WIREDGOV

The Government must simplify and clarify the significantly more complicated system it has created for child health under its reforms says a new NHS Confederation report.
The Government  must act now to minimise the risks to children and child health as it fundamentally reforms the NHS.  There is a real sense that insufficient attention has been paid to what the reforms will mean for child health. To rectify the situation, the Government should start by clarifying and simplifying how services will work together and go on to produce a cross-government strategy.

These are the messages from an analysis of views of leaders across the health and social care system carried out by the NHS Confederation in conjunction with the Royal College of Paediatrics and Child Health (RCPCH) and the Office for Public Management.

Under the reforms, there is potential for services to improve as clinicians take on more of a leadership role and public health becomes the responsibility of local authorities.

But, children with the most complex health problems could lose out the most as their different needs will be the responsibility of different organisations or groups of organisations. Responsibility for these needs will also shift between organisations as children get older, their health problems change or if they move home.

The report details how these responsibilities will be split under the reforms across six different organisational levels that range from the local to national. At the same time, health and local government commissioners will work across different geographical populations making it harder still to join up services.

Successive public inquiries and reviews have shown that it is at the boundaries between different organisations’ responsibilities that children often fall through the gaps and their care suffers.

The report also says that children risk losing out overall as the Government target to create 4,200 new health visitors is being put in place without regard for locally defined needs. Child health teams usually employ a range of professionals to meet local need. Because the target only focuses on one specific job role, many established and successful teams are having to be re-arranged and in some cases disbanded simply to employ more health visitors.

The government should, the report says, make the target more in tune with the rest of government policy and focus more on outcomes. In some areas the priorities for child health include speech development or readiness for school which might require extra speech and language therapists or other professionals. By making the target less focussed on one particular role and more on what is really needed in local areas, the Government will be better able to deliver the more preventative services that the policy is meant to prioritise.

The report says there is now an urgent need for the government to pay more attention to what its reforms mean for children. The Department of Health has taken some action while this report was being written but it must leave absolutely no doubt about where accountability for child health lies between different organisations in its new system.

New commissioners of services must be supported to join up their efforts and ensure children do not fall through the gaps. Failure to do so could be disastrous for individual children and almost certainly more expensive overall in the longer term.

More importantly, there is a desperate need for the government to draw up a cross-government strategy that links up all the relevant organisations – from police to schools – in focusing on working together to improve child health.

This will be vital if we are to hang on to the improvements that have been made by the current system where local authorities and primary care trusts work together over the same areas.

While improvements have been made over the last five years, the report makes it clear that, currently, the UK has higher all-cause childhood mortality compared with other European countries.i Children and young people in the UK also have worse health and well-being outcomes than their European counterparts.

Making services work for children and young people has to become more of a priority across Government so that problems are identified and dealt with early and, in the longer term we have a healthier economically active population.

NHS Confederation deputy policy director Jo Webber said:

"There is a real sense that the Government have not paid sufficient attention to child health as part of its NHS reforms. This can not go on and there is a risk that we will not do the right thing for our children.

"Major reform does offer important opportunities to improve care but only if all the organisations involved - especially the new ones - are clear on how they will interact together.

"Currently, we simply do not have that clarity. The Department has started to take some steps as this report was written but there is still much more to do. The consequences of simply bumping along as we are could mean we will fail large numbers of children young people for no reason.

"While maintaining a focus on outcomes, the Department of Health must work with other government departments to draw up a cross government strategy. It must then lead the implementation of that strategy with the rest of central government.”

On health visitors, Jo Webber said:

"The health visitors target was a welcome sign that the government prioritised child health - especially in terms of prevention and safeguarding.

"It would be more sensible and more effective if the government altered its target to focus on outcomes. It can not be right that trusts are having to re-arrange their teams to accommodate a specific job role that might not best meet the needs of local people. Worse still, in a very few places, we have been told these teams are being disbanded to make way for extra health visitors.

"Whatever happens, we need to ensure that any increased resources will genuinely better meet the Government's overall objective of prioritising child safeguarding and more preventative child health services."

Professor Mitch Blair, Officer for Health Promotion at RCPCH said

"Ensuring that children's health is as good as it can possibly be requires a much greater focus specifically on the child and lessons from Europe indicates we have still not got it right in this country.  The reforms offer enormous opportunity for doctors, nurses, therapists and commissioners to really work together effectively to design services around the child but they need the right infrastructure and support to make that happen.

"Children are not "little adults" - and the health and other services they need must not be fragmented or tacked as an afterthought onto adult service contracts.  All children, but particularly those who are severely ill and disabled need properly integrated care, commissioned specifically around their needs.  There is too little emphasis in the detail of the reforms on how this will be achieved. The NHS Operating Framework published last month failed to focus sufficiently on children's and young people's services. The Government needs to demonstrate a clear commitment to children and the long-term health of the next generation by improving its focus and investment in their immediate and wider health and child protection needs."

Notes to editors:

The NHS Confederation is the only body to bring together the full range of organisations that make up the modern NHS. We are an independent membership organisation that represents all types of providers and commissioners of NHS services in England. We also represent trusts and health care boards in Wales; and health and social service trusts and boards in Northern Ireland.

The Office for Public Management (OPM) is an independent public interest company supporting public services to improve social outcomes. OPM works extensively with clinicians, commissioners, managers and policy-makers across the health and social care sector, and has long-standing expertise around the design, development and evaluation of services and commissioning models to improve health outcomes for children and young people.   

Contact Francesca Reville 020 7074 3312 or Niall Smith 020 7074 3304. For out of hours media enquiries, please call the Duty Press Officer on 07880 500726.