Speech on child health


Delivered to the Royal College of Paediatrics and Child Health  11 July 2017

Good morning and can I start by paying tribute to the Royal College and to thank you for hosting me today. It is a pleasure to be at this great Royal College. A Royal College embarking on celebrating 21 years since granted a Royal Charter, 21 years where you have spoken out for children and ensured the voices of children are heard at the very highest level.

It was Nelson Mandela who told us: “There can be no keener revelation of a society’s soul than the way in which it treats its children.” If that great man was right, then our country is in a great deal of difficulty. The state of children’s health in the UK, and in England in particular, should be a matter for profound concern and concerted action. But sadly currently it isn’t.

We can point to nearly any element of children’s health, from care for disabled children, to child and adolescent mental health, to childhood injury, and, to childhood obesity. In all those areas we find examples of good practice but the overall picture reflects social inequality and failure, sometimes on a massive scale.

And my argument today is despite all the other challenges that face us as policy makers, from how we navigate Brexit with its inevitable impact on the NHS or we confront the fiscal and societal challenges of an ageing population, we must not allow the health and wellbeing of the next generation to be neglected and overlooked.

So as Labour’s shadow health secretary, I want to put children’s health at the heart of Labour’s vision for a 21st Century National Health Service, and at the heart of our drive to improve the health of our nation.

It’s an ambition that has long been part of my Party’s mission. In the Labour manifesto of 1945 we stated: “Labour will work specially for the care of Britain’s mothers and their children – children’s allowances and school medical and feeding services, better maternity and child welfare services.”

During the recent general election campaign, in which the future of the NHS played such a central role, we quite deliberately placed a focus on children’s health – talking of an ambition to make Britain’s children the healthiest in the world.

So today I want to say a bit more about why children’s health is so central to my vision to improve the wellbeing of the country.

And I’m also here today to announce Labour’s new Child Health Forum, where we’re inviting experts like yourselves, and members of the public across the country, to get involved with developing the detail of our policy platform.

We know that what a child experiences in the womb and through its early years has a profound effect on the rest of its life. As the review into health inequalities carried out by Sir Michael Marmot and commissioned by the last Labour government stated:

“The foundations for virtually every aspect of human development – physical, intellectual and emotional – are laid in early childhood. What happens during these early years, starting in the womb, has lifelong effects on many aspects of health and wellbeing – from obesity, heart disease and mental health, to educational achievement and economic status.”

The message is clear – if we don’t get children’s health right we will never have a healthy adult population in this country.

Yet when we consider how we are placed internationally we see the United Kingdom is not doing well in key areas of child health compared to other countries in Europe. For example, the rate of deaths to children under the age of one year old is higher than all our neighbouring countries and considerably higher than Scandinavian countries.

Breastfeeding remains lower than many other comparable countries; we fare poorly on aspects of physical health such as obesity.

Just last week the Children’s Commissioner revealed that there are estimated to be over two million children with health-related vulnerabilities, including 800,000 with mental health disorders.

Sadly the Government’s response to the issue of child health has been piecemeal, fragmented and unstrategic.

Indeed the Sustainability and Transformation programme have had shamefully little to say about improving children’s health and wellbeing.

In the general election we said we would halt these plans and review whether they’re really delivering for patients. Whatever the future of STPs today, a big test of them will be whether they deliver for children.

And now we see the consequences of the lack of an overarching approach. Let me offer three examples.

Firstly on immunisation. It doesn’t matter whether it is vaccination against measles, mumps, rubella, meningitis, diphtheria, tetanus, pertussis and even polio.

Immunisation rates are falling and, in some cases, have been on a downwards slide for each of the last three years. Children in England are not being protected as well as children in the rest of the UK.

In the official report on immunisation, vaccination coverage in England at one, two and five years of age was, for all reported vaccinations, below that of the other UK countries.

Secondly in the crucial area of childhood obesity, we are currently failing our children on an enormous scale.

Not only has the government’s feeble effort at a childhood obesity strategy fallen flat but they continue to push through massive cuts to public health and education budgets.

They even tried, and hopefully it would seem failed, to deprive children in the first three years of primary school of their free school lunch.

