Analysis: Health report verdict: can do better

The latest progress report on the government's 10-year plan for improving children's health was generally positive about the progress the NHS has made towards its goals. But as Helen Gilbert finds, a number of concerns about progress remain.

Three years on from the launch of the government's 10-year vision for children's health services, steady progress is being made according to a Department of Health review published last week (CYP Now, 14-20 November).

The National Service Framework for Children, Young People and Maternity Services (NSF) sets out standards on children's health that the NHS should be working towards. The review by Sheila Shribman, the national clinical director for the children, young people and maternity services, found particular progress had been made in mental health services and care for newborns.

But the Children's Health, Our Future review also warns that children's health services are "still seen as a low priority in some quarters" and concluded that more work needs to be done.

Shribman told CYP Now: "The message from the report is that we are not serving all children and young people well yet. There is very good progress but there is no room for complacency. Child and adolescent mental health services (CAMHS) has had significant investment but in other areas, such as school nurses, there are concerns."

School nurses a priority

Her worries about school nurses are shared by David Munday, professional officer at the Community Practitioners' and Health Visitors' Association. He fears the government's pledge to have a nurse in every secondary school by 2010 will not become a reality. "We believe they won't be able to achieve it until 2023 and that's if school nurses stay at the current rate and increase without losing anyone," he says.

"There are some primary care trusts (PCTs) that don't have any trained school nurses. We brought it up with the government, which said it's up to local decision making. The massive problem with this is that PCTs will use the money to deal with more short-term targets. It's understandable but it's not going to secure the future of the next generation."

Jo Butcher, assistant director of health, well-being and environment at the National Children's Bureau, agrees: "School nurses are a key part of the children's workforce but our members tell us that services are under threat."

One criticism of Shribman's review is the lack of attention given to children's trusts. According to Stella Charman, director of CAMHS Consultants, the only way progress will be made is if people are talking to each other and working together.

"At the beginning I saw Every Child Matters and the five outcomes and I thought this is a joined up piece of work," she says. "But in the commissioning section there was little reference to local authority children's trust arrangements and these are really important."

Charman also thinks the significant variations in the quality of CAHMS provision is worrying. The report highlights that the number of full-time equivalent staff per 100,000 people varies from region to region, with a maximum of 21 and a minimum of six. "My concern is that a number of areas have got a bit stuck and I'm not clear on the plans to un-stick them," she says. "Some areas have financial difficulties and PCT money has not got through, there may be areas where CAMHS is not top of the agenda or where services are struggling to recruit. There ought to be some baseline level for service delivery."

Progress for newborns

Elsewhere, Shribman's review praises the work being done in services for newborn babies and highlights the 24 neonatal care networks that have been established across England. According to Shribman, these networks - which break down barriers between primary, secondary and tertiary care and agencies - are the way forward for children's health services.

But Patricia Hamilton, president of the Royal College of Paediatrics and Child Health, says: "Neonatal networks are indeed in place - but referrals to the most specialist units are difficult because they are full or lack sufficient nursing staff."

A spokeswoman for premature baby charity Bliss adds: "Many baby units in the UK are understaffed, with only 12 out of 226 claiming to operate at or above the recommended minimum nursing levels. We would like to see a concrete commitment from government to make the necessary funds available so more nurses can be recruited to cope with current and future demand."

Funding is also on the mind of Steve Broach, Every Disabled Child Matters' campaign manager, who points out that the review refers to the £280m the Department for Children, Schools and Families has committed to short breaks for disabled children, but makes no mention of the money the Department of Health is supposed to provide for these services. "We need to see that commitment delivered on," he says.

But Shribman is aware more must be done. "We are only three years into a 10-year programme on the NSF and there is a long way to go. We need to sustain efforts to date and build on them."


- The National Service Framework for Children, Young People and Maternity Services was published in September 2004

- The framework is a 10-year programme designed to improve the health and well-being of children and young people by setting standards for all organisations providing services to children and their delivery partners

- It forms an integral part of the Every Child Matters agenda, which aims to ensure that services are working together to help children and young people achieve the five outcomes: be healthy; stay safe; enjoy and achieve; make a positive contribution; and economic wellbeing.

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