National policy and prioritisation
Nearly all respondents (90%) said the health and wellbeing of children and young people was not considered enough in national policy. Many felt that the national focus and prioritisation was disproportionately focused on adult services. In part, this is related to the lack of voice given to children and young people in the design of policy that affects them and services they use. Respondents were clear that the voice of children and young people should be central to developing a vision for the future of children and young people’s services. As outlined in a recent NHS Providers’ blog (NHS Providers, 2024) to mark Children’s Mental Health Week, enabling children and young people to have a say in how they want to receive care and working with them as equal partners can help services better meet their needs and manage rising levels of demand.
When asked what policy changes they would like to see national government make to help their organisation to improve services for children and young people, the most popular responses were:
- Increasing investment in prevention and early intervention in the NHS (44%).
- Adopting a cross-government approach to improve the health and wellbeing of children and young people (40%).
- Increasing investment in targeted early years support across a range of health and wider services (39%).
The emphasis on prevention and early intervention is notable and reflective of the view that, to create a sustainable healthcare system for the future, focus must shift towards keeping people well at home and in the community. Prevention initiatives in childhood are vital in preventing the onset of long-term illnesses later in life.
There was also support for increasing investment, in the form of: public health funding for children and young people (35%); national funding to support with waiting list reduction (31%); and better support and investment in social care (27%). This is important as the Health Foundation reports that the public health grant has been cut by 24% since 2015/16, and this has had the greatest impact in the most deprived areas (Health Foundation, 2024). The grant is allocated by the government to local authorities each year to provide services including children’s health, sexual health and smoking cessation.
The prominence of the ask around social care draws attention to the importance of social care partners in supporting children and young people. Trust leaders, especially those delivering mental health and learning disability services, work very closely with these partners, who play an essential role in supporting people to live well in the community. Pressures in the sector have a profound impact on the people accessing these services, as well as NHS delivery.
Recommendation:
Government should increase the public health grant to restore the provision of key services, such as health visiting and school nursing, which support children and young people to live well in the community and help to prevent ill health. Without this fundamental enabler the efforts of services closest to children, young people, their families and communities will not reach their full potential.
Recommendation:
The new government should develop and implement a cross-departmental strategy for the health and well-being of children and young people to support national prioritisation and focus on early years support and prevention. A cross-departmental strategy would mirror collaboration taking place between services and across systems at a local level, and would also align with similar recommendations made by the Children’s Commissioner for England.
System working
Respondents were asked to describe how their local ICSs are currently supporting the delivery of children and young people’s services and addressing health inequalities. System working was viewed as playing an important role in ensuring these services are prioritised locally, and facilitating better joined-up, partnership working. In one example, regular communication between key system partners had led to a reduction in the number of children and young people escalating into crisis. When discussing how systems are tackling health inequalities faced by children and young people, respondents referenced the Core20PLUS5 (NHS England, 2021) approach, system-wide audits on health inequalities, and programmes to reduce variation in access. System-level work on health inequalities tended to be at an early stage, and results on the longer-term ambitions of ICSs further away.
Three quarters (76%) of respondents said their trust is involved in improvement initiatives taking place at system level for children and young people’s services. Likewise, 77% said they knew who their ICB executive lead for children and young people’s services was. While these figures show good levels of engagement with this agenda at system-level, there is scope to develop this further, and for all trust types to be brought into improvement work (ambulance trusts were less likely than others to feel involved).
However, only a third of respondents (33%) said they were satisfied that their local ICS plans adequately prioritised children and young people’s services, and 39% of respondents felt dissatisfied with their ICSs’ plans, with levels of dissatisfaction higher among ambulance and community trusts. Again, this suggests that there is further work to do to ensure that trusts from all sectors, are brought into system-level work to tackle some of the challenges being felt across the system.
Overall, respondents said systems needed to dedicate a proportionate amount of spending on children and young people to address the existing inequities. However, they acknowledged that the financial pressures facing ICSs would likely make these conversations challenging.
