By Fiona Simpson

Amid a cost-of-living crisis and off the back of the Covid-19 pandemic, the NHS celebrates 75 years since its inception against a backdrop of emerging challenges for children’s health.

Latest figures from NHS Digital show that in 2022, 18 per cent of children aged seven to 16 and 22 per cent of young people aged 17 to 24 had a probable mental disorder, meanwhile, nearly 1.2 million children in England are currently accessing support for special educational needs and disabilities without an education, health and care plan.

As demand for services across all areas of child health surge, experts assess how well the UK’s health service meeting children’s needs now and what must be done to ensure continued support for the next generation.

Andy Bell, chief executive, Centre for Mental Health

The NHS was conceived as a “cradle to grave” health service, free at the point of use by being funded through general taxation. In 1948, there was little recognition of children and young people’s mental health as an issue, let alone a priority for the newly created NHS.

Children’s mental health is now acknowledged as a major concern by governments, schools, and the public. Young people are much more literate than ever about mental health. Specialist community and inpatient services provide vital support for young people with mental health difficulties, while a wide range of voluntary and school-based services offer counselling and other interventions nationwide.

But demand for help vastly outstrips supply. As fast as the NHS can expand its offer, the number of children needing help grows faster. Thresholds for support are often too high, and waiting times too long, as scarcity of supply leads inevitably to rationing of care. The result is that children’s needs escalate until they reach crisis point and need more intensive support at a higher cost.

We need systemic change to support children and young people’s mental health. That means starting with prevention – offering early help for young families, ending child poverty, and tackling racism, domestic abuse and bullying. It means building comprehensive systems of support for young people – including early support hubs in every community and mental health teams in all schools and colleges – adapted to every child’s needs and affirming of their identities. And it means investing in specialist services so that young people and their families don’t have to endure long waits for care and admissions to hospital far from home.

Integrated care systems have the potential to bring organisations in local areas together to make this possible. But they need sufficient funding to rebuild children’s mental health services and to commit to making large-scale changes so that no young person is left without the right help.

Steve Jamieson, chief executive, Royal College of Speech and Language Therapists

For too long, speech and language therapy services have been a low priority, with ongoing confusion about who is responsible and a reluctance by all parties to show leadership, resulting in speech and language therapy services falling between the cracks of health and education.

This was further exacerbated by the pandemic when NHS staff were redeployed and services stopped. The true impact of the pandemic on children and young people’s communication and language development is only now beginning to show, with data from health visitors evidencing more two-year-olds who are below the expected level of development compared with before the pandemic.

The number of children and young people waiting for speech and language therapy services in England for 18 weeks or more, now stands at an eye-watering 22,854. No parent wants their child to be waiting, particularly at the youngest ages. However, to focus only on reducing waiting lists is also troubling, with many speech and language therapists feeling like they are on a conveyer belt of care, not given the time and freedom to provide the support which would make a real difference.

To further compound the issue, our recent survey of the speech and language therapy workforce shows vacancy rates in children’s services running at 25 per cent. In some areas it is even higher.

The recently published NHS Workforce Plan for England, while acknowledging the shortage of speech and language therapists, only focuses on the NHS and doesn’t take into consideration demand and unmet need. The assumption is that current demand is represented by the number of substantive staff and fails to address the current unmet need we know exists in speech and language therapy, both pre-pandemic and in its aftermath.

Being able to communicate is the bedrock for all learning and development. If we are committed to giving children the best start in life, we urgently need services to be properly resourced and speech and language therapists empowered to deliver service transformation, with a focus on early identification and delivering evidence-based support. We also need to better equip parents and the wider children’s workforce to play their role in supporting children’s communication. 

Dr Camilla Kingdon, president, The Royal College of Paediatrics and Child Health

Childhood obesity has long been a problem in the UK and increasing obesity rates are leading to more cases of type 2 diabetes, asthma, and high blood pressure in our children.

This year, a Diabetes UK study showed a rapidly escalating diabetes crisis in the UK, with type 2 diabetes becoming more prevalent among younger people. Demand for care for children with type 2 at paediatric diabetes units across England and Wales has also increased by more than 50 per cent in the last five years.

The causes of obesity are often complex and layered. But we know that children living in the most deprived areas are most affected. It’s no coincidence that these areas also have the highest rates of food insecurity. Today in the UK, one in three children are overweight or obese by the time they leave primary school and nearly a quarter of five-year-olds in England have obvious tooth decay. These are tell-tale signs of poor nutrition and deprivation and, in a rich nation such as ours, should be unthinkable.

Currently, the NHS spends £10bn per year treating diabetes. This is a whopping 10 per cent of its budget on one condition alone, and with the latest figures pointing to a rapidly escalating diabetes crisis, this will only increase. We simply can’t afford to go on like this. Serious action is needed to curb childhood obesity and safeguard future health services.

It’s time to start thinking long-term about child health and work towards decreasing demand on an already overstretched system. Good planning is essential across the child health workforce, especially for roles such as health visitors and school nurses who play a key part in delivering prevention and early interventions.

We also need a range of innovative and child-focused preventative health policies too. Let’s start by expanding free school meals to all children, introducing mandatory guidelines on the amount of sugar and salt in baby foods and putting child poverty back on the political agenda.

Education and empowering individuals to make better choices is important but will ultimately fall short if we do not have adequate government legislation, industry-level regulation and economic assistance.

Christine Lenehan, director, Council for Disabled Children

Disabled children have always been significant users of health services, they depend on the interactions between health, social care and education to achieve the best outcomes in their lives.

There is significant evidence of growing complexity in this area and a change in the profiles of children, with more children being diagnosed as neurodiverse and needs changing over time.

For example, 80 per cent of under-18s in specialist inpatient units are now girls with autism but no learning disability, a significant contrast to 10 years ago when the majority of young people were boys with significant learning disability and autism.

The pandemic put real pressure on these children and their families with the withdrawal of children’s community services including nursing and therapy, as resources were reallocated to the Covid emergency. The system is still struggling to recover with excessively long waiting lists for community services including diagnostics and therapy in most integrated care boards.

However, there has been progress such as the introduction of key working services which support children with autism and/or learning disabilities on the edge of admission to inpatient care or while in it, and these have made a huge difference to the quality of family and young people’s experiences. Staff also tell us they feel they have moved from being part of the problem to part of the solution.

Focused work on improving the needs of children with palliative care and life limiting conditions has also ensured quality and consistency.

On broader issues the appointment of an executive lead for children in each integrated care board gives us a real opportunity to ensure children, and in turn disabled children, remain a focus in a system which by necessity primarily looks at the needs of older adults. These in turn are now supported by a regional structure of staff championing the needs of children with special educational needs and disabilities, so while challenges remain there is cause to be positive about the future.

IN NUMBERS

• 18% of children aged seven to 16 have a probable mental health disorder
  
  

• 50% increase in paediatric type 2 diabetes in the last five years
  
  

• 22,854 children are waiting for speech and language therapy for more than 18 weeks

Sources: NHS Digital; RCPCH; Speech and Language UK