Who cares about children? Most of us, I think, including successive governments that have outlined lofty ambitions along the lines of ‘Britain should be the best country in the world for children’, as in the most recent Conservative Party manifesto.
The ethical, scientific and economic case for investing in children’s health is sound, and largely understood and accepted. Health in the earliest years – from pre-conception, through birth and early childhood – lays the foundation for lifelong health and wellbeing. So protecting health during the early years is more important than at any other age, and there’s growing evidence that failure to do so will cost individuals and society dearly. Yet far from being ‘the best in the world’, the UK has one of the highest mortality rates for children and young people in Western Europe; children in the UK are more obese than the EU average; and we lag behind many other rich European countries in reducing poverty and child inequalities (which are vital steps for improving child health and wellbeing).
Just as I couldn’t be rallied to action by the charity worker because I had too many other things to do and spend my money on, in the context of Brexit, austerity, pressures on the NHS and social care, and an unstable political climate, the child health and prevention agenda has to scramble for ‘the political attention it deserves’.
Praise where it’s due, plans to transform mental health support for children and young people are welcome, and over recent years there have been notable improvements in some measured outcomes for children and young people, including smoking, drinking and teenage pregnancy rates. But at the same time, the government hasn’t clearly set out a long-term, cross-departmental strategy for child health, with aspects of its recent child obesity strategy described as ‘unbearably weak’. Children's services have been hit hard by cuts to public health budgets, with valued early intervention services being shut or scaled back, fewer health visitors, and no sign of change – local authority public health services are planning on spending less on 0-5 children's health in 2017/18 than they planned to in 2016/17. Austerity and welfare reforms have disproportionately affected poorer children, and levels of child poverty are increasing. All of which make it considerably more challenging, if not impossible, for local and national governments to achieve the big ambition for children.
Two questions then: first, why don’t ambitions for children seem to translate into positive actions and outcomes? And second, what needs to happen to change this situation?
The King’s Fund recently held a meeting to discuss these questions with some leading child health and behaviour change experts, a parent and young people.
One of the main problems surfaced at this meeting was that the child health agenda is predominantly about prevention – investing in children’s health and wellbeing benefits us all, but at an undisclosed future date. This is a challenge for policy-makers at both a local and national level. Governments ‘bore easily,’ said an Early Education Fellow at the meeting. ‘They’re bad at persistence, work in electoral cycles, and need to lead their own thing, in a new way.’ Unprecedented pressures on the NHS and social care because of rising demand and constrained resources, mean there’s little appetite for commissioners and other decision-makers to divert precious resources for immediate patient and service user needs, into prioritising the prevention agenda.
So, what’s to be done? I want to finish this blog with a clear and simple plan of action, developed with experts at our meeting, to help realise ambitions for children. But I can’t. There’s no easy solution, many questions remain. But it's not impossible.
The UK needs to look to and learn from its European neighbours who rank highly in country comparisons of child health and wellbeing measures. Improvements in some measured outcomes for children and young people deserve more understanding and celebration. ‘If you want to know why teenage pregnancy has gone down, ask us,’ said a young adult at our meeting, but no one in the room was brave enough to trade short-term awkwardness for the opportunity to gain some invaluable insights. Do we need more compulsory child health targets?
At the meeting, there was also consensus that the health, education, social care and youth justice sectors need to work together better. Often the language of health is not helpful for effective cross-sector and cross-departmental working, but how do we get beyond these barriers? And how do we learn from previous attempts to prioritise the health of children and young people that had mixed results?
The Fund has brought together some of its recent work on child health to give it more visibility. But we acknowledge that the Fund hasn’t always given children and young people’s health the focus it deserves. Now, we will commit to giving greater prominence to infants, children and young people in our work, and challenge ourselves on where we can go further. We will ask: how is this discussion, research, report or programme relevant to children? And we will continue to bring together passionate and willing people, with those who can make things happen, to think and debate with us. We welcome your thoughts and ideas.
Finally, there’s a real opportunity for sustainability and transformation plans (STPs) and accountable care systems, to lead the way in improving children’s health and wellbeing. Yet, children are barely mentioned in STPs, again illustrating how children’s health too often falls by the wayside. Changing this, and ensuring that scarce resources are most appropriately allocated to deliver the best outcomes for children, would be a small but important step towards the ambition for Britain to be the best country in the world for children.