The welfare of children should be everybody's business but both health and social care reforms and wider austerity policies are failing to address this vital issue. The situation is reaching a crisis point - a new BMA report suggests how government should respond.
We are failing our most vulnerable children. That is the stark conclusion in a new report published on the 16th May 2013 by the British Medical Association’s Board of Science entitled ‘Growing up in the UK – ensuring a healthy future for all our children’.
The report lays bare the harsh reality that far too many of our children and young people are being let down by a lack of political will. Successive governments have failed to see children as our most precious national resource and to deliver policies and funding streams to protect and promote their best interests.
‘Children are the living messages to a time we will not see’ said American author Neil Postman. This fundamental truth has been recognised by political theoreticians from Karl Marx to Winston Churchill. It is of even greater relevance today as children and working age people become an increasingly scarce and precious resource. In the 1950’s, one third of the population was teenagers and young adults; this will fall to one seventh within 50 years. Babies born today will be at their peak of productivity by the age 50, when the 20-year olds today will be approaching pensionable age. Who will generate the nation’s wealth to support their needs? The successful nurture of children should be the top priority for politicians. The BMA report exposes the fact that they are not.
There have been dramatic changes in the health of our nation’s children during the last 50 years. Most children are healthy and fewer die than in our grandparent’s time. The culture of services has been transformed, with parents today being encouraged to have access to their sick children at all time in hospital. Attractive new children’s hospitals and wards, including areas specifically designed for the needs of adolescents, are supported by passionate and dedicated staff. Major advances in molecular and genetic sciences have transformed the understanding, investigation and management of diseases hitherto thought to be incurable or life limiting. Effective immunisation has slashed the incidence and toll of polio, whooping cough, measles and rubella.
So, what’s the problem? The BMA’s report rigorously exposes how the outcomes for too many of our children are falling woefully below the standards achieved in other equivalent developed countries worldwide. It is one of the first recent comprehensive attempts to collate the key data and to offer informed commentary.
There are countless examples in the report of the way our health services are failing to provide universally high quality care for children even for those with common conditions such as asthma, diabetes and epilepsy. Moreover, in a cited review of childhood deaths (1), identifiable failures in management at the individual patient level were found in 25% of cases, and a further 43% had further potentially avoidable failures in care.
952,741 families have a child with a disability. The stories of their frustrations in accessing high quality, coordinated services and entitlements, which should be delivered with humanity and compassion, are searing indictments of our care.
One in ten children suffers from a serious mental or emotional ill health problem, yet fewer than 25% are able to access the services they need. 40% of 15 year-olds drink alcohol each week, with Canadian colleagues recently wondering why in England we are “sleep walking” into allowing such large scale preventable problems for children; namely fetal alcohol syndrome, which is barely, if at all, on the national radar.
The health system, as a whole, delivers care for our children that could be so much better. We know what needs to be done. As the Report observes, we have the best defined standards of care for children; many reports including the National Service Framework for Children, Young People and Maternity Services published in 2004 which set out comprehensive standards for every aspect of the health of children have been published. Yet they lie on dusty shelves in libraries.
Furthermore, the Report highlights the well documented social determinants of ill health. Poverty and inequalities are inextricably linked with every aspect of poor child and adult health outcomes. There are soaring rates of obesity, of substance misuse, and preventable ill health. Poverty is a health concern; it is time we saw it as such.
Instead we have politicians - of all political parties - who have singularly failed to put children at the centre of policy with appropriate will and resources to deliver change.
Not enough has been done to protect children and promote their health and wellbeing despite the Kennedy Report into the Bristol children’s heart hospital scandal, and the Laming Inquiry into the Victoria Climbié tragedy, which exposed the scandals of inadequate health and social care services nationwide.
And the social determinants of ill health are worsening for children. David Cameron when in opposition, said that ‘If Britain is the least family-friendly country in the developed world, then the next Conservative government will make it the most’. Yet current policies are unlikely to be judged by health policy analysts as family friendly. Indeed the Institute for Fiscal Studies reported that Coalition government policy on tax and benefits since 2010 is responsible for the steep rise in child poverty. Child poverty is not inevitable in times of economic recession; UNICEF reports that policy choices to protect children have been made in countries that are poorer than the UK.
The consequences of all these failings are stark: there are more than 1900 ‘excess deaths’ among children each year when compared to the best performing country in Europe.
What then, do we need? The BMA report sets out comprehensive recommendations for the future. Action is needed from politicians, Parliament, professional organisations, the media, local agencies and parents and families. The welfare of children should be everybody’s business.
The Report calls for a range of actions including:
(1) Improved transparency, responsibility and above all accountability for leading and delivering children’s services.
(2) An annual State of the Nation’s Children’s Report to monitor progress.
(3) A routine ‘Child Impact’ analysis of all government legislation.
(4) A formal inquiry by the Parliamentary Health and Education Select Committees into the health and welfare of children today.
Better leadership and improved political advocacy is needed from all professional bodies involved in the care of children, alongside a fair and accurate media portrayal of the circumstances of children and their value in society today.
‘It was the best of times, it was the worst of times’. This famous quotation from Charles Dickens is as relevant today as it was 150 years ago. The BMA report should be a wake-up call and a springboard for serious action to address the inconvenient truths it encompasses.
(1) Pearson, GA (Ed) Why Children Die: A Pilot Study 2006; England (South West, North East and West Midlands.), Wales and Northern Ireland. London:CEMACH. 2008.