Health professionals must begin to notice the young

At different points in their lives, they are heavy users of some services. The more vulnerable they are, the likelier they will call on services for support and understanding. Like adults, they have a right to have a say and to be taken seriously about their experiences in accessing, and being helped by, the services they need.

We worry about how well our children and young people are. News stories abound about their tendency not to engage in healthy activities, to be more obese than their forebears and to take unnecessary risks with their safety. We hear about their tolerance for and use of drugs, alcohol and tobacco. We are told they do not get enough sunlight to maintain adequate vitamin D levels and that they are often unsure how to let adults in the right professions know when they are unwell, or vulnerable, or both. Their depression and mental health issues are regularly highlighted as cause for concern. One in 10 are noted to have a diagnosable mental health problem. And their access to many of the services that help them recover is at best a postcode lottery.

My office’s work with particular groups of children – the voiceless ones, the used and abused, the marginalised and excluded, the incarcerated – regularly uncovers and reports on how well these vital services respond to the issues children and young people raise with them. Let’s leave aside the big front-page news stories of recent years where high-profile investigations found wilful ignorance and a lack of intervention that could have saved a child. There is still a continued reluctance that is endemic across the health sector to engage in purposeful, productive information sharing on even the most highly secured, protected and anonymised basis. This is prevalent even between different parts of the health economy, let alone sharing with people who happen to be outside it, but who work with and seek to protect the same children. 

Inequalities and injustices
We cannot afford this. In monetary terms, it is a waste to have so much duplication, yet still so many gaps in the child’s experiences of services. In the workforce, it leads to things missed that should be addressed, problems left that should have had an intervention, and joint working opportunities set aside when working together could have paid enormous dividends. From the child’s point of view, services tend to be far better where under-18s have a voice and a hand in making them so. The inequalities and inequities found in the system are as clear as they are unacceptable.

My two most recent reports on health issues are called Why Are They Going to Listen to Me? and It Takes a Lot of Courage. The first presents heartfelt evidence from young offenders about their sense that they are not worth listening to – the message they have had from professionals in the secure estate, whose job is to try to make them well. The second comes from young patients’ experiences of sexual and mental health services, who told our researchers they had to find every ounce of their courage to say anything when they had cause to complain.

Children need to be asked to tell the people who know how to try to make them better what’s wrong; and to have a seat at the tables where decisions are made about what services should look like. What they say may not be comfortable for adults to hear. But as children, and service users, it isn’t their job to make us feel comfortable.

Maggie Atkinson is the children’s commissioner for England