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Audit Commission - Under-fives need a healthier start in life

Government policies and programmes have not significantly improved the health of the under-fives in the past decade, according to a new study by the Audit Commission.

Giving children a healthy start, published today (3 February), says more than £10 billion has been spent, directly or indirectly, on improving the health of under-fives in England since 1998. But results are disappointing considering the level of investment.

Some aspects of young children’s health have improved. There are fewer deaths in infancy and obesity rates are slowing overall. But gaps between the health of children in disadvantaged areas and those in better off places have grown. A child in a deprived area is 19 per cent more likely to have bad teeth than the average child.

The report recommends how to achieve better value for the money being spent on young children's health. Acting now could cut diabetes, heart disease and hypertension and ease a future strain on NHS resources.

Steve Bundred, Chief Executive of the Audit Commission, said:

'It’s encouraging to see some improvement in the health of babies and young children, but the under-fives rarely seem 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.
'Large inequalities persist and this report bears out the outcomes displayed on the Oneplace website. Despite progress, our infant mortality rate remains higher than countries such as the Netherlands, France, the Republic of Ireland and Spain. Even before they are born, for many, place and parents’ income determine their quality of life and their lifespan.'

Councils and health organisations are aware of health issues facing young children, such as a decline in immunisation rates for mumps, measles and rubella. However, the number of health visitors in England has dropped by 10 per cent. And some parents from vulnerable groups are not using Sure Start children’s centres because they are unaware of the service, or they say they dislike the 'judgemental nature of health professionals'.

Some councils and health organisations have reached out to vulnerable people with tailored services. Yet the gap between rich and poor has hardly changed in a decade and local policies for children vary widely. The Commission found children from minority groups were likely to have poorer health and their parents are less likely to use health services.

Councils and the NHS need to be clear about how much they are spending on the under-fives. The money should be targeted to have the most impact on the most vulnerable groups. And the impact must be monitored and reviewed.

The Audit Commission would like to see a single set of local priorities agreed by those responsible for driving improvements in children's health, supported by a clear statement of government policy.

The report also recommends that government and local organisations with responsibility for children’s services should monitor the impact of the economic downturn on children's services.

Notes for editors

  • In its summary, Giving Children a Healthy Start includes advice to help organisations achieve better value for the amount of money already being invested in health services for the under-fives. This includes:
  • local services should work under a single joint set of priorities and targets, supported by a clear statement of government policy that is not subject to frequent revision and addition
  • responsibility (and therefore accountability) for commissioning and delivering services is clear locally
  • the amount spent on under-fives’ health within an area is identified and its targeting reviewed, so as to have most impact on the most vulnerable groups
  • data on the extent to which intended users are actually accessing services is routinely examined and action taken accordingly to identify and attract those that are not
  • the targeting and impact of individual interventions and services are rigorously reviewed and investment and disinvestment decisions made accordingly
  • local statutory bodies monitor the quality and impact of services for the under-fives in the light of financial pressures to ensure that they are maintained
  • the good practice that is evident in some localities is celebrated and information about it widely shared
  • The new report focuses on the health of children from birth to five years old and assesses how local organisations are addressing their health needs.
  • Since 1998/99 an estimated £10.9 billion has been dedicated, in whole or in part, to programmes aimed at improving the health of under-fives. This includes £7.2 billion for Sure Start, which had dedicated funding for health improvements in the early phase of roll-out.
  • Since 1999 there have been 26 national policies aimed at improving the health of under-fives as a way to reduce health inequalities.
  • The report contains findings from focus groups that looked at the barriers to service access and common themes for vulnerable groups (pages 29-38).
  • The report has case studies on initiatives in Burnley (page 31), Walsall (page 33), Hull (page 35), Redbridge (page 36) and Blackpool (page 48).
  • Among its examinations of data, the report contains information about:
  • Health visitor workforce
  • Take-up rates of children's centre services
  • Funding for under-fives 1998/99 to 2010/11
  • Sure Start children’s centres funding 1998/99 to 2010/11
  • Key health outcomes for under-fives
  • The Audit Commission is an independent watchdog, driving economy, efficiency and effectiveness in local public services to deliver better outcomes for everyone.
  • Our work across local government, health, housing, community safety and fire and rescue services means that we have a unique perspective. We promote value for money for taxpayers, auditing the £200 billion spent by 11,000 local public bodies.
  • As a force for improvement, we work in partnership to assess local public services and make practical recommendations for promoting a better quality of life for local people.
  • Further details about Oneplace or the role of the Audit Commission can be obtained from www.audit-commission.gov.uk.

Contact: Nigel Watts, Media Relations Manager, 020 7166 2129 or 07813 315538

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