Failing Children (again and again)

Sir Al Aynsley-Green, Professor Emeritus of Child Health at University College London and former National Clinical Director for Children and Children’s Commissioner for England, has written to the Eye to expose the continued neglect of children in the NHS: ‘We have failed, are still failing and are likely to continue failing far too many children and young people through inadequate health services’.

‘Ten years ago, the Bristol Inquiry was cataclysmic in its condemnations (1), saying that children had been the ‘Cinderella’ service in the NHS for far too long. Lord Laming’s equally devastating conclusions followed from his Inquiry into child protection triggered by the murder of Victoria Climbie (2). Both uncovered the care of children being subordinated to the demands of adult services; lack of concern for vulnerable individuals; failure to protect children’s rights; quality of care less than it should be; failure of communication, effective planning and partnerships with professionals and parents, and lack of responsibility for children with ineffective leadership.’

‘Even before the financial crisis, the UK ranked bottom of the 21 richest countries for the well being of children. (3,4) Sir Michael Marmot’s recent review (5) on health inequalities documents highlighted (again) the impact of social disadvantage on longevity and morbidity, with so much adult ill health having its roots in childhood. Now we have Sir Ian Kennedy’s follow-up report on children’s health services commissioned by Labour in 2009 (6).’

‘He has exposed yet again that although there are patches of excellence, health services for many children and young people are still highly unsatisfactory, because of ongoing failure to give them political priority in the NHS coupled with cultural barriers between services that prevent professionals working together. He highlights again the imperative for effective leadership, and is highly critical of the role and the lack of training of GPs in the care of children.’

‘As National Clinical Director for Children, I lead a taskforce to define standards of care for children, young people and maternity services through a National Service Framework; it was published in 2004 and defines evidence-based standards of care for every aspect of children’s health (7). Alas, the NSF’s orientation was changed by Labour from ‘must-dos’ with hypothecated money for implementation to nothing more than aspiration over ten years. Without incentive to change, there was little progress.’

‘The Coalition’s proposals for children’s services (8) are set in the context of GPs being given responsibility for commissioning, just as Kennedy has highlighted their lack of training and failure to deliver effective children’s health care. The proposals appear to shoe-horn children’s services into adult-centric ideological reforms rather than starting with the fundamental question of how they should best be structured. Children are our most precious resource and it is beyond belief that we have failed so dismally to protect their best interests for so long.’

Time for the Health Select Committee to investigate?

1 Kennedy I (2001) Learning from Bristol: The Report of the Public Inquiry into Children’s Heart Surgery at the Bristol Royal Infirmary 1984-1995.
2 The Victoria Climbie Inquiry(2003)
3 UNICEF (2007) An overview of child wellbeing in rich countries. Innocenti Report Card 7
4 OECD (2009) Doing better for children
5 Marmot M (2010) Fair Society, Healthy Lives: Strategic Review of Health Inequalities in England post 2010.
6 Kennedy I (2010) Getting it right for children and young people. Overcoming cultural barriers in the NHS so as to meet their need.
7 National Service Framework for children, young people and maternity services (2004):
8 Achieving Equity and Excellence for Children. How liberating the NHS will help us meet the needs of children and young people.(2010)