Public health prescribed activity - consultation response

The College has significant concerns regarding the ability for local authorities to deliver both prescribed and non-prescribed public health provision alongside the funding cuts. The importance of high quality, universal public health provision was highlighted several times in our 2017 State of Child Health Report and follow-up One Year On report.

See call for evidence

Our response

• Alongside significantly reduced spending on public health, the impact of current economical policy and growing poverty in the country and its affect on children and young people (CYP) cannot continue to be ignored. Well resourced, quality public health provision is urgently needed to mitigate the impact of poverty on child health outcomes, and the subsequent health of the population for years to come.
• Vulnerable groups of CYP (including looked after children, children in the safeguarding system, children living in poverty, refugee and asylum-seeking children) would benefit from explicit mention within the principles to ensure equitable provision, ie public health prescribing must take account of the ‘dose’ required to achieve the desired ‘response’ for vulnerable groups.
• We consider health visitors and school nurses as vital for reducing health inequalities at the local level. It is difficult therefore to see how effective prescribed or non-prescribed public health activity can be provided unless there are enough skilled professionals on the ground.
• Analysis by the RCN in 2017 demonstrated that there was a significant drop of over 1000 health visitors since 2015, alongside a 16% drop in the number of full-time school nurses between 2010 and 2017. It is worth noting that there is a lack of robust data on workforce numbers, but current estimates continue to suggest numbers are falling.
• The lack of data on children and young people's mental health is a gap that urgently needs action, given evidence of increasing concerns about our children's mental health. 
• Despite a continued focus by government, rates of childhood obesity in the UK are not improving and for deprived groups there is evidence of further escalation. The difference between obesity prevalence in the most and least deprived areas has increased from 4.5 to 6.8 percentage points for children in reception year and from 8.5 to 15 percentage points for children in year 6 in England.

Our recommendations

• We recommend that there be the inclusion of a principle which ensures parity of esteem for CYP is considered with regards to all prescribed public health activity.
• We have called for the Survey of the Mental Health of Children and Young People to be repeated every three years, to identify the prevalence of mental health problems among children and young people to aid the planning of services.
• We ask that the principles be modified to be person-centred, for example, with the first bullet point reading ‘where adults, CYP have a right to experience standardised care.’ This would ensure that principles focus on the populations they are designed to support as opposed to specific services and their delivery model.

We respond to a wide range of consultations to ensure that the College’s position, and ultimately children’s health, is represented. Members can get involved in current consultations by contacting the Health Policy team: health.policy@rcpch.ac.uk