Primary care trusts and local councils have failed to work together to successfully prioritise improving the health of under-fives, an Audit Commission report has warned.

Although councils and PCTs were aware of health concerns including obesity, low birth weight and accidents, this was not reflected in their strategic plans and local area agreement priorities, the commission stated this week in its report Giving Children a Healthy Start.

Few local authorities and PCTs in our research had a rigorous approach to identifying the take-up of existing services and addressing any gaps

It said better value for money could be obtained by local services working together under a joint set of priorities and targets, supported by a clear government policy that was not regularly changed.

The report noted that there have been 27 national policies aimed at reducing health inequalities in the under-fives since 1999.

The report said £10.9bn had been invested in programmes aimed at improving the health of under-fives in the past 12 years but this had “not produced widespread improvements in health outcomes”.

“Some health indicators have indeed worsened - for example, obesity and dental health - and the health inequalities gap between rich and poor has barely changed,” it said (see box).

The commission also highlighted that children from minority groups had poorer health outcomes and their parents were less likely to access mainstream health services.

“Local bodies need to tailor and target their service provision appropriately for these groups. But few local authorities and PCTs in our research had a rigorous approach to identifying the take-up of existing services and addressing any gaps,” it said.

The Audit Commission also raised concerns about the world class commissioning programme, saying it had led to confusion between children’s trusts and PCTs in some areas about who had specific responsibility for children’s health commissioning.

This, the report warned, was “perpetuating the lack of clear senior responsibility for children’s services that was heavily criticised in Sir Ian Kennedy’s inquiry and in Lord Laming’s inquiry into the death of Victoria Climbié”.

Audit Commission chief executive Steve Bundred said under-fives rarely seemed to be a priority locally.

“Overall, the findings are disappointing. Children need a healthier start in life and policies are not delivering commensurate improvement and value for money,” he said.

“Large inequalities persist. Even before they are born, for many, place and parents’ income determine their quality of life and their lifespan.”

The government published its children’s health strategy - Healthy Lives, Brighter Future - in February last year, pledging a “stronger and better joined up support during the crucial early years of life”.

Health inequalities among under-fives

Childhood obesity

  • 1995: 10 per cent
  • 2008: 14 per cent

Infant mortality - deaths per 1,000 births

  • 2001: 5.6
  • 2008: 4.8

Percentage of areas adopting local area agreement targets

  • Proportion of children in poverty: 30 per cent
  • Prevalence of breastfeeding at six to eight weeks: 21 per cent
  • Obesity in primary school reception year: 17 per cent


HSJ and sister title Local Government Chronicle are holding a Children’s Services Workforce Forum on 3-4 March,