Writing for The Leaders Council in a special report, the founder of social enterprise Five Rivers Child Care and co-interim CEOs of major children’s charity Barnardo’s critique the government’s Health and Care Bill currently progressing through Parliament, calling for a greater focus on children’s services.
The intention behind the Health and Care Bill is to implement the policies that were set out as part of the NHS’s recommendations for legislative reform. These recommendations can be found in the NHS Long Term Plan and the February 2021 government White Paper entitled: ‘Integration and Innovation: Working together to improve Health and Social Care for all’.
In their 2019 election manifesto, the Conservative Party pledged to enshrine the NHS Long Term Plan into law, with the Bill now moving through Parliament in a bid to make this a reality.
A major part of the Health and Care Bill is a drive towards more integrated health and care services. While this has been welcomed by many in the industry, providers and charities working with children are concerned that there needs to be more of a focus on children and young people, for a healthcare system designed with adults in mind may not operate to best meet the needs of the young.
Pam McConnell is the founder of Five Rivers Child Care, a social enterprise operating across England and Ireland that has been running for 32 years, providing services for ‘looked after’ children who have experienced abuse and neglect in their early childhood. McConnell wants to see the reforms that the Bill proposes in the health and social care sector expanded to cover children’s services. She is, however, concerned that it could take a long time for such changes to be integrated into her industry.
McConnell writes: “The Health and Care Bill’s drive towards integrated services and greater collaboration between the health system and its key partners is welcome. However, a stronger focus on children and young people is needed to achieve its goals of improving the health of the population.
“We cannot expect a system designed with adults in mind to meet the needs of the young. We need to see the reforms being talked about in health and social care replicated in children’s services, but I fear that these changes may take a long time to permeate into our industry.”
McConnell also believes that children’s services would benefit from a nationally funded plan, rather than looked after children having to be provided for through a mixed provision of services procured by local authorities.
She says: “Those children whose primary needs are not met in the family home or who are vulnerable to such abuses may enter the care system, known as the ‘looked after’ system, where a mixed provision of services is procured by the local authority to meet the needs of these children. From my years of experience in the sector, I believe that parents would rather have access to more help sooner and through locally provided services that properly support their children.
“I believe our sector would benefit from having a centrally funded national plan for children’s services, rather than it being dependent on a postcode lottery. Funding through local councils means severe pressure on the ability to plan long term. Hefty commitments that have been sewn in prior eras leave little choice for councils. There could be a helpful move to form a separate capital pot for supporting infrastructure needs, rather than diverting funds away from service delivery.”
The co-interim CEOs of Barnardo’s, Lynn Perry and Michelle Lee-Izu, share McConnell’s sentiments that the Health and Care Bill could support improvements to children’s services similarly to how it proposes to do so in adult health and social care, if it embeds children and young people at its heart.
Expanding upon this, Perry and Lee-Izu highlight that the integrated care systems being proposed in the Bill ought to support a single point of access to services for children across a spectrum of need.
Perry and Lee-Izu write: “The Health and Care Bill provides a unique and timely opportunity to tackle the blight of child health inequalities and mental ill health, brought into stark relief during the pandemic. A more coherent, accessible support offer from prevention through to acute intervention, so desperately needed, for all children and families, could be facilitated by this Bill. We therefore welcome the government’s recent move to require Integrated Care Boards to address the needs of children and young people under the age of 25, but implementation now needs to be ambitious, clearly focused and deliver real change for children, young people and families.
“Children’s health and social care is in crisis. Specialist Children and Adolescent Mental Health services are failing to keep pace with demand to address potentially life-threatening eating disorders, for example. The children’s social care system, responsible for parenting our most vulnerable children, has been described by the Chair of the Independent Review of Children’s Social Care as a ‘tower of Jenga held together with Sellotape’. These pressures are a wakeup call for a system where children, young people and families are often left with limited, inadequate and uncoordinated support.
“Childhood suffering is too often left to become distress, illness, and crisis. Expensive acute services have become overwhelmed and are an unnecessary destination for too many children and young people. Integrated Care Systems should therefore be a springboard to catalyse change in the way services work together locally. Working co-productively, interrogating local data and designing local solutions provide real opportunities to build service capacity and support for children and families across a spectrum of need. Integration can also increase access to support for all children and families via a single gateway, for example, through schools, GP surgeries, youth groups and voluntary sector services which, crucially, are effective at reaching our most marginalised communities who bear the brunt of ill health.”
Perry and Lee-Izu add that the health and wellbeing of children thrives within thriving families, and that to facilitate this, the legislation needs to deliver integration between services for adults and children.
“To realise the full benefits of integration, those working with adults need to have a keen awareness of any concern or impact on children in the family, and those working with children need to be able to signpost parents and/or carers and other adult family members to the support they need”, Perry and Lee-Izu explained.
“Increased integration would also support improved transitions between child and adult services, avoiding the counterproductive ‘cliff edge’ at age 18 that is still the experience of too many young people.”
In order for the government to achieve its ambition within the Bill to reduce health inequalities, Perry and Lee-Izu emphasise that investing in children will become a vital part of the strategy. For, as they say in the special report, the foundations for a life of good health are laid down in one’s formative years.
“The ambition of government ministers is that integrated care systems will reduce health inequalities. To achieve this, investing in children is essential, as the foundations for a lifetime of good health are laid in childhood.
“Barnardo’s wants to see children, young people and the voluntary and community enterprises who support them robustly represented within integrated care system structures. The Better Care Fund should specifically address integration within children’s services – at the moment it is skewed towards funding adult service integration.”
This article includes extracts from The Leaders Council’s March 2022 Special Report exploring the effects of the Health and Care Bill. The full report, including Pam McConnell, Lynn Perry and Michelle Lee-Izu’s contributions in full, can be found here.
Photo by Danny Nee on Unsplash
