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Chief Medical Officer: Prevention pays - our children deserve better

Report on children’s health makes strong case for change as data shows five excess child deaths per day in UK compared to Sweden.

  • Report on children’s health makes strong case for change as data shows five excess child deaths per day in UK compared to Sweden
  • Billions could be saved by investing in young people

Much more needs to be done to improve UK children’s health, and acting early will save taxpayers’ money, the Chief Medical Officer has said in a frank assessment of the state of the health of the nation’s children.

CMO’s latest report. - which has the backing of several children’s charities - calls on government, the whole health service, social care and education professionals to take action and make improvements now. It highlights a strong economic case for doing more, sooner. For example, reducing obesity by just one percentage point among children and young people could lead to savings of £1 billion each year as children would be less likely to end up with long-term health problems needing NHS treatment.

In addition to improvements on physical health, the report highlights the need for society to support children to build emotional resilience, supporting children through better communication to learn from their mistakes and deal with life’s inevitable ‘ups and downs’.

Professor Dame Sally C Davies, Chief Medical Officer said:

My generation unquestioningly expected our future to be better than our parents’ and grandparents’. But our children and grandchildren face a far more challenging outlook. We need a renewed focus on children.

This report questions whether we have got the balance right in our society and should act as a wake-up call. The evidence is crystal clear and the opportunity is huge – investing in children is a certain way of improving the economic health of our nation, as well as our children’s well-being.

Specific recommendations for change in the Chief Medical Officer’s report include:

  • A named GP should be available for every child with long term conditions;
  • A review of the cost-effectiveness of extending the Healthy Start Vitamin Programme to every child: NICE should be asked to examine the cost-effectiveness of offering the Healthy Start vitamins to every child. Healthy Start vitamins contain vital ingredients for children’s development, including vitamins A, C, D – all critical for growth, vision, healthy skin and strong bones;
  • A new national children’s week to help change our national culture to celebrate children and young people and help bring together the myriad of organisations with the power to make a difference – including government, charities and the NHS;
  • Ofsted and the Care Quality Commission should routinely ask for evidence on how well children’s and health services work together as part of the inspection process, to drive real joining-up of services across the system; and
  • A regular survey on mental health among children and young people, including comparisons with other developed countries, should be commissioned and published annually, to improve the evidence base for meeting young people’s mental health needs.

The report paints a stark picture of the experience children have growing up in our society, as well as the dramatic difference between the experiences of poor children and better-off children. The report highlights that:

  • Other countries do much better than the UK when it comes to children’s health. Over a quarter (nearly 27 per cent) of our children are either in or at serious risk of being in poverty, compared to just 16 per cent in the Netherlands;
  • Currently, 12.5 per cent of toddlers are obese. 17 per cent of boys and 16 per cent of girls up to the age of fifteen are obese too. The long-term societal cost of childhood obesity is estimated to be as high as £700 million each year; and
  • 75 per cent of lifetime mental health disorders start before 18 years of age, with the peak onset of most conditions being from 8 to 15 years. Approximately 10 per cent of adolescents suffer from a mental health problem at any one time. The report also highlights a number of good examples of things that are already going on, like the government commitment to increasing the number of health visitors and the number of families that will be helped by family nurse practitioners. But it calls for wider and faster action.

Dr Hilary Cass, President of the Royal College of Paediatrics and Child Health, said:

We know that the UK lags behind much of Europe when it comes to child mortality rates and that there is too much variation in care of some common conditions such as asthma and diabetes. We’re also faced with one in three children aged nine who are overweight or obese and storing up health problems for the future, and increasing numbers of children suffering from poor mental health.

Today’s report provides a timely reminder of the challenges we face and the importance of child health in the overall health of the nation. The focus on improving evidence around mental health, widening access to leisure activity to encourage children to be active, extended training paediatric training for GPs and ensuring more effective transition between child and adult health services is all welcome and have the potential to immeasurably improve health outcomes for children.

Investing in children is not only an investment in today’s young people; it’s a sound investment for the future. Healthy children are much more likely to become healthy adults. So in the run-up to the next election, as the political parties prepare their manifestos, the challenge is to ensure that child health is high on the agenda. We have a duty to this generation of children, to the next generation and to generations to come.

Dr Hilary Emery, Chief Executive of the National Children’s Bureau said:

It is unacceptable that five more children die each day of avoidable causes than in Sweden. The UK must have greater expectations for children’s health if we are to be the best place in the world for children to grow up. As a nation we must be much more ambitious about giving every child the best start in life and this should be a priority for all decision makers in central and local government.

Case study – Offering Vitamin D supplements to everyone in Birmingham

The current Healthy Start vitamin programme includes minerals vital for children’s development, including vitamins A, C, D – all critical for growth, vision, healthy skin and strong bones. It is targeted at children in families who receive certain benefits and aims to bring the health of the poorest up to the standard of their classmates from better-off backgrounds.

In Birmingham they offer vitamin D universally and have seen a huge boost in the number of people taking up the offer. Nationally, we know that low numbers of eligible families take up the offer of vitamin D for their children. But in Birmingham, they made it universal and now one in five take up the tablets, meaning thousands more children have the building blocks for healthy bones. The scheme also halved the number of cases of rickets and other vitamin D deficiency problems, and led to big increases in public awareness of the need for vitamin D.

