Kids First?

Health and Social Care Secretary Jeremy Hunt has been busily briefing that the NHS will get a substantial funding settlement for its 70th birthday, but how should any extra cash be prioritised for maximum benefit? Hunt is fond of saying that patient safety is ‘paramount’, and yet has singularly failed to enforce legally mandated safe-staffing and skill mix levels that are essential to patient safety. Patients, and members of staff, are avoidably harmed every day in health and social care because of staff shortages right across the service. So where should Hunt and NHS England start to reverse this wholescale avoidable harm?

The law, as enshrined in the 1989 Children’s Act, made it clear that “the welfare of the child is paramount”. Adopting this legal principle would mean that in any situation the right of children to be both protected from avoidable harm and to live healthy lives should override all other concerns in health and social care. So how is England complying with this law? Even if in its narrowest interpretation, protecting children from the risk of abuse, services are struggling. A recent survey by the National Network of Designated Healthcare Professionals for Safeguarding Children (NNDHP) found that there was huge variability across Clinical Commissioning Groups in England in their commitment to resource their statutory obligations, with no logical explanation.

Safeguarding children is highly complex and stressful, and to do it competently costs money that many CCGs are unwilling to commit, even though it is supposed to be their paramount obligation, overriding all others. Doctors, nurses and social workers working is safeguarding are covering populations up to ten times greater than the agreed safe standard. Unsurprisingly, recruitment and retention of staff has become a big problem. CCGs are about to get a big wake-up call as the Children and Social Work Act 2017 kicks in. The Act puts duties on three ‘safeguarding partners’ – the local authority, CCGs and the Chief Officer of Police – ‘to make safeguarding arrangements that respond to the needs of children in their area.’ If they don’t, and failures ensue, all will be held to account for missing child abuse.
Paramountcy for childcare also requires adequately resourced services for children to access. Last year, an angry Justice Munby was forced to blow the whistle to the media to get care for a 17 year old at acute risk of suicide, saying the nation would have ‘blood on its hands’ if a bed could not be found, and that he was ‘ashamed and embarrassed’ at the lack of provision. As the NHS’s longest serving health secretary, Hunt too should be ashamed at embarrassed at the state of child health and welfare.

One in five children in England live in poverty, it’s highest since 2010, and there is clear evidence that the future health of adults is clearly defined by the number of adverse childhood experiences they endure. UK child mortality is not only higher than many other countries but is on the increase, both for the neonatal period and for children under 5. As an excellent review by paediatrician Neena Modi paints a depressing picture. About a third of 10-year-old children are overweight or obese; a quarter of 5-year-olds have tooth decay, self-harm among girls aged 13–16 has risen by two-thirds in the last 3?years and compared with 2015–2016, there has been a decrease in 2016–2017 in coverage of four of the six routine vaccinations at age 1 and 2 years, and coverage for Measles, Mumps and Rubella decreased for the third year in a row, following previous annual increases over 9?years.

Over 80% of obese children will remain obese as they grow older, and this will lead to them losing about 15–20 healthy-life years as adults. Teenagers, even if only at the upper end of normal body weight, have a substantially increased risk of premature death in adulthood. Air pollution experienced in fetal life, infancy and early childhood scars lungs for life, increasing the likelihood of chronic respiratory conditions in old age. As Modi puts it: ‘these are classic examples of societies fouling their own nests, by failing to see the destructive consequences for everyone of not safeguarding child health.’ If child welfare was truly paramount, it would receive ring-fenced funding and all the resources it needed from keeping children safe and secure in the home to providing adequately staffed emergency services when they are admitted with sepsis or meningitis. Hunt, who has overseen the worst decline in NHS performance on record in nearly six years in office, celebrated his longevity (and brass neck) by declaring ‘judge me on my results.’ If he wants to leave a positive legacy, he should ensure the legal paramountcy of child welfare is matched by paramountcy of funding. All our futures depend on it.