RCPCH responds to the initial report of the Major Conditions Strategy

In June 2023, we responded to the Department of Health and Social Care call for evidence for the Major Conditions Strategy. On 14 August the government published an interim report that sets out the case for change and the strategic framework for the development of the final strategy.
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The strategic framework focuses on:
  • Primary prevention – acting across populations to reduce risk of disease
  • Secondary prevention – halting progression of conditions and risk factors for individuals
  • Early diagnosis – identifying health conditions early to make treatment quicker and easier
  • Prompt and urgent care – treating conditions before they become crises
  • Long term care and treatment – in both NHS and social care settings

In response to the report, RCPCH President Dr Camilla Kingdon, said:

The type, prevalence and severity of illnesses experienced by children are very different from those in adults. This is why from the offset we were deeply concerned about the Major Conditions Strategy, which despite replacing several key health strategies for children, is starkly adult and treatment focused. We are outwardly worried about how children would fit into the strategy but moved forward in good faith and engaged with the call for evidence with clear inputs and recommendations for children, young people, and their families. However, having read this interim report, we are no more reassured. The Secretary of State says, in the Foreword, that the intention is to ‘ensure the NHS is still there for us in 75 years’. We believe that the only way to ensure the NHS survives is by tackling the roots of ill-health, which are invariably found in childhood.

The report reiterates existing policies alongside non-specific ambitions on prevention and inequalities. It is positive that this initial report mentions a life course approach, but it is unclear what specific policies will be implemented to support this, especially for children and young people. It is also positive that elements of the 10-year mental health and cancer plans have been incorporated into this initial report, however we worry that in blending these individual streams of work into one overarching strategy, important child focused details have been lost or overlooked. For example, the section on chronic respiratory disease goes into great detail on smoking cessation and tobacco control but makes no mention of childhood asthma. Asthma is the most common long-term condition among children and young people and is one of the top ten reasons for emergency hospital admission in the UK. This is a damning omission that points to a wider trend of children and young people being forgotten about in health policy.

Ultimately, the College reiterates our call for a separate and meaningful Child Health and Wellbeing Strategy to address and prevent the worsening of poor health outcomes for children. Moreover, much more work needs to be done in order to make this particular plan workable in the long-term, starting with adequately including the needs of children and young people. In the final strategy we must at the very least see a specific plan of action to reduce glaring health inequalities, most of which start in childhood, a detailed section on what each of the major conditions mean for children (where relevant) and clear engagement with children, young people, their families, and those working within child health to fully understand their experiences and address their unique set of needs.