Children lose out to demands of adults in NHS, says report

Children lose out to demands of adults in NHS, says report
Ian Kennedy

Professor Sir Ian Kennedy, said children have a low priority in the NHS. Photograph: Sarah Lee for the Guardian

Children are suffering from a culture that does not give their health needs the priority and status they deserve, according to a report.

Professor Sir Ian Kennedy says in what he terms a “radical analysis” that children and young people – because they are a supposedly healthy minority – constantly lose out to the demands of adults within the NHS.

Those who are fit and well cared for at home do fine, but the NHS is failing to provide more than “mediocre services” for those who need much more, such as the disabled and the abused, he argues. Part of the problem is the “silo mentality” of services that should have children’s needs at their heart. Time and again the disjuncture between the NHS, education and social services is shown up by the tragic deaths of vulnerable children, such as baby Peter Connelly who died in Haringey.

“Services for children could and should be a lot better,” said Kennedy at the report’s launch. “Within the NHS, when they are good they are very, very good, but too often they are mediocre or worse, particularly as regards the long-term needs of disabled children and mental health care.”

Kennedy, whose inquiry in the late 1990s into the deaths of babies undergoing heart surgery in Bristol led to major reforms in acute services, says there are cultural issues at play. Children and young people were not consulted, he said, and their needs were subordinated to the dictats of top-down policies. A Unicef report ranked the UK bottom out of 25 developed countries on the wellbeing of its children. Child mortality has fallen in the UK, but by less than in other comparable countries.

“Children currently have a low priority in the NHS,” said Kennedy, whose inquiry was commissioned by the NHS chief executive, David Nicholson. Little was done to promote their mental and physical health and prevent problems arising. Instead they ended up in hospital accident and emergency departments. “About half of children under 12 months and a quarter of all children will attend A&E in a year,” said Kennedy.

Kennedy’s solution is to integrate those services that should have children at their core. He wants the portion of the health budget that is spent on children removed from general NHS spending. A proposal to channel that – and all other funds for children – through what used to be the Department for Children, Schools and Families was reworked after the election when the new government made it clear the DCSF would revert to being the Department for Education.

Kennedy calls for a cultural shift so that those who work with children in the health service see themselves as part of something bigger – complementary to those within education and social services. David Nicholson said at the launch that the report “doesn’t make comfortable listening for people who have spent most of their years leading the NHS, but it is necessary to raise these issues”. He accepted that “over the last 20 years or so, children’s services have never been a major priority for the NHS”.

“What we need in health service leadership terms is a revolution in the way we look at children and children’s services,” he said.

The health minister Anne Milton said: “There are examples where services are truly excellent. We need to stop that being patchy and turn it into a commonplace across the NHS.” She said the government had launched a white paper that would address Kennedy’s concerns and she hoped children, young people and their parents would comment.

A spokesman from the Royal College of Paediatrics and Child Health called the report “a crucial document for the future health of children and particularly important given that the recent government health white paper has little to say about children.

“We support Kennedy’s emphasis on the joining up of children’s services. We also strongly support his emphasis on early intervention, as it helps to ensure the best outcomes for children and is a crucial investment for their wellbeing in later life.”