Background information

  1. Access the full report.

  2. Key economic figures:

  • £4 trillion: the approximate cost of a range of preventable health and social outcomes faced by children and young people over a 20 year period, according to according to research by Action for Children and the New Economics Foundation.
  • 6-10%: The annual expected rate of return on investment to be achieved by investing in interventions early in life to improve later outcomes, according to James Heckman.
  • 6%: The National Audit Office estimate of current Government spending on early action. They estimate that this has remained relatively static. The report concludes that “a concerted shift away from reactive spending towards early action has the potential to result in better outcomes, reduce public spending over the long term and achieve greater value for money.”
  • 4%: The percentage of health spending in England in 2006/7 on preventative measures according to Health England research.
  • Our analysis estimates the annual public sector annual costs of preterm birth to age 18 at £1.24 billion and £2.48 billion in total societal costs (including parental costs and lost productivity).
  • Based on our analysis the annual potential annual long term cost to society of one major kind of injury, severe traumatic brain injuries, may be between £640million and £2.24 billion in healthcare, social care, social security costs and productivity losses.
  • Our analysis estimates the long term annual costs of child obesity as £588-686million.
  • Our analysis estimates the annual short terms costs of emotional, conduct and hyperkinetic disorders among children aged 5-15 to be £1.58 billion and the long term costs £2.35billion.

Recommendations in full:

  1. Cabinet Office supported by Public Health England, and the Children’s Commissioner should consider initiating an annual National Children’s Week.
  2. Public Health England in collaboration with the Early Intervention Foundation should assess the progress on early intervention and prevention, continue to develop and disseminate the evidence base for why this matters and build advice on how health agencies can be part of local efforts to move from a reactive to a proactive approach.
  3. Public Health England, working with Directors of Public Health and Health and Wellbeing Boards, should support the work of the Big Lottery Fund programmes and ensure that the lessons learnt are disseminated.
  4. Public Health England should undertake a Healthy Child Programme evidence refresh, starting with the early years.
  5. Public Health England should work with local authorities, schools and relevant agencies to build on current efforts to increase participation in physical activity and promote evidence based innovative solutions that lead to improved access to existing sports facilities.
  6. Nutrition:
    • CMO recommends that NICE examines the cost effectiveness of moving the Healthy Start vitamin programme from a targeted to a universal offering.
    • Department of Health to set out next steps in the light of evidence from the Scientific Advisory Committee on Nutrition (SACN) about folic acid.
    • Action is taken if required on iodine following recommendations by SACN
  7. The Social Mobility and Child Poverty Commission and Public Health England should work together to ensure that efforts to narrow attainment gaps in education complement efforts being made to narrow health inequalities.
  8. Public Health England should work with NHS England, the Department for Communities and Local Government and the Department of Health to identify how the health needs of families are met through the Troubled Families Programme.
  9. The Department of Health, NHS England and Public Health England, alongside representatives of children and young people, should build on the You’re Welcome programme and the vision outlined in the recent pledge for better health outcomes for children and young people to create a ‘health deal’ which outlines the compact between children and young people and health providers, and creates a mechanism for assessing the implementation of this.
  10. Children with long-term conditions, as vulnerable people, should have a named GP who co-ordinates their disease management.
  11. As plans are made to extend GP training paediatrics and child health should be part of the core component of extended training.
  12. Health Education England should commission education to ensure that the workforce is trained to deliver care that is appropriate for children and young people, in the same manner as is being currently carried out for age-appropriate care for older people.
  13. Health Education England, the Department of Health and Public Health England should work to ensure that commissioned education of health professionals stresses the important role of school nurses.
  14. PHE should develop and enact a youth social marketing programme, “Rise Above” to engage young people around exploratory behaviours through multiple platforms.
  15. Public Health England and other leading independent organisations working in the field should work together to strengthen the evidence base for programmes that develop resilience in young people.
  16. Public Health England should develop an adolescent health and wellbeing framework which includes the inter-relationships of exploratory behaviours. As part of their public-facing work, Public Health England should model engagement with young people on multiple health and wellbeing issues through a variety of platforms.
  17. Public Health England, the PSHE Association and other leading independent organisations in the field should review the evidence linking health and wellbeing with educational attainment, and from that promote models of good practice for educational establishments to use.
  18. The Children and Young People’s Health Outcomes Forum annual summit should provide an opportunity for the review of health outcomes that are relevant to children, and to examine regional variation.
  19. Regulators, including the Care Quality Commission and Ofsted, should annually review the effectiveness of inspection frameworks and the extent to which they evaluate the contribution of all partners to services for children and young people. This includes the contribution of statutory partners, local safeguarding boards and health and wellbeing boards to the health and protection needs of children and young people.
  20. The review of Safeguarding Children and Young people: roles and competences for health care staff – intercollegiate document should embed the professional responsibility to the whole family, and professional bodies should develop the necessary innovative tools to support this.
  21. DH should work with the Office for National Statistics, Public Health England and relevant third sector organisations to investigate opportunities to commission a regular survey to identify the current prevalence of mental health problems among children and young people, with particular reference to those with underlying neurodevelopmental issues, those aged under 5, ethnic minorities and those in the youth justice system. This data collection should include international comparisons and be linked to the Child and Adolescent Mental Health Services data set, providing key data for developing local services to meet clinical need. An annual audit of services and expenditure in the area should be undertaken.
  22. The National Institute for Health Research should develop a research call to provide the evidence base to improve health outcomes for long-term conditions in childhood, to match the best worldwide.
  23. The National Institute for Health Research (NIHR) Clinical Research Network, including the NIHR Medicines for Children Network, should work with children and young people to review the design of clinical studies in order to facilitate increased participation of children and young people in drug and other trials.
  24. The four UK Chief Medical Officers have agreed that the Chief Medical Officer in Northern Ireland, Dr Michael McBride, will lead a group with the four public health agencies and The Royal Society for the Prevention of Accidents (RoSPA) to develop strategies to combat blind cord deaths.

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