The health of children and young people is crucial to the future wellbeing and prosperity of England. Yet health outcomes for our children and young people are worse than in similar countries and their experience of care is sometimes poor. This is simply not good enough. While there have been improvements, these have mainly been in specific areas and have not led to comprehensive or system wide changes that are really required to improve outcomes.
To address this, we need to establish parity of esteem between children and young people and adults within the NHS. We want the NHS to provide a service which accepts, at a system level, responsibility for children and young people from birth through to age 25, their health care and their outcomes.
The RCPCH has published Child health in 2030 in England: comparisons with other wealthy countries, which uses long-term historical data to project outcomes for children and young people's health in 2030. This sets out the challenges facing the NHS and its care of children and young people alongside existing problems:
- Mortality: The UK infant mortality decline has stalled and mortality has begun to rise after more than 100 years of continuous improvement. If UK infant mortality begins to decline again at its previous rate, the UK rate will be 80% higher than the EU15+ in 2030. If it continues at its current 'stall', it will be 140% higher than these comparable countries in 2030.
- Health inequalities: England has very high levels of health inequalities observed in most key outcomes. These are likely to widen over the next decade as problems in areas such as infant mortality and obesity are worsening more quickly amongst the most deprived section of the population.
- Living well: Approximately 28% of children and young people in England have a long term condition requiring medical follow-up and it is estimated that approximately 6% have a disability. The care they receive from the NHS determines their ability to live well, attend school and to participate in society. But children and young people have historically been under-represented in many quality frameworks and poorly reflected in NHS priorities.
- Mental health and emotional health: Wellbeing amongst English children and young people is at the lower end of the EU15+ countries. Reported mental health problems have increased five-fold over the past 20 years and will increase a further 63% by 2030 if current trends continue.
- Lack of data and monitoring: There is a lack of timely data on many children's health outcomes and this is a major barrier to improving outcomes. This is particularly the case for financial data and how much is spent on children's services and clinical areas such as disability and mental health.
NHS England's Long Term Plan presents an opportunity to introduce a strategic framework for children and young people's health, which has been missing in recent past years. The Plan must assess the health needs of children in England and what should be done to address them. To do this, we want NHS England to engage with children and young people and recognise that they play a central role in shaping their own care.
The ambition for NHS England to improve children and young people's health
The RCPCH wants NHS England to play a positive role in the lives of children and young people and be responsible for delivering improved health outcomes for them. Improving health outcomes for children is morally and economically the right thing to do and we want to continue working with NHS England to achieve this goal. Our goal for NHS England is:
By 2028, children and young people in England will have better physical health, mental health and wellbeing. Children and young people, and their parents and carers, will experience a seamless service delivered by an integrated health and care system. There will be a skilled workforce that listens to them, responds, and meets their needs.
To deliver this goal, NHS England must place children and young people at the heart of what they do and develop a Children and Young People's Health Strategy to be delivered by a funded transformation programme led by a dedicated programme board. The strategy should set out a governance and accountability framework for the commissioning, implementation and delivery of interventions to improve children and young people's health outcomes. We have identified specific recommendations where NHS England needs to focus its energies and attention. Investment to deliver these actions could transform provision and result in hugely better health outcomes and experience for children and young people in England and help achieve our goal.
These actions include an NHS which:
- Supports interventions to reduce the number of deaths in infants, children and young people
- Gives children the healthiest start and continues throughout their life course
- Promotes mental and emotional health of children and young people
- Integrates care for children with complex or multiple needs
- Encourages and supports collaboration with other partners
- Is tailored and responsive to the needs of children and young people throughout their childhood and as they transition to adult services. Such as diabetes and epilepsy services.
- Maximises women's health before, during and after pregnancy
- Prioritises quality and safety of care for all children and young people, including those from vulnerable groups
- Is properly staffed by motivated and dedicated child health professionals
- Uses data and technology to improve outcomes from children and young people
In order to determine progress towards the overarching goal, we propose the following measurable outcomes:
- Outcome 1: Deaths in infants, children and young people will be comparable with the best performing countries in western Europe.
- Outcome 2: Infants, children and young people with long term conditions, disability and complex needs will be supported through the life course to live healthily lives and have better control over the care they receive.
- Outcome 3: Children and young people with mental and emotional health needs will have timely and appropriate access to evidence based services and treatment which they require.
The RCPCH recognises that addressing these challenges will not be easy, nor could it be achieved by NHS England alone.
The 'enablers' needed to deliver the goal and outcomes are:
- Children, young people and their parents and carers, are central to collaborating and the co-production of a cohesive NHSE child health strategy.
- Children and young people experience a seamless and integrated healthcare system that is well connected to other support they need.
- A system which focuses on prevention and early intervention.
- Appropriate levers and incentives are developed and extended to drive improvements in treatment and care for children and young people.
- A workforce strategy specific to children and young people that will ensure professionals have the right knowledge and skills to meet their needs.