The scope and ambition in today’s NHS Long Term Plan to map out the provision of all healthcare in England over the next decade is huge, and I welcome that. It represents a significant change of emphasis in health towards both children and prevention. As with all change, it will need strong leadership and drive to ensure that ambition translates into real change. That said this is now an important platform with the potential to improve children’s lives, if it gets the support and investment it needs.
My priority is to look at what these plans will mean for children, in particular the millions of children who have a health condition – physical, mental or developmental – that impacts on their daily lives and their lifetime prospects. Last year, I was invited by Simon Stevens, along with other leading figures working with children, to help the NHS consider what should be included in the Long Term Plan. I argued that the NHS needed to take a broader look at child health – to move from ‘surviving to thriving’. I called on the NHS to think about how it could help children ‘live well’ and how it could promote a broad range of health outcomes which would in turn also promote children’s well-being and their social, emotional and educational achievements.
So I am really pleased today’s 10 year plan unambiguously states that “the NHS plays a crucial role in improving the health of children and young people: from pregnancy, birth and the early weeks of life; through supporting essential physical and cognitive development before starting school; to help in navigating the demanding transition to adulthood”.
I believe this needs to start as early as possible, so it is good to see a strong focus on pre-natal and maternity services within the plan. In particular, I welcome the unambiguous target to “achieve 50% reductions in stillbirth, maternal mortality, neonatal mortality and serious brain injury by 2025”. Moreover the approach outlined in the plan – one that focuses on working with vulnerable families, identifying risk factors early and ensuring continuity of midwives throughout pregnancy, birth and the postnatal period – is absolutely the right one. It is good to see this will be backed up by a range of measures to help improve mental health care for new parents, particularly mothers, as this can have a huge and lasting impact on children.
The focus on the early years is light though and there certainly needs to much more work on the detail in this area. This is a crucial period between the end of maternity services and when children begin school. Tens of thousands of children begin school with significant, but treatable, development conditions. This can have a lasting effect on their education. While the plan contains positive words about better links with local authority provision, it is does not contain clear commitments to early years healthcare, such as family nurse partnerships or access to educational psychologists and speech and language therapists. This is a real missed opportunity and one that needs to be rectified.
There are though more specific – and again welcome – commitments around children’s mental health. By 2023, the NHS will be treating an additional 345,000 children a year. This is a significant increase in the number of children receiving help and is of considerably greater scale than previous announcements. Moreover, the NHS also confirms it will introduce a waiting time target for children’s mental health, although no date is given. More importantly still, for the first time the NHS makes a commitment to treat all children who require specialised mental health treatment by the end of the Long Term Plan – something that I particularly wanted to see in place. The right to receive mental health care when needed should be a basic right for all children, but for years the NHS have said it is simply not possible. It always was, and I welcome this important shift in thinking.
But this goal will only be achieved if there is further serious investment in community and school-based provision. I am disappointed that the Plan only restates previous commitments in last year’s Green Paper to work more closely with schools and colleges. The NHS can do much more than reach a quarter of schools by 2023 if the political will is there. Indeed, if the NHS is serious about meeting the commitment to treat all children who need help I think they will need to commit to an NHS-funded counsellor in every school – and I will continue to make the case for it.
Similarly, there are welcome measures around autism and learning difficulties, but with lots more to do. There is a long-overdue commitment to introduce waiting time standards for autism diagnosis, though not other conditions such as ADHD. There are also a range of important measures to reduce the need for children to be admitted to hospital and to “restrict the use of seclusion, long-term segregation and restraint for all patients in inpatient settings”. Crucially, this includes measures to improve discharge for children in in-patient settings. However, there are not the concrete commitments for other forms of special educational need requiring NHS care, and little to respond to damning judgements from the CQC and Ofsted on current provision. Again, these issues will need to be addressed.
Throughout the plan, I am pleased to see the NHS repeatedly recognise the social and economic determinants of children’s health outcomes. A child’s home environment remains a major factor in how likely they are to have certain health conditions and their outcomes from these conditions. I would like to have seen more specific actions to mitigate this included within the plan, though there are two exceptions to this that are particularly noteworthy. Firstly, I am pleased to see the NHS commit to funding keyworkers for children with autism or learning difficulties who also have other vulnerabilities, such as being looked after. Secondly, the range of ‘top tips’ for GPs developed with young carers for young carers, including social proscribing and better mental health support is very welcome.
Finally, there are a number of specific and important commitments for children with the most serious illnesses. There will be new clinical networks to improve care for children with diabetes, epilepsy and asthma. Children with cancer will be offered whole genome sequencing, both to improve survival rates and to reduce the long-term consequences of cancer treatments. There is an increase in funding for children’s palliative care and hospices.
So, there is much to be positive about in today’s 10 year plan – and I pay particular tribute to those in the NHS who have been working really hard to do more to improve the mental health care system for children. If these plans are followed through, thousands more children suffering from acute conditions will be helped.
However, this is not the end of the debate. Much more needs to be done for those children with minor conditions, and to improve the system as a whole. That will require leadership, additional funding and bold policies – in the NHS and across Government – and I will continue to push hard for a system that is capable of identifying problems early and treating all children who need help, whenever they need it.
