Written by Alison Firth, Head of Health Policy and Dr Ronny Cheung, Officer for Health Services
Turn your mind back six months to September 2024 – you might remember it was a big month in the health policy calendar. Kicking off the month, on 5 September, RCPCH published our flagship report on child health services. The timing was critical – we had a new government fresh back from summer recess, and we wanted to make sure child health services reform was top of their agenda.
Which is why we couldn’t believe our ears when, just days later, we heard the Prime Minister Sir Keir Starmer saying, “But perhaps Lord Darzi’s most damning finding is about the declining physical and mental health of our children.”
The publication of Lord Darzi’s Independent Investigation of the NHS in England we hope will turn out to be a seminal moment for child health. All too often, we see government health policy documents focus on the health needs of adults. As a result, children are waiting longer than adults to access healthcare, paediatric services are not recovering at the same rates as adult services, and there is a growing gap between child health services demand and capacity.
Lord Darzi highlighted in particular that:
- Children and young people are 24% of the population and account for only 11% of NHS expenditure.
- As of June 2024, more than 1 million people were waiting for community services, including more than 50,000 people who had been waiting for over a year, 80 per cent of whom are children and young people.
- There has been a surge in multiple long-term conditions, and, particularly among children and young people, in mental health needs.
- Fewer children are getting the immunisations they need to protect their health.
Our Blueprint for Child Health Services echoed this and more. And it proved to be incredibly timely. Shortly after the Darzi Review came the announcement of a new 10 Year Health Plan. The Blueprint opened several doors at the Department of Health and Social Care and NHS England, as our policy and public affairs teams took forward conversations to ensure our recommendations were front and centre of the minds of decision makers as well as key partners across the health.
Our conversations have made a difference.
In the first three months of this year, we have secured major wins in the form of government commitments including:
- That elective care must be delivered equitably and inclusively for all adults, children, and young people
- That Integrated Care Boards (ICBs) plans should reflect the needs of all age groups, including children and young people
- Publication of explicit guidance on neighbourhood multidisciplinary teams for children and young people, with use of the Connecting Care for Children model as a key exemplar framework.
We recognise that these commitments are just the start, but there is no doubt they represent a significant shift in thinking at the highest levels of decision-making in government. They will begin to set a stronger foundation for our child health services and ensure children and young people receive the equity of investment they deserve in comparison to adults.
Below – under the Blueprint’s themes – we reflect in more detail on these commitments as well as other recent steps forward and share what the College thinks needs to happen next.
Fair funding for children
Over the past six months, we have seen some increased visibility of children and young people in national health reform initiatives. In particular, we’ve been pleased to take part in positive engagement on developing metrics for the Government’s Health Mission, ensuring the commitment made to raising the healthiest generation of generation ever becomes a reality.
As the saying goes, “what gets measured gets managed”. Defining the right metrics is a key step in the journey to ensuring that all national health funding commitments include a specific proportion that is allocated to children’s health services. We are continuing our advocacy efforts through the government’s spending review process that is currently ongoing and due to report in June.
Children prioritised by Integrated Care Systems
We know from experience that when children are not specifically mentioned in policy and funding plans, they are often forgotten about completely. The NHS England 2025/26 priorities and operational planning guidance for the first time explicitly mandates that Integrated Care Board (ICB) plans should reflect the needs of all age groups, including children and young people. We called for this in our Blueprint and have been pushing decision-makers on this point since, so welcome this as a significant step forward.
As a next step, we must ensure that the inclusion of children in plans is not simply a tokenistic measure. We are now developing a local influencing strategy, with plans to involve our network of members across England, to ensure Integrated Care Systems urgently deliver on the guidance set out by NHS England.
A sustainable child health workforce
The recent announcement of a postgraduate training review marks a step towards building a sustainable child health workforce. We hope this will prove to be an opportunity to improve training and retention, support lifelong careers and tackle increasing burnout. We’ve also had positive engagement with the 10 Year Health Plan's "People" workstream, which aims to address the workforce challenges facing the NHS, and were pleased to be invited to input directly into their work as the national voice for the paediatric workforce.
Looking ahead, our advocacy efforts will focus on the Long Term Workforce Plan, ensuring that the needs of the child health workforce are prioritised, alongside calling for a dedicated child health workforce strategy which takes a whole system approach to recruitment and retention.
Improve data and digital solutions
Progress has been made in the realm of data and digital solutions with the Children's Wellbeing and Schools Bill, which moves forward the development of a single unique identifier. This is further supported by the 10 Year Health Plan, which emphasises the importance of making better use of technology in health and care by setting “analogue to digital” as one of the three key shifts for the future.
We must continue to ensure that technological advancements are inclusive and equitable and focused on the needs of children and young people. At a basic level, ensuring the digital red book is taken forward and expanded will provide all professionals with a full picture of a child’s health as they move between services. The College has also recently launched a digital solutions survey to gather insights and feedback from our members, which we have shared with the 10 Year Plan team, and will make the results available publicly soon.
Reduce pressure on urgent and emergency care
In January we welcomed the publication of the latest NHS England Elective Reform Plan, which emphasised that delivering the 18-week standard and reforming elective care must be done equitably and inclusively for all adults, children, and young people. In our Blueprint, we called for equity in recovery for children’s waiting times in line with adults, and this plan is a welcome step in that direction.
Now the hard work starts to turn this four-year plan into tangible reality and transform child health services from being left behind to leading the way. After 18 months of focused work, our refreshed RCPCH Standards for Children and Young People in Emergency Care Settings will be published this summer, which will further guide our advocacy efforts in driving improvement in these settings.
Reinvest in community health services
The community shift outlined in the 10 Year Health Plan aims to provide more care closer to home and reduce the reliance on hospital-based services, and will surely bring welcome investment into these overstretched services. We’ve had a sneak peek of what this looks like in the form of the NHS England Neighbourhood Health Guidelines, which pleasingly state that the focus in 2025/26 should be supporting adults, children and young people with complex health and social care needs who require support from multiple services and organisations.
While this is welcome, community waiting lists require urgent attention, and we continue to advocate for a specific target to address this issue, including development of a dashboard that highlights these waiting times at ICB level in comparison to the national picture. The 10 Year Health Plan's shift to focus on community health services is a promising development, but the devil will be in the detail. Our advocacy efforts going forward will be on ensuring that neighbourhood health services effectively meet the specific needs of children and young people.
Improve the interface between primary and secondary care
National NHS England guidance on multidisciplinary teams (MDTs) for children and young people is now available, with the Connecting Care for Children model serving as a key framework. This is a fantastic development. RCPCH has been calling for this since 2018, as part of our influencing work for the NHS Long Term Plan with renewed calls made more recently as part of our Blueprint report. Improving collaboration and communication between primary and secondary care is crucial for ensuring seamless and coordinated care for children and young people.
We hope to see funding put behind this guidance through the 2025 Spending Review to support local areas with taking forward its implementation. The College has a role to play in supporting the workforce involved in these multidisciplinary teams, and we will maintain our ongoing conversations on improving paediatric training for the wider child health workforce. Work is also underway to refresh our Facing the Future Standards to support these national policy changes.
Next steps
As we continue to build on these successes, we remain committed to ensuring that every child and young person receives the highest standard of care including through better support for the paediatric and wider child health workforce.
The findings of the Darzi Review confirmed the concerns our members have been raising for years - our child health services are in crisis. Our Blueprint report provides a pathway to recovery, and we will continue to work with government ministers as they take forward plans for the NHS. The 10 Year Health Plan provides a valuable framework for guiding our efforts and we are working hard to ensure that the needs of children and young people are at the forefront of the plan.
Given the last six months of progress, at RCPCH we remain hopeful that the government is now recognising that investing in paediatric services and the child health workforce is fundamental to the future health and economic wellbeing of our society.
The RCPCH Policy and Public Affairs teams, including our valued Officers without whom none of this is possible, look forward to working with and for our wider membership to make the next six months even more productive for children and for the child health workforce than the last six have been.