The Royal College of Paediatrics and Child Health (RCPCH) calls on policymakers to use the opportunity of the NHS long term plan to improve health for children and young people, as the report predicts that in England, by 2030:
- mortality rates are set to be 140% higher for infants than in comparable wealthy nations
- reported mental health problems may increase by 60%
- A&E attendances among children and young people likely to increase by 50%
- nearly one-third of England’s most deprived boys will be obese.
A properly funded health strategy which could transform the life chances of children and young people is needed urgently if England is to stem the predicted rises, says the country’s most senior paediatrician.
The Child health in 2030 in England: comparisons with other wealthy countries report, published today by the RCPCH, the professional body serving more than 18,000 paediatricians, compares England with European and other western countries known as the EU15+.
Using long term historical data to project outcomes for children and young people’s health in 2030, it concludes that whilst England is middle of the pack for some outcomes, on the majority England is likely to fall further behind other wealthy countries over the next decade.
Infant mortality in England and Wales rose in 2015 and again in 2016, reversing the 100-year decline in one of the key indicators of population health. This report reveals that even if infant mortality begins to decline again at its previous rate, infant mortality rates could be 80% higher than the average across the EU15+ in 2030. If mortality continues the current ‘stall’ then it will be 140% higher in 2030.
Professor Russell Viner, report author and President of the Royal College of Paediatrics and Child Health (RCPCH), said:
“This report shows that England currently has poorer health outcomes than the average across the EU15+ in most areas studied, and the rate of improvement for many outcomes is lower than the EU15+. This means that unless current trends improve, England is likely to fall further behind countries of similar wealth over the next decade making it harder to give children the best start in life, receive the care they need and remain healthy into productive, happy adult lives.
“This report clearly identifies the danger on the horizon - but trends shown here are not inevitable. Each of them could be turned around if key actions are undertaken. We acknowledge that admirable action has been taken on some fronts, such as the Government’s Childhood Obesity Plan, which we believe will help to reverse current obesity trends if fully implemented. In childhood diabetes, a focused national strategy has driven major improvements in diabetes control in English children and young people. However, there is more work to be done elsewhere. That’s why it’s hugely encouraging that child and maternal health have been included as a work stream in the NHS England Long-Term Plan. The forthcoming Plan provides a crucial opportunity for improving child health and my message to policy makers is to act now or the consequences are grave.”
The report, which bases projections upon the assumption that recent trends will continue for the next decade, found:
- If infant mortality begins to decline again at its previous rate, rates will be 80% higher than the EU15+ in 2030. If UK mortality continues the current ‘stall’ then it will be 140% higher in 2030
- England and Wales had notably high mortality for one to 19-year-olds for chronic respiratory conditions (e.g. asthma) and epilepsy (2001-2015) - mortality in both conditions is likely to remain substantially higher than the EU15+ average if current trends continue
- Key risk factors for infant mortality are higher in England than in comparable countries – it has higher proportions of young mothers and higher proportions of smoking during pregnancy than most EU15+ countries. Low breastfeeding rates are also concerning
- Mental health
- Reported mental health problems in England are set to increase by 63% in 2030 if recent trends continue
- Around 30% of 11–15-year-olds in England reported being bullied one or more times in the previous two months - if current trends continue, bullying in England will continue close to or above the average across the EU15+ to 2030
- Obesity: Nearly one-third of England’s most deprived boys will be obese in 2030 if the Government’s Childhood Obesity Plan is not implemented
- Accident and emergency attendances: A&E attendances among children and young people are set to increase by 50% in 2030
- Outpatient attendance: If current trends continue, there will be a further increase of 48% (16.5 million) in outpatient visits by 2030. This is considerably higher than expected from the population increase projected for the same period (5.1%)
Poverty lies at the root of many risk factors for infant mortality as well as other major child health challenges. Children and young people working with the RCPCH have identified poverty as a major area of concern, particularly with regards to its impact on mental health and nutrition.
Professor Viner continues:
“Child poverty is predicted to increase over the next decade, which, if true, may make our predictions under-estimates. Children living in poverty are more likely to be obese, have mental health issues and die early.
“We welcome the opportunity provided by NHS England to work with them on proposing how we can improve children and young people’s health in their Long-Term Plan. This Plan must set out a clear vision for delivering world class health and wellbeing outcomes for our next generation.”
The report also highlights where England is predicted to perform to the EU15+ average. Areas include:
- Self-reported injuries: The UK historically has had low mortality from non-intentional injuries compared with the EU15+, but more rapid declines among other countries means that mortality in the UK is likely to be similar to the EU15+ median by 2030.
- Smoking: Declines in smoking among English young people have been among the most rapid in the EU15+. Projections suggest smoking among young people will be negligible across England and the EU15+ by 2030 if current trends continue.
- Diabetes control: The past five years have seen marked improvement in diabetes control in England. Maintenance of this rate of decline in markers of diabetes control may place England at a similar level to other wealthy countries by 2030.
The Child health in 2030 in England: comparisons with other wealthy countries report makes a series of recommendations. These include:
- Children and Young People’s Health Strategy: NHS England to develop and support the implementation of a Children and Young People’s Health Strategy for England in partnership with key arm’s length bodies and sector agency partners. We recommend that the strategy is delivered by a funded transformation programme led by a dedicated programme board
- NHS system: Sustainability and Transformation Partnerships (STP) and Integrated Care Systems (ICS) offer a real opportunity to have a joined-up collaborative approach to health care planning. We recommend that each organisation appoints a lead for children and that plans are developed and implemented by working with children, young people and families and by working with social care, education, youth justice and the voluntary sector
- Funding: NHS England should ensure that funding designated for expanding children’s services, e.g. for Child and Adolescent Mental Health Services, reaches frontline services in Clinical Commissioning Groups
- Obesity: opportunistic recording of weight and Body Mass Index (BMI) for all children (2-18) once a year
- NHS England must increase capacity and access to specialist weight management services for children and young people
- Tailored health promotion advice and support for women who smoke, are overweight or misuse substances
- Mental health: NHS England must work with Public Health England and local authorities to ensure all maternity professionals and health visitors are trained to identify maternal mental health problems
- Local child and adolescent mental health systems should be commissioned to cover population need using ‘local offers’ so that they are structured around the child or young person, delivered as close as possible to their home and supported by a family-centred approach to care planning and information sharing
- Healthy start: Investment in health visiting and school nursing services must be increased and protected.
Professor Viner concludes:
“If we are to turn the tide on these predictions, development of a Children and Young People’s Health Strategy for England and funding for a transformation programme to lead improvements in children’s health will be essential.”