Nursery World - Are we betraying children?

As a British Medical Association report on children and health reveals how UK outcomes are falling behind other developed nations, Sir Al Aynsley-Green calls on the sector to respond at a local level in order to drive change on a national scale.

Growing Up in the UK is about children and their health today. The image on the right reminds us of the species we are talking about. She is a beautiful newly born infant girl, a citizen in her own right. Like all other newly born babies, she is defenceless, exquisitely vulnerable, and her survival and long-term potential depend critically on the care given to her by adults.

The nurture of babies and children is not just the responsibility of parents and families, as vital as that is, but it should be everybody's business - communities, faiths, schools and professional staff as well as politicians.

It could be argued that nations should be judged on their enlightenment, not only by the commitment they give to children in policies but through the reality of health, education and social outcomes as children progress into adulthood.

Children are our nation's most precious resource. Political theorists - from Karl Marx through Winston Churchill, Tony Blair and Gordon Brown - have recognised this fundamental truth. More recently, European Union theoreticians have argued the cause of investing in children to create the 'child-centred social investment strategy', and this became manifest in England through the Every Child Matters policy of the New Labour Government.

Political rhetoric is important in setting a context and flying a signal, but it is ephemeral, subject to change in party political focus, and driven by external circumstance. What should matter most is sustained cross-party political will to recognise the importance of children and translate fine words into practical policy that supports the lives of children and their families. So, how well are we doing in the UK?

Children, generally, are healthy and few die compared to 50 years ago. The culture of services has been transformed - for example, by accepting that parents should have unlimited access to their sick children in hospital, and be involved in making decisions in their care. The increasing importance of the voice of children and young people is being realised based on Article 12 of the United Nations Convention on the Rights of the Child.

Meanwhile, resources and facilities have improved, such as attractive new children's hospitals including wards purpose-designed for adolescents. Major scientific advances have transformed the understanding of the pathogenesis of diseases, their diagnosis and treatment.

INCONVENIENT PARADOX

Despite these important developments, Growing Up exposes the inconvenient paradox that all is not well for children and their health in the UK, with so many outcomes for our children falling way below the benchmarks of other developed nations. Why is this the case?

Sir Ian Kennedy's Inquiry (2000) into the scandal of children's cardiac surgery in Bristol also exposed that, nationwide, care for children was subordinated to the demands of adults and that children were not mainstreamed in Government policy - they were an 'add-on'. Unable to vote, children and young people have little political traction, and this coupled with a failure of leadership and of political advocacy by professional organisations led to their needs being under-recognised.

Revisiting children's health services ten years later, Kennedy found patches of excellence, but that cultural barriers in Government, and in services, perpetuated. His findings triggered the then-Government to launch 'a new crusade to improve the nation's children's health', including a National Service Framework (NSF) setting out standards for children's healthcare. After four years of work, involving more than 300 experts, the NSF was published to international acclaim.

But then children were betrayed by politicians, with the defined 'must-dos' turning to nothing more than 'aspiration' over a ten-year period. This lack of political will created a fury in the sector with a shadow of distrust lasting until now. A unique opportunity at a time of financial abundance to give children the priority they deserve was lost. Why did this happen? The inconvenient truths include:

the 'churn' of ministerial appointments (six ministers and three secretaries of state in five years)

failure to get continued focus for children's health from the Government through successive secretaries of state in the Department of Health (DoH)

political fashion - 'shifting the balance of power' becoming the DoH mantra

political indifference

failure of Parliament to hold the DoH to account

lack of media pressure

the silent voice of the sector and lack of concerted, effective and sustained advocacy.

THE CHILDREN'S PLAN

In 2007, the New Labour Government launched The Children's Plan, incorporating five outcomes - 'be healthy, stay safe, enjoy and achieve, make a positive contribution and achieve economic well-being'. As with the NSF, this policy received international acclaim for the comprehensive way in which children and their services were regarded.

In 2010, within minutes of the new Coalition Government being announced, every image of the Every Child Matters policy was removed in what had been the Department for Children, Schools and Families, now renamed the Department for Education, the former plan being systematically dismantled.

