I read this amazing blog last week, partly focused on on the marginalisation of the children’s agenda in the STP landscape.
Building communities with resilient children at their hearts | The Nuffield Trust
…….Powerful words by Professor Sir Al Aynsley-Green argues that the UK now needs a long-term, coherent, cross-party ideology and overarching policies that see children and young people as a vital priority and as citizens in their own right.
I was asked for my take on that by a few people of late who have expressed a concern that the children’s agenda is seen as important as the elderly one.
I had a think. Is a tricky conundrum. And I don’t have a definitive answer.
My response to the question is coming from a “health” lens, quite broadly, but a health lens nonetheless
For me 5 key points
Why is it as it is…….
· the key drivers of cost growth are: disease incidence (prevention),
· high cost technology (manufacturer pressure & patient expectation) and
· over diagnosis (clinical culture and system pressure)
· And NOT demographic pressure or the “ageing population”
the Glasgow work (Deep End and other) found that the current problems in NHS in Scotland are as a result of
· falling % of NHS £ to “community and primary care” led to hike in non elective (and a range of other issues)
· problems not due to too little funding overall
· worried well – especially in most affluent population
· systemic and cultural incentives leading to over diagnosis and over treatment. Diagnosis that leads to treatment that may do harm, may not help and has opportunity cost.
· degradation of primary and community care over 10 years, including social care.
The basic ask of STP is to
· fix the provider model
· systematise integration and collaboration – micro to macro scale
· put into place structural (transformative – actually and transactional) changes that lead to greater sustainability of the health and care system in the long run.
And thus the central challenge for SPTs =
· shift from where we spend the ££ (frail poorly folk) to where we get the most gain (earlier in life, the earlier the better)
· address the specialist / generalist mix – not right for current challenges, never mind the future
· address the power and resource imbalance between hospital and GP + other non hospital – ditto
Onto children’s agenda- where the above intersects the children’s agenda
· Because children and young people aren’t sick (or at least they’re not sick in big enough numbers) – the NHS isn’t that much fussed because it’s there to treat sick people. Wrong mission syndrome?
· of course the energy and emphasis for ACS and other will be on the here and now, the current pressing demands. Understandable
· We will never satisfy that, if we try we will neglect our responsibility for future generations.
· This would be a failure of stewardship and a wasted opportunity.
· Todays (mostly) healthy children will end in frail patients in 50 years or more time. This represents a window of opportunity to establish “healthy ageing” from birth. “healthy ageing” if done well will result in delayed or prevented morbidity and (more importantly) more economically active population.
Areas of focus for the system to ACT as a SYSTEM
This is principally coming at the issue from a health and social care lens. Those with background in education may come at the issue from an entirely different perspective – validly.
In rough order of importance (to health outcomes)
Obviously some overlap in these areas
· Adverse childhood experience
· Mental health – challenging behaviour v’ poor emotional wellbeing and mental health…. (schools are constantly challenged with this issue). CAMHS/Mental Health (getting ALL tiers right, not just T3 &4),
· Children in care, inc care leavers
· School readiness, education outcomes
· Cigs (5 kids a day start), obesity (20% of 10/11 yr olds obese)
· services and models working with the most complex children & young people – often described as fragmented and unable to cope. Classic eg = would be a young person they had on one of their wards for over a week…. Medically fit for discharge for 7 days but so complex no one knew what to do next….
And within each of these inequalities between best / worst etc.
Just my own starting point
The implication and the ask of the ACS
In your rush to provide better care for those with complex illness and manage multimorbidity ….. both of which consume vast resources for not a lot of gain……DON’T forget that we also have responsibility to be stewards of the future health and wellbeing of people who are currently (mostly healthy) children……
It will require a different way of thinking about things, and maybe agreement about a different mission.
There….. children’s JSNA written in less than a side!
Archie Cochrane – yes, he of Cochrane reviews – was once talking to an undertaker at a Crem. The undertaker said – “Ive never seen a place where so much goes INTO the machine and so little comes out”…
Archie was reputed to have said – “you should try working in the NHS”….
Others have also written in this space
The conundrum of children’s and young people’s health: time to address it-https://www.kingsfund.org.uk/blog/2017/01/conundrum-children-young-people-health
Agree with all there also
Core Quality and Outcome Measures for Pediatric Health – http://jamanetwork.com/journals/jamapediatrics/article-abstract/2634363?amp%3butm_source=JAMA+PediatrPublishAheadofPrint&utm_campaign=10-07-2017