truly child-centred care possible.”