The DoH published its policy statement, Achieving Equity and Excellence, that same year, timed to coincide with and, arguably, to neutralise Kennedy's highly critical report on the lack of progress in improving children's services. It has now published its Report of the Children and Young People's Health Outcomes Forum. It sets out principles with the potential to change the focus of children's healthcare towards accountability through defined outcomes: putting children, young people and families at the heart of what happens; acting early and intervening at the right time; integration and partnership; safe and sustainable services; workforce, education, and training; knowledge and evidence; leadership, accountability and incentives.

The sceptic experiences deja vu, seeing philosophies and words identical to those of the NSF, and believes that without any political commitment to the outcomes, let alone the funding streams for implementation, the publication is destined to gather dust on the library shelves alongside the many other unimplemented policy declarations in recent years.

On the 19 February 2013, the Government announced a national pledge to reduce the number of excess deaths in children (some 1,600 per annum when compared to other developed countries), and to start a data revolution so the NHS and local authorities get better information they can use to improve the health of young people. The announcement also included making sure children and young people are at the heart of the new health and care system and that their voices are heard; and the creation of new roles and bodies to ensure the issue stays top of the agenda.

These comments and pronouncements are welcome, but the history of children's health policy is such that there is limited confidence that anything meaningful or substantial will change, especially against the backdrop of financial austerity.

Growing Up provides a compendium of hard evidence on the circumstance of children's health in the UK today. What the overall data cannot do, however, is to expose the real human cost of this circumstance on the day-to-day lives of individual children and their families. The voices of children and families are not evident. Who is listening to them?

Take, for example, Rachel and Simon (not their real names), the parents of five-year old Emily (not her real name), a child with complex congenital malformations and learning difficulties. 'Wading through treacle', they say. 'Who is in overall charge of my child? Why do I need ten different appointments at different times to see the specialists involved in her care? What is going to happen to her as she grows up and becomes an adult? Who is responsible for integrating her education, health and social care needs? Why do we have to fight every inch of the way for her entitlements? Who cares?'

No one chooses to be the parent of such a child, and the children themselves certainly do not, yet where is the compassion in our society? Any one of us could be confronted with these realities in our families.

As Ingrid Wolfe, quoting Charles Dickens, says in her chapter, 'It was the best of times, it was the worst of times'. The Victorian times were devastating for the lives of countless children. Of course, we cannot directly compare the appalling circumstance of children 150 years ago with today. But are there not parallels?

In 2013, we are experiencing the most challenging era for children, young people and their health in the past 30 years, driven by a disastrous financial environment leading to deep cuts to public services coupled with political turmoil.

Should there not be outrage that the lives of so many children and their families are blighted by the facts exposed in Growing Up? Who speaks for them? Where is the evidence of concerted and effective political advocacy from the professional organisations that claim to have their best interests at their heart?

I issue a call to action by all concerned by the plight of children and the threats to their services. The facts and a menu of recommendations are here in this outstanding book. So, to every reader, my challenge is if you really care about children, what are you going to do about it?

As well as striving for national political focus and action through membership of our professional organisations, it is from the local level that change for children should be driven - parents in exposing poor practice; the new responsibilities of staff in the light of the inquiry into the scandal of care in Stafford to be 'whistle-blowers'; and effective leadership. There is much to do and as Neil Postman said in his book The Disappearance of Childhood, 'Children are the living messages to a time we will not see'.

Their future lies in our hands now and we cannot afford to continue to fail them.

This is an edited version of the foreword to Growing up in the UK by Sir Al Aynsley-Green, Professor Emeritus of Child Health, University College London, and former children's commissioner for England

REPORT: KEY FINDINGS, CONCLUSIONS AND RECOMMENDATIONS

Report of the Children and Young People's Health Outcomes Forum (2012) concluded that more children and young people are dying in the UK than in other countries in northern and western Europe.

In 2011/2012, the highest number of children ever recorded in the UK were referred to local authority care, mainly for abuse and neglect.

Poverty is one of the main reasons that the UK under-performs on child well-being.

Changes to the tax and benefits system could reverse recent improvements by hitting the most vulnerable hardest, exacerbating child poverty and widening social inequalities.

The UK moved up UNICEF's league tables for child well-being - from bottom of 21 in 2007 to 16 of 29. However, this latest data relates to 2009/10 and does not reflect the impact of policies implemented since the 2010 election.

There is an urgent need for a health of the nation's children annual report to review trends and assess what works best to improve child well-being and to: