Matthew Dodd and Amanda Allard, co-chairs of the Children and Young People’s Health Policy Influencing Group, outline what the government needs to do to reverse the decline in children’s health outcomes.
We have had years of chronic underinvestment, and there has been a shocking decline in the health of the most disadvantaged children in recent years. Babies, children and young people make up around 25% of the population, yet they only account for 11% of NHS expenditure. As a coalition of over 60 charities and Royal Colleges advocating for action on child health, we were therefore hopeful that the Autumn Budget would bring about the transformative change needed.
We welcome the steps taken in this direction: the Chancellor’s £22bn pledge for the NHS is essential to start rebuilding the health system. But we are disappointed that no measures have been announced to specifically address the huge waiting lists for children’s health services. Children's hospital waitlists have grown to a record high, at times growing at double the rate of the adult waiting times.
In addition to much-needed funding, integrated approaches and different ways of thinking can significantly improve children’s health services. Our Roadmap for the Healthiest Generation of Children Ever, published this Monday, outlines key steps the government must take to ensure babies, children and young people‘s health is prioritised.
Children must be centred in health policy making
The government can only fulfil its ambition for the healthiest generation ever if children are a central pillar of Health Mission and the NHS Ten Year Plan. Their specific developmental and health needs, separate from those of adults, are met through a distinct set of services, staffed by a specialised workforce and underpinned by specific legislation, but they have never been treated equitably in national or local decision-making. The Darzi Review acknowledged that “the patient voice is simply not loud enough”: their experiences must be put at the centre of the policy debate on health.
Prevention must be balanced with focus on long-term conditions, disabilities and palliative care
The Health Secretary has declared an ambition to shift from treatment to prevention – funding children’s health services is integral to this. Evidence shows health inequalities start in the earliest years and widen over the course of childhood and across the life course. The failure to provide children with timely access to services can irreparably damage their health, puts unacceptable pressure on emergency care, and leads to greater demand on resources in the long run.
And while prevention is rightly central to the government’s Health Mission, the needs of children with long-term health conditions and impairments, often caused by non-preventable factors, and those in palliative and end-of-life care, must not be overlooked. These children must receive timely, equitable access to health services that are integrated with other services that they use.
Health systems must be made directly accountable for improving child health
Current accountability for Integrated Care Boards is fragmented and unclear, and national guidance often fails to include system priorities for children. As Integrated Care Systems mature, a clear pathway to accountability for child health, including reformed CQC inspections, must be developed.
The children’s workforce must be renewed
There is an urgent need for a sustainable solution to the shortages in the children’s health workforce, from midwifery and health visiting, through allied health professionals, play specialists and school nurses, to consultant paediatricians. Babies, children and young people need skilled professionals who feel valued and have manageable caseloads. The workforce should reflect the diversity of the communities it serves.
Alongside new recruitment, much more must be done to encourage professionals to stay in the NHS. Professionals who work across all ages, for example GPs, should be supported to maintain and grow their child health capability.
A single unique identifier for children can drive a data revolution
Important information on children’s needs and outcomes is held by many services including health, children’s social care and Early Help, local authority Special Educational Needs and Disabilities (SEND) teams, by police and youth justice services, and by education settings. But the lack of high-quality, shared data means it is hard to have a population health profile and to work efficiently together, for example, between primary care and schools.
Confident sharing of information is the first step in ensuring that services can carry out effective multi-agency working for safeguarding and health and wellbeing purposes. We urge the government to adopt the NHS number as a single unique identifier for children alongside a package of measures to boost workforce confidence.
Only significant reforms to children’s health will help reverse the current decline. If the government wants to keep its pledge to raise the healthiest generation of children, it must commit to a new approach that is inclusive, child-centred and focused on prevention and early intervention. Both investment and fresh thinking are needed.
Read HPIG’s Roadmap for the Healthiest Generation of Children Ever here.
Image credit: iStock
