- Consistent funding targeted to areas of early intervention
- A better understanding by systems of the gaps in provision of care and treatment for their population to ensure that local areas can meet the needs of their children
- Improved management of demand
- Better communication with children and their families
- The health and wellbeing of a nation’s children has been described as the best predictor of its future prosperity; failing to ensure good, safe care for our children today also risks failing their future.
In response, Professor Steve Turner, RCPCH President said:
The CQC’s latest report paints an alarming picture of child health services across England, with rising need, increasing waits and poorer outcomes. As a nation we are failing our children. Despite the best efforts of paediatricians and the wider child health workforce, the CQC’s assessment is a clear message that not enough priority has been given to recover child health and care services post pandemic.
In our blueprint for child health services, published last month, the College highlighted the risk of cementing a two-tier healthcare system where services for children are left behind and fare worse than adults. This report provides stark evidence that this is already happening. We have a window of opportunity to address this now, and our blueprint suggests how this could be achieved.
Strengthening child health services must also mean greater clarity on support for the existing child health workforce as well as plans for the paediatricians of the future. The government’s ambition to shift from hospital to the community and from treatment to prevention cannot be achieved without addressing today’s gaps in the child health workforce, such as the dramatic decrease in the number of health visitors the CQC have today highlighted. Our College is calling for a specific child health workforce strategy to address the challenges across the workforce, including those faced by paediatricians.
It is right that the CQC have today called for a greater focus on children and young people’s services. The College stands firmly behind this call. With a renewed focus we can turn this around and just last month we presented the UK government with a series of practical solutions that will enable them to deliver on their commitment to raise the healthiest generation of children. Next week’s budget will be the first real test of the government’s commitment to this ambition, and we now look ahead to the Chancellor’s statement. Children are 25% of the population and 100% of the future population; we need to look after them.
Report findings
The report covers findings across a range of relevant areas for the College: access and waiting times, secondary care, community health services, workforce, dental care, health inequalities, autism and learning disabilities, patient safety, integration and local systems, equality, diversity and inclusion and sustainability. Specific findings include but are not limited to:
Access and waiting times
- The CQC has concerns that children and young people are not always able to access services in a timely way – both planned and in an emergency.
- The number of children on waiting lists for paediatric services has increased by 7% in the past two years, with the number waiting more than 18 weeks increasing by 32% over the same period.
- The waiting list for children and young people needing community health services has increased. It has increased more in the same period than adults – by 32% (adults 22%) from 214,220 to 282,240, although this is partly because services were added to the list in Feb 2024. The number of health visitors, who give individual support for young children and their parents, has declined by 45% over the last 9 years.
- Waiting time to begin assessment for a possible autism diagnosis is far too long, with average waiting times even longer for children and young people – 356 days in April 2024 compared with 238 days for adults.
- Crowded emergency departments meant waiting areas did not always assure the safety of children and young people. In one case, staff could not ensure appropriate visual supervision or carry out risk assessments and mitigate risks in waiting areas.
Children’s mental health
- Demand continues to rise with ever increasing more numbers seeking care and support for their mental health.
- In 2023, 1 in 5 children and young people between the ages of 8 and 25 were estimated to have a mental health disorder.
- Between June 2022 and June 2024, the number of children coming in contact with mental health services increased by 29%, but the number of interactions they had with mental health services only increased by 11%.
- Results from CQC surveys show that children and young people had a worse experience than adults and faced long waiting times at all stages of care. This included waits for initial assessments, diagnoses, medicines, and therapies.
- The safety of mental health wards continues to cause concern. Lack of resources, ageing estates and poorly designed facilities can lead to issues around privacy and dignity for patients, as well as compromising the safety of both patients and staff.
Dental care
- Parents flagged they found it difficult to get appointments, even in emergencies, and we heard about children left in pain while waiting for an emergency appointment.
- Proportion of parents and carers saying they had difficulty accessing NHS dental services for child was higher (31% for parents compared with 23% of the general population).
- There are major issues of deprivation when it comes to dental care. It is notable that the tooth extraction rate related to decay is nearly 3 and a half times higher for children and young people in the most deprived communities, compared with the most affluent.
- Schoolchildren living in the most deprived areas were more than twice as likely to experience tooth decay than those living in the least deprived areas.
- EDI and sustainability
- Between March 2018 and March 2023, the proportion of staff from ethnic minority groups increased from 19% to 26%. The report highlighted data from the 2023 NHS staff survey showing that staff from ethnic minority groups are still considerably more likely to experience discrimination, compared with staff in white ethnic groups.
- There is evidence in the report that steps are being taken across Trusts and local systems to help the NHS reach net zero by 2045.