It’s important to recognise that childhood obesity not only leaves children susceptible to major health problems such as diabetes, high blood pressure, asthma and cancer in later life, but, during childhood it also is associated with poor psychological and emotional health due to issues such as stigmatisation, bullying and low self-esteem.

But despite all of the evidence, there is a profound lack of action – and the result is that levels of obesity amongst our schoolchildren are continuing to increase.

More than one in three children in year six in our primary schools are either overweight or obese – and there is little sign of the problem doing anything other than getting worse.

If the crisis in childhood obesity is not tackled, half of all UK children will be obese or overweight by 2020.

Not only is it a betrayal of the nation’s children it makes no sense for the future sustainability of the NHS either.

The UK spends about £6 billion a year on the medical costs of conditions related to being overweight or obese and a further £10 billion on diabetes, but less than £638 million a year on obesity prevention programmes. Unless we act we are building up future pressures on the NHS.

Thirdly, perhaps the Government’s biggest failing is on Children’s Mental Health.

Half of all lifetime cases of psychiatric disorders start by age 14 and three quarters by age 24.

Around 13% of boys and 10 per cent of girls aged 11-15 have mental health problems – at least three young people in every classroom.

Suicide is the leading cause of death in young people aged 15-24. Supporting our young people’s mental health is crucial, particularly through prevention and early intervention.

Yet just 11% of children’s mental health needs are met by the NHS while the NHS spends 14 times more on adult mental health than the children and adolescents’ service.

We know that in in many parts of the country CAMHS budgets are raided to fund wider gaps in the NHS because of the lack of ring fence.

Cuts in one part of the system as usual lead to pressures elsewhere in the NHS. Indeed today I’m publishing our new analysis from the House of Commons Library that shows the number of young people presenting at A&E with mental health problems has risen 33% over three years.

The backdrop to all this is of course inequality in health and rising child poverty.

For example, infant mortality, an area where the UK has one of the worst records in Europe, is more than twice as high in the lowest socio-economic groups in our society compared with the most well-off.

Similarly, obesity is twice as common amongst children living in the most deprived areas as compared to children in the most privileged areas.

Your own RCPCH report, State of Child Health, from earlier this year makes clear: “Children living in our wealthiest areas have health outcomes that match the best in the world. But the gaps between the rich and the poor are stark, and some of the outcomes amongst our deprived groups are amongst the worst in the developed world.”

The number of children living below the poverty line has increased by 400,000 since 2010, reversing a decade of major progress under Labour. At a local level, the figures are even more appalling: in some areas as many as 47% of children live in poverty.

A boy born in Chelsea has a life expectancy of over 84 years. Yet just five miles away, a boy born in Islington can only expect to live to around 75 years of age.

Child poverty is a scar across Britain and one we’re determined to confront.

A third of the most deprived children are predicted to be overweight or obese by 2020 compared to just under a fifth of the most affluent.

And 5-year-olds in the most deprived constituencies are almost seven times more likely to live with dental disease than their peers in Jeremy Hunt’s local authority in Surrey.

So improving the health of all our children regardless of their background is central to Labour’s health strategy. Put simply, no child will be left behind under the next Labour Government.

Just as the last Labour Government had as its driving mission to eliminate child poverty, so for me as Health Secretary in the next Labour Government it will be a driving mission to defeat child poverty and child ill health.

So what should our response be?

Our starting point will be familiar to everyone engaged in the debate about the future of the NHS, namely workforce and resources.

So first on workforce.

Today you have published new evidence of the strain on the paediatric workforce.

Prior to reaching consultant level, children’s doctors train for around eight years.

This study shows that almost one in five of paediatric trainee positions are currently vacant even though trainees themselves report high levels of enthusiasm for the speciality.

Even more alarming is that this figure jumps to nearly one in four in more senior trainee positions, and almost 90% of children’s units express concern over how they will cope over the coming six months.

I’m also publishing today new analysis of the community child health workforce with 10% of school nurses, 11% of health visitors and 12% of district nurses lost to the NHS in the past two years.

It’s a scandalous loss of expertise and particularly concerning against a backdrop of a drop in nurse trainees.

