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Guest authors bring different perspectives and diverse voices to our blog. They do not always represent the views of The King’s Fund.


Putting the care back into health care means treating children as people not statistics


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    Rukshana Kapasi

As health care specialists, we spend a huge amount of time considering, empathising with, and addressing the needs of the people we want to help. We intimately understand the challenges children and young people face, and how these may impact their health and development long term.

Exposed daily to this kind of emotional and physical distress, it can be easy for compassion fatigue to creep in. Our brains work automatically to protect our own mental health, almost desensitising us to the trauma experienced by others.

It’s much easier to think of people as statistics, especially when it comes to children and young people. But the more we think in terms of statistics, the more immune to them we become, the more empathy we lose and the less potential there is for an effective, caring health care system that works well for everyone.

We need to put the care back into health care.

Chronic underinvestment in children’s health and social care, the Covid-19 pandemic and its aftermath, and the enduring cost-of-living crisis have all combined to create a crisis that means children growing up with disadvantage are increasingly more likely to experience ill health.

As child poverty deepens, health inequalities become more and more entrenched.

Barnardo’s research A crisis on our doorstep reveals that one in five parents (20%) said their child’s physical health had worsened due to rising costs of living, while the high cost of heating means that children living in cold, damp homes are more likely to have illnesses in later life.

The cost of living is leading to more children needing hospital treatment for issues including malnutrition and poor oral health, and one in five 8–25-year-olds now has a probable mental health condition.

The average height of a 5-year-old in the UK has slipped 30 places in the world rankings due to poor diet and living standards – and the number of children on paediatric waiting lists is at a record high.

The data illustrating the depth of the crisis in children’s health seems to be limitless, so it’s no wonder a sense of hopelessness pervades the sector, even though we know that behind every figure is a family.

But bringing health back to a human level is easier said than done when health care providers are working within a broken system. Children and young people are the starting point for building healthy lives, so investment needs to start with babies, children, young people and families.

Barnardo’s partners in integrated care systems (ICSs) across the country often say they feel there’s only so much they can do at an NHS provider level without joined-up action and ambition across the sector.

But there are examples of where things are being done differently. Through the children and young people’s Health Equity Collaborative, Barnardo’s and University College London’s Institute of Health Equity are working with three regional ICSs in England to identify ways to overcome the barriers to being mentally and physically healthy. The ICSs involved have reported that early intervention and prevention with children now has a greater priority in their integrated care boards and integrated care partnerships.

“Children and young people are the starting point for building healthy lives, so investment needs to start with babies, children, young people and families.”


The partnership will develop a framework to underpin action for greater equity in children and young people's health and wellbeing, and data indicators will be used to support the development of pilot interventions in the three partner ICS areas. Benefits are already being reported. For example, Birmingham and Solihull Integrated Care System now works with children and young people to learn from their experiences, help them overcome the challenges they are facing and, importantly, give them the opportunities to influence change.

Its top 100 suppliers will soon come together to use the Birmingham and Solihull ‘health pound’ to bring social value back to children through direct investment for internships and apprenticeships to encourage better and brighter futures.

South Yorkshire Integrated Care Board is prioritising early intervention and prevention with a two-year pilot project supporting pregnant women, birthing people and families in its four most deprived neighbourhoods. These services will apply a holistic family intervention model, connecting to Family Hubs and interventions provided by midwifery services and the Healthy Child Programme. It will provide antenatal education, support with sleep, debt management, social prescribing and a link to existing services, including healthy lifestyle groups and local community support groups.

Cheshire and Merseyside Integrated Care Board is supporting an upstream, evidence-based, three-year population health programme that will include increasing access to toothpastes and toothbrushing, targeted towards children most at risk of dental decay, and developing a supervised toothbrushing scheme at scale.

These are steps on the right path towards a resilient and sustainable health care service and show how we can work to improve outcomes for children and young people.

The formation of ICSs presents a real opportunity to focus on the building blocks of health for babies, children and young people. The examples above demonstrate the value of a collaborative approach that puts the voices of children at the heart of strategy, service design and delivery.

Local systems know their communities best and can work in partnership to build trust and create accessible services that meet local need. But to be successful, they need strong national direction and support that incentivises these kinds of innovations.

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