Children and young people have often been missed out in the rush to think about integrated care and the focus this tends to create on adults with chronic disease. Children’s services have also received little attention in the Sustainability and Transformation Partnerships (STPs). There is a similar concern about wider policy, and the lack of cooperation outside the health sphere. In that light, I asked Professor Sir Al Aynsley-Green to give us his reflections based on his wide perspective on these issues.
Nigel Edwards, Chief Executive, Nuffield Trust
Children and young people matter – to families and to society. Quite simply, they are our nation’s most precious resource. As well as being citizens in their own right today, they are the workers and parents of the future on whom our prosperity will depend.
Dramatic changes in demography mean that fewer working-age adults are supporting an ever-increasing, ageing population.
Investing in our children should be our nation’s key priority. But is it? And how well are we doing for our children and young people?
Sadly, despite some well-intentioned proposals in the parties’ election manifestos, a vision or clear policy framework for what we want to achieve overall for our children has been lacking from public policy for many years. In fact the siloed nature of policy-making – which divides issues into health, education, social care and youth justice – does little to promote an overall framework.
Recent policies have focused more on school improvement through league tables of SATS attainment than on promoting children’s health. The Prime Minister’s recent ‘industrial strategy’ failed to mention the importance of having healthy, educated, creative and resilient children and young people who are equipped with the life skills to become the productive leaders and workers we need.
We have outstanding children and young people. The majority are loved by parents and work hard to achieve and contribute to society. And there are countless professionals dedicated to supporting them. New medical advances prevent illnesses and improve the treatment of hitherto incurable diseases.
Despite this, too many children and young people in the UK experience some of the worst outcomes for health, social care, education, youth justice and poverty in the developed world.
We have some of the least happy internationally, with soaring rates of mental ill health: the number of under-18s attending A&E because of a psychiatric condition, for example, more than doubled between 2010 and 2015. The House of Commons Health Committee exposed ‘serious and deeply ingrained problems with the commissioning and provision of children’s and adolescents’ mental health services’ so that many are unable to access the help they need.
Outcomes for physical health are lagging behind those in neighbouring countries: the UK has one of the highest mortality rates for children and young people in western Europe, and nearly a third of children aged two to 15 are overweight or obese. And the failure to re-educate and re-integrate young offenders produces a ‘revolving door’ of re-offending, while social care and the police repeatedly fail to protect some of the most vulnerable young people.
Inequalities in education, expectation and opportunity are embedded, with ‘the truly shocking dominance of private-educated elite and affluent middle class in the upper echelons of public life’ described by Sir John Major. Policies on austerity are having a disproportionate impact on poor families and children and the UN Committee on the Rights of the Child has consistently exposed how far the UK has to go to fulfil its obligations in protecting children’s rights.
So why do we have these dismal outcomes? They are largely the result of public and political indifference to the importance of children and young people in society, with national political focus for children being short term, ephemeral, inconsistent and, in the case of some policies, proved untrustworthy. For example, the dismantling of the government’s 2003 ‘Every child matters’ policy programme (recognised to be a benchmark for children worldwide) and the refusal to implement national standards for children’s health services are colossal blunders driven by political ideology, not by the best interests of children.
So, what’s to be done? We need a paradigm shift in thinking about the importance of children and young people – the starting point being a consideration of what children and young people need to achieve their potential.
Politically, they need a long-term, coherent, cross-party ideology and overarching policies that see children and young people as a vital priority and as citizens in their own right, with an explicit commitment from the very top – especially for the most vulnerable.
In local communities, we need to make real the African proverb, ‘it takes a village to raise a child’, with the nurture of children being everybody’s business. Children need nurture from parents and families; play, exercise, exploration and experience of managed risk in their neighbourhoods with friends, role models, and experience of spirituality. Education needs to provide more than attainment targets – core skills, expectation, values and purpose in life are all essential. Government should be there to support local services based on needs and evidence, with protection of human rights.
Developing national and local strategies demands responsibility and accountability, defining objectives and measures, listening to children, young people and families, working in partnerships and engaging with the media. Robust leadership is paramount.
Professionals must look out of the destructive bunkers and silos that currently bedevil services, putting the child and family’s needs at the centre, seeing the world through the eyes of the child, young person and family. They must be more effective advocates for their best interests.
We know what has to be done! We know what is needed – healthy, educated, creative and resilient children. We cannot continue to fail so many children. It takes a village to raise a child.
Please note that views expressed in guest blogs on our website are the authors' own and do not necessarily reflect the views of the Nuffield Trust.
Aynsley-Green A (2017) 'Building communities with resilient children at their hearts'. Nuffield Trust comment. https://www.nuffieldtrust.org.uk/news-item/building-communities-with-resilient-children-at-their-hearts