Ahead of the general election on 8 June 2017, we examine the big issues around health and care.
What’s the issue?
The UK is making progress on a wide range of health indicators for infants, children and young people – for example, infant mortality has improved significantly since the 1970s. But the rate of improvement has tailed off in recent years, particularly in comparison to other countries. The UK has slipped down international league tables, especially for infant mortality (from being among the best, the UK is now 15th out of 19 comparable countries) and for non-communicable diseases. The birth rate in the UK is rising (unlike in most comparator countries), which, with the increasing prevalence of long-term conditions among children, may make this deteriorating performance even starker over the next 20 years.
The UK also performs poorly in a number of other measures of health, such as rates of childhood obesity or attainment of immunisation targets. It is not all bad news though: for example, young people’s health-related behaviours such as smoking and drinking have improved markedly (even though the reasons for this are not well understood), and so have cancer survival rates.
What’s behind this?
Health and wellbeing in childhood are particularly important for public policy, because there is a wealth of evidence that they influence or determine health in the next generation of adults. Early years have a particularly strong influence, not only in laying the foundations for future health but also in relation to other issues such as educational attainment and social problems.
It is not safe to assume that the issues affecting children and young people’s wellbeing, and their experience of them, will be the same as those affecting adults. As a result, policy development may need information to be collected directly from children and young people about their lives.
The health of infants, children and young people is heavily affected by, and interdependent on, a wide range of social, economic and environmental factors: clinical services and care are only part of the picture. There’s a case for considering children’s health and wellbeing in all areas of policy, but currently there is no overarching national strategy with responsibilities spread across the NHS, local authorities, Department of Health, Department for Education and Ofsted.
Furthermore, key policies such as the current plan for reducing childhood obesity have been criticised as insufficient, services for children and young people experienced larger funding cuts than any other area of public health in 2016/17, and children’s services do not feature in most sustainability and transformation plans (STPs). Reductions in local authority budgets have notably affected SureStart centres (which support health and development in early years), and the number of health visitors in post has reduced (and caseloads have gone up for those remaining). In hospital services, there are concerns that there are too few paediatric consultants, trainee doctors and advanced nurse practitioners.
Child and adolescent mental health services have been identified by the Secretary of State for Health as ‘the single biggest area of weakness in the NHS’ and are now being prioritised. Additional funding has been promised, and proposals for mental health significantly outnumber those for any other aspect of child health in NHS England’s Next steps on the NHS five year forward view.
Inequalities in child health, and its socio-economic determinants, are perhaps the most concerning problem. The last government’s manifesto made pledges to reduce child poverty, but it is actually increasing, with 30 per cent of children in the UK living in poverty after housing costs in 2015/16. There are notable differences between advantaged and disadvantaged children’s health and life expectancy. Failure to improve this would mean that health inequalities persist into the next generation.
The King’s Fund view
A key test of public policy is how well it addresses the needs of future generations as well as those of the current one. This requires explicit consideration of the needs of infants, children and young people, without assuming that these will be the same as adults’.
Progress is currently slipping in some areas and there is a need to reinvigorate policy to protect and improve children’s health. New ideas, and clear leadership, are needed.
Improving the health and wellbeing of infants, children and young people is not just about clinical and care services or health promotion. It needs to be reflected in broader economic and social policy, including housing, education and welfare benefits. The partnerships and interfaces that are needed for this are different to those for adults and require a particular style of leadership. It is particularly important to prioritise action on inequalities in child health.