As if the cuts to the current workforce aren’t bad enough, there appears to be no account being taken of the growth taking place in the overall number of children. In the next ten years, the number of 0 to 16 year olds in the UK is projected to grow by almost 700,000.

So, to make sure all children have access to the services they are entitled to, and to reduce health inequalities, we are committed to investing in the child health and public health workforce.

We would ask Public Health England and Health Education England to work together to identify how the public health workforce will need to be developed and shaped to support the UK’s new ambition of having the healthiest children in the world.

But it’s not only in the area of workforce that the government are failing our children:

This Government’s failures in acute services are well documented. The sustained underfunding of the NHS has pushed staff to the brink and has caused a collapse in patient standards. Waiting lists are up, treatments delayed and A&E targets have been abandoned.

Our research reveals the impact this is having for children in hospital.

Procedures to repair broken bones, remove rotten teeth or insert grommets are among more than 40,000 operations that have been cancelled over the last four years.

Over 12,000 surgical procedures on children and young people were cancelled last year alone, that’s an increase of 35% in three years.

These are children waiting in pain and suffering for treatments and, as you in this room know, there will be serious long term effects to their physical and mental wellbeing.

In a separate piece of research we looked at the number of hospitals which have had to close wards because of maintenance problems – one hospital in the North of England told us of a utilities failure in their maternity unit – no electricity throughout the night, beds that couldn’t be adjusted, and no heated mattresses for the babies.

So the NHS’s biggest financial squeeze in history, capital budgets raided, public health budgets siphoned off, with valued early intervention services at risk, and the outcome is that local authority public health services are planning on spending less on 0-5 children’s health this year than last.

It is beyond debate that our NHS and care system now needs more investment.

And at the election Labour pledged a boost of £7bn to turn round NHS services and deliver a long overdue pay rise for staff by scrapping the pay cap.

And we promised to properly and effectively ring fence local authority public health spending in order to protect non-NHS services too.

But for Labour it’s a priority, not only to boost investment in our health and care system, but to make sure that money is used well.

And for me the starting point in gaining best value for health spending is to prioritise prevention.

So improving children’s health services is not only the right thing to do in putting children at the heart of our NHS policy, we will also instigate a new drive for effective action on prevention across government.

Labour strongly supports a ‘Health in All Policies approach’ and there is no better place to start than by addressing the serious problems confronting the country in children’s health.

At the election we began to set out the basics of how this would work:

Labour would introduce a Child Health Bill, legally requiring all government departments to have a child health strategy to set out how they will support this new ambition and to work in an integrated way in order to deliver that strategy.

We want to work with experts like you to develop a new Index of Child Health to measure progress against international standards, looking at for example obesity, dental health, under fives (including breastfeeding, immunisation and childhood mortality), and mental health.

Let me be very clear on this, unlike the current government, we do not shy away from developing clear plans for better child health, neither do we shy away from collecting and publishing the data that can inform those plans.

Labour is not scared of setting targets to improve our children’s health and we have a strong track record of taking the action necessary to achieve our collective goals in improving health.

One of the areas where we face a number of challenges is around diet and nutrition.

I’ve spoken of how the UK has one of the worst childhood obesity rates in Western Europe.

Tooth decay is the single most common reason why children aged five to nine require admission to hospital. More than four in 10 children in England (42%) have not seen an NHS dentist in more than a year even though ideally, they should have a check-up every six months. The role of dental public health has been diminished in recent years, and we will make it a priority.

The Labour Party’s manifesto pledged to halve childhood obesity within ten years. And we would introduce legislation banning junk food advertising from being broadcast before 9pm, stopping unhealthy food from being promoted during primetime television, such as the X Factor, Hollyoaks and Britain’s Got Talent.

Our shadow education secretary, Angela Rayner and shadow public health minister, Sharon Hodgson, pledged to extend free school lunches.

I want to see more schools do what the Charlton Manor School I visited in Greenwich does, where the inspirational head teacher, Tim Baker, has deliberately put healthy eating and nutrition at the heart of the school ethos.

We want also to go further and do more to help mothers and under fives:

Breastfeeding rates in the UK are among the lowest in the world. Just 44% of mothers in England were recorded as breastfeeding at their six to eight week health visitor review in 2014-15.

For Labour in government it will be a priority to offer better support to mothers and to reinstate the infant feeding survey.

We should be considering specific initiatives, like the “1001 Critical Days Strategy”, to give support to mothers from conception to age two.

So Labour would develop a cross-departmental initiative to support breastfeeding, with a national public health awareness campaign promoting breastfeeding, including in the workplace and proper investment in peer support.

We fully understand that a successful approach to breastfeeding requires the time and resources being available to give proper support for new mothers, whilst making sure that mothers who are unable to breastfeed, for whatever reason, are also supported.

Perinatal mental illnesses affect at least 10% of women, but access to mental health services is variable at best. Maternal mental illness approximately doubles the risk of subsequent mental health problems in children.

According to one estimate, the long-term cost to society of a single case of perinatal depression is around £74,000, mostly because of adverse impacts on the child.

The NSPCC have done some excellent work as part of their All Babies Count campaign to make the case for pregnant women and new mums at risk of, or suffering from, mental illness to be identified as early as possible and given appropriate and timely expert care. We agree.

Of course the Prime Minister has promised parity of esteem for mental health – but has so far failed to deliver. Labour’s strategy will be focused on prevention and early intervention, whilst ensuring acute CAMHS receive the money they have been promised.

Labour will work towards eliminating the scandal of Out of Area Placements for acute mental health treatment.

And Labour will introduce statutory high quality PSHE into all schools to ensure teachers, parents and pupils know how to spot, report and cope with online, and other types of abuse and bullying.

We know there are many pressures which can cause adverse childhood experiences from poor housing and deprivation to problems at home. Its time also for a full understanding of the pressures of social media and to ask ourselves what action should be taken.

Social media has revolutionised the manner in which young people communicate with themselves and the outside world.

An increasingly digitised world brings welcome benefits but also negative effects such as cyber-bullying.

The University of Manchester produced a report last week, looking at the common themes in the lives of young people who die by suicide. The study found suicide-related internet use in 26% of deaths in under 20s, and 13%t of deaths in 20-24 year olds, equivalent to 80 deaths per year.

We know that a child growing up with a parent who has alcohol or drug abuse issues can impact on the health and wellbeing of the child. I have worked with an excellent charity called NACOA and I spoke in the House of Commons earlier this year about my own experience as a child of an alcoholic. We believe it’s time to put in place a clear cross-government strategy to support such children.

The shameful picture of child health in England is terrifyingly real and should be receiving urgent attention from all who are concerned about the future health and wellbeing of our country, and particularly, its children.

Of course, there are other extremely important challenges facing us at the present time but that is no excuse for the current disregard for the state of child health.

The Conservative government is squeezing our NHS and taking money from our public health system and our schools.

Labour will make child health a national priority and one which brings together all of the academic, medical and economic expertise that we have in this country, to design and implement a programme that can ensure that, at some point in the not too distant future, we can point to our record on the health of our children with pride rather than dismay.

Labour has a strong track record on improving the health of children and young people. Amongst many other things, we can proudly point to the success of Sure Start and the continuing success of the teenage pregnancy strategy.

We also created a properly resourced public health system that enabled us, for example, to implement, right across the country, the very important Healthy Schools programme.

Much of this success is in danger of being reversed. The raiding of public health budgets and the downgrading of the public health system, including the invaluable network of public health observatories, places us at an enormous disadvantage in taking forward steps on child health.

Nonetheless, despite being in opposition, Labour has shown the way forward on child health. For example, it was Labour that managed to steer through parliament the legislation on protecting children from tobacco smoke in cars and the introduction of standardised cigarette packaging.

In the absence of government leadership and action on child health, Labour will, over the next 12 months, convene a series of workshops which will draw together the evidence and expertise that we know exists in abundance in the field of child health.

We will develop evidence-based and feasible proposals for the action that is needed, not just to halt our relative decline in terms of the health of our children, but to create a dynamic programme for the country that can gain widely based public, professional and political support and which will give our kids the chance to have the healthy childhood they deserve.

So today I’m launching our new Child Health Forum, so that you can feed in your ideas, let us know what you need from the nation’s health and care system, and together we can work to give every child in the UK truly the best possible start in life.

Thank you.