APPENDIX 20
Memorandum by the National Society for
the Prevention of Cruelty to Children (PH 39)
INTRODUCTION
The National Society for the Prevention of Cruelty
to Children (NSPCC) is the UKs leading charity specialising in
child protection and the prevention of cruelty to children. The
NSPCC exists to end cruelty to children through a range of activities
designed:
— to prevent children from suffering
abuse;
— to prevent children from suffering
significant harm as a result of ill-treatment;
— to help protect children who have
suffered abuse overcome the effects of such harm;
— to help children who are at risk
of such harm; and
— to work to protect children from
further harm.
We have over 160 teams and projects throughout
England, Wales and Northern Ireland whose work includes: family
support, assessment, counselling and therapy to children and families
experiencing abuse, investigations into allegations of child abuse
and work with other organisations to provide care and a voice
for children.
SUMMARY
The NSPCC has adopted its FULL STOP Campaign
in order to end child cruelty within a generation. To achieve
this objective, there needs to be a shift in attitudes, values
and behaviour towards children within society. This includes a
need for children to be a central part of any strategy to improve
the nation's health: they represent a quarter of the population
and are the adults and parents of the future. Children should
be nurtured with respect, valued as individuals and supported
in attaining their full potential. The benefits of such an investment
cannot be exaggerated. Children with good self-esteem are less
likely to smoke, drink, misuse illegal drugs or attempt suicide.
They are also likely to accord their own children similar respect.
Sufficient investment in services to detect
and prevent child abuse should be an important element of any
strategy aiming to improve children's health and well-being. Children
cannot thrive when they are experiencing neglect, or physical,
sexual or emotional abuse. Early intervention and good family
support services can make a significant difference to the outcomes
for children and families at risk of, or living with, such abuse.
Health professionals, teachers and childcare workers are all crucial
to this process.
In our submission to your Committee's investigation
into Children's Health (December 1996), we identified six general
principles which should underpin effective and child-friendly
services. These are:
— children have unique needs;
— children have basic rights to which
all health care organisations should subscribe;
— children and parents should be involved
as much as possible in their health care;
— practice should be based on evidence
of need and effectiveness;
— a partnership approach is required
from all members of the network of children's health services;
and
— progress requires focused activity.
The NSPCC believes that an inquiry into public
health should include an assessment of the following:
1. how current structures to improve public
health are addressing the health needs of children (often neglected
in health service provision) and how their impact is evaluated;
2. the extent to which children and their
families are consulted and involved in developing services which
are appropriate to their needs;
3. the role of professionals in preventing
and detecting child abuse;
4. the role of the voluntary sector in improving
public health, and in particular children's health; and
5. the risks and benefits of area-bound initiatives,
specifically whether the health needs of all children are being
sufficiently addressed, as the majority of children live outside
the boundaries of the Government's targeted initiatives; and the
potential value of a single, over-arching plan for all children,
developed jointly by the health and local authority, which incorporates
the various programmes designed to improve the lives of the children
who live there.
- THE HEALTH
NEEDS OF
CHILDREN
1.1 For the NSPCC, a healthy child is one
who:
— experiences a life which is more
than just free of illness;
— has the opportunity to develop and
grow in safety and with dignity and respect;
— receives a rounded education both
in school and at home which prepares them both for the world of
work and the world of parenthood;
— lives in an environment which is
friendly to their particular needs; and
— has both the space and support to
make the transition into adolescence and then into adulthood.
1.2 Article 24 of the UN Convention on the
Rights of the Child accords children the right to "the enjoyment
of the highest attainable standard of health and to facilities
for the treatment of illness and rehabilitation of health. States
parties shall strive to ensure that no child is deprived of his
or her right of access to such health care services".
A 1999 survey by the NSPCC, the Children's Society
and the National Children's Bureau of the first Health Improvement
Programmes revealed that children's health needs were generally
accorded a low priority. Only 16 per cent of authorities identified
children's health as a key priority, and a minority of HIMPs hardly
mentioned children. We are currently undertaking a similar analysis
of the three-year programmes published recently to assess whether
priorities have shifted.
1.3 The NSPCC, in common with many other
organisations, believes that the Government should accord children's
health the distinct priority it deserves by developing a National
Service Framework for Children, to include issues such as infant
well-being, mental and sexual health, substance use, safety and
child protection, loss and bereavement support, nutrition, physical
activity, chronic illness and disability.
1.4 Child and adolescent mental health services
should be improved as a matter of urgency, to address the issues
outlined in the Audit Commission's 1999 report, Children in
Mind. It would be useful to assess to what extent its recommendations
are being implemented.
1.5 Adequate resources should be allocated
to evaluating the impact of public health programmes on children's
physical and mental health, and their promotion of positive parenting.
2. CONSULTING
WITH CHILDREN
AND THEIR
FAMILIES
2.1 Article 12 of the UN Convention accords
children the right to be consulted in matters affecting their
lives, consistent with their age and stage of development.
2.2 Children have their own distinct views
and experiences and should be involved in developing and evaluating
services which suit their needs. It would be interesting to know
how many health action zones and other such programmes have genuinely
consulted with children and young people as part of their development
and implementation process. Whilst it takes time, such participation,
if undertaken by skilled workers who are open and honest about
the extent to which views can be acted on, can improve the likelihood
of services being used.
The NSPCC is currently establishing a minimum
of two Young People's Advisory Groups (YPAGs) in each of our eight
regions. These groups aim to ensure both that the NSPCC has access
to the views of young people on issues of importance to them,
and that these views are included in its planning process, both
regionally and nationally. The groups also aim to enable young
people to approach other organisations so that they too will consider
young people's services in their service provision planning processes.
3. THE ROLE
OF HEALTH
PROFESSIONALS, TEACHERS
AND CHILDCARE
WORKERS
3.1 Midwives, health visitors, GPs, school
nurses, community psychiatric nurses, paediatricians, A and E
specialists and other health professionals are all trusted with
the care of children, even before they are born. They should be
equipped with sufficient training in child protection and child
development to enable them to work to prevent child abuse, and
to identify it when it has occurred. Teachers and childcare workers
share a similar position of responsibility, and such training
should also be prioritised for them. All public health programmes
for children should identify such training as a specific requirement.
At present, teachers receive between only one and three hours
of child protection training during the whole of their training,
while school nurse training in child protection is uneven across
the country.
3.2 There should be increased resources
for and expansion of midwives' and health visitors' roles, to
ensure adequate numbers of visits to mothers in need of support,
and early detection of post-natal depression. Such early intervention
and support can help to promote better understanding of infants'
needs and promote a mother's strong early bonding with her baby,
all of which promote protection of the infant.
We would like to see more ante-natal home visiting
schemes, such as the one adopted in Lambeth, to promote better
relationships between mothers and their health visitor before
the birth, to enable early identification of mothers who may be
in need of particular support and advice.
3.3 School nurses provide a valuable link
for school-aged children between the health and education sectors.
They are well placed to secure integrated care for vulnerable
children, those with mental health problems, children suffering
or at risk of abuse, and children with chronic illness. The NSPCC
would like to see the school nursing service strengthened and
developed, as outlined in the Community Practitioners and Health
Visitors Association consultation document: School Nursing:
a National Framework for Practice.
3.4 The NSPCC recommends that the new Health
Development Agency should, in accordance with its remit:
(i) develop the evidence base for the effectiveness
of family support interventions for promoting positive parenