Lack of focus on health and wellbeing of children in majority of STPs ‘major cause for concern’

The majority of Sustainability and Transformation Partnerships (STP) - the proposals put together by the NHS and local councils to meet the health needs of the local population in 44 areas of England - are failing to take into account the needs of infants, children and young people, according to a review undertaken by the Royal College of Paediatrics and Child Health (RCPCH).

The report The State of Child Health: STP says that while most STP set out the case for change well and cover important key themes such as prevention, early intervention, more care delivered in the community, better mental health services and integrated working, there is a lack of detail underpinning the vision.  It concludes that the lack of profile given to infants, children and young people (who comprise 25% of the UK population) by the majority of STP, is a major cause for concern.

The RCPCH report is based on a review of the 44 published STPs plan, and reveals major deficiencies including: 

  • Lack of a life course approach: The majority of STP do not demonstrate appreciation of the life-long impact of poor health in childhood.
  • Lack of recognition of the needs of infants, children and young people: The majority of STP contain little mention of the health and wellbeing needs of children, except in relation to Child and Adolescent Mental Health Services; though notable exceptions are Birmingham and Solihull, and Greater Manchester, where children are considered a priority, and have set out in detail how they will improve care over the next five years. Cheshire and Merseyside STP hosts the only Acute Care Model Vanguard for women and children and is developing a dedicated work-stream.  
  • Limited engagement with clinicians and the public: To date, STP have not demonstrated that they have met their statutory duties to engage with children, young people and their families, including vulnerable and hard to reach groups, and those with complex needs and disabilities. There has also been limited engagement to date with paediatricians and other child health clinicians. 
  • Workforce shortages: Demand for children’s healthcare is increasing, with the number of hospital admissions for children in England rising by 25% between 2013/14 and 2015/16 and an estimated 241 whole time equivalent (WTE) career grade vacancies (i.e. consultant level paediatricians). STP do not make clear how these serious workforce shortages will be addressed.

Professor Neena Modi, President of the Royal College of Paediatrics and Child Health, said:

“We’re disappointed at the lack of focus on the health and wellbeing needs of infants, children and young people.  It is short sighted and a major cause for concern, that they appear to have been forgotten.  Investing in child health is a hallmark of a mature society committed to securing the wellbeing of future generations; as a healthy child grows into a healthy adult, able to contribute to the economic productivity of the nation, such investment also makes strong financial sense. 

“We’ve found a real lack of clarity around strategic direction, oversight, accountability and responsibility for STP as they evolve. Furthermore, it is highly unlikely that STP, or any new models of care, will be successful given the substantial workforce shortages and major funding constraints that the NHS is currently experiencing.”

The report makes a series of recommendations, including:

NHS England and NHS Improvement must:

  • Ensure that all STP, develop, implement and evaluate a strategic plan which meets the needs of infants, children and young people within their respective geographical footprints. 
  • Define a core set of nationally consistent metrics to be captured by STP, that encompass processes, outcomes and patient experience relevant to infants, children and young people, and set out plans for nationally consistent evaluations of these metrics in order to assess the impact of the new models of care. 

STP must:

  • Have a named, accountable lead for infants, children and young people
  • Have local paediatricians and child health or sector professionals involved in the development and implementation of its plans
  • Have a strategic plan for infants, children and young people; which includes compliance with the NHS England’s digital child health strategy. 
  • Publish a  public consultation  plan which includes the views of children and young people and their families, including children with complex needs and disabilities and those who are vulnerable or hard to reach 
  • Clarify how shortfalls in the paediatric workforce will be addressed 

The RCPCH also makes a series of pledges, including ensuring paediatricians are kept up to date on the progress of STP, advising paediatricians directly involved in developing and implementing STP, and making available an experienced network of families, children and young people to assist in public engagement in the development and implementation of STP.

Professor Modi added:

“Infants, children and young people across the UK deserve a consistently high level of service and care regardless of where they live. STP will need to address specific local needs, and we fully support the emphasis on prevention and the need to deliver more care closer to home. However, there must be central, national oversight of STP performance covering processes, experiences and above all outcomes. Any development must allow data to be recorded and analysed centrally as only then will it be possible to evaluate whether the stark health inequalities highlighted in the RCPCH report “State of Child Health”, are improving.

“We are ready to do our part, and look forward to working with NHS England, NHS Improvement and the STP to make sure these plans deliver exactly what is needed for infants, children and young people. Sadly, at the moment the majority do not.”

You can read the full report on our website.