Considering a new report stating that child health outcomes in England are poorer than its western counterparts, NHS England should develop a Children and Young People’s Health Strategy as part of its long term plan, says Professor Russell Viner

Child care

Child health outcomes in England are lagging behind our western European counterparts. This statement should come as a surprise – we are a wealthy nation with universal healthcare and have seen enormous improvements in children and young people’s health in the last century.  

But progress over the past 30 years has slowed or in some cases stalled, and in 2018 our children have poorer health outcomes than those in comparable nations.

A new report by the Royal College of Paediatrics and Child Health – Child health in 2030 in England: comparisons with other wealthy countries  –  has used long term historical data to estimate outcomes for children and young people’s health in 2030, and concludes that – without intervention – England is likely to fall further behind other wealthy countries over the next decade.

Worrying findings

Perhaps this also comes as a surprise. Unfortunately, it is not much of a surprise at all for paediatricians.

We have seen reported mental health problems amongst children and young people increase five fold over the past 20 years. We treat the young patients who account for 5.5 million emergency department attendances each year.

And we have seen infant mortality rise in 2015 and 2016 – reversing a century of seemingly inexorable decline.

This report predicts that by 2030, infant mortality may be 140 per cent higher than in comparable countries if rates continue at their current “stall”

It is sadly not a surprise to us either that this report predicts that by 2030, infant mortality may be 140 per cent higher than in comparable countries if rates continue at their current “stall”. Reported mental health problems in England are set to increase by 63 per cent if recent trends continue.

Children and young people’s attendances at accident and emergency could increase by 50 per cent. These projections may not be surprising, but they are undoubtedly of huge concern.

Opportunity for action – NHS long term plan

This future is not inevitable. Other wealthy nations such as the Netherlands have turned around key outcomes such as infant mortality by a concerted national focus.

With NHS England’s long term plan just around the corner, we have the best chance in years to ensure that infant, children and young people are front and centre of our health services.

We were hugely encouraged by the inclusion of a Healthy Childhood and Maternity workstream within the long term plan, and by NHS England’s openness in working with charities such as ourselves. Yet the proof of the pudding will be in the eating.

Getting it right for child health today is key to improving the health of future generations to come, which is why we are calling for NHS England to develop and support the implementation of a Children and Young People’s Health Strategy, delivered by a funded transformation programme.

We all have a role to play to ensure that this report’s predictions never come to pass. We need a system where children and young people are at the centre of decision making, and their interests championed.

Commissioners must clearly evidence this routine involvement of children, young people and their parents in the design, delivery and evaluation of child health services.

We were hugely encouraged by the inclusion of a Healthy Childhood and Maternity workstream within the long term plan

Sustainability and transformation partnerships and integrated care systems must have a dedicated lead for children and young people at executive or board level responsible for delivering a children and young people’s health improvement plan in their local area.

They must take a collaborative approach to healthcare planning, working closely with children, young people and their families, as well as with other relevant sectors.

NHS England must support the roll out and evaluation of innovative, flexible multidisciplinary models for delivering integrated health services to children and young people. These models should align strongly with primary care networks and with sector wide models developed by STPs and ICS/ICPs.

A renewed focus on early childhood services is essential to help shift the NHS from a disease focused to a truly national health service, and we need to enhance health visiting services and ensuring linkage across health visiting, primary care networks and school health services.

Child health workforce

These are just some of the recommendations that need to be implemented to ensure a brighter future of our children and young people. However, they will be hugely difficult to achieve without a significant expansion in the child health workforce.

We want to see NHS England work closely with Health Education England to model the future children’s health workforce within the best models of care. This must include setting the workforce need for medical, midwifery and nursing staff, as well as allied health professionals, pharmacists, health visitors and school nurses and youth services.

We must think outside the box to tackle our workforce issues, considering new models such as child wellbeing workers in early childhood settings, primary care and schools. We also need a paediatric physician’s associate workforce to help plug current gaps – and welcome the recent announcement of regulation of the PA workforce.

We want to see NHS England work closely with Health Education England to model the future children’s health workforce within the best models of care

Hundred years ago, one in six babies in this country did not live to see their first birthday. Thankfully, due to huge scientific advancement and our incredible NHS, we have consigned these terrible outcomes to the past.

Yet without prioritising and investing in child health now, we risk condemning today’s children to increasingly unhealthier futures than their European counterparts.

We must all work together to transform the life chances of infants, children and young people in England, starting this year with an NHS long term plan that prioritises and champions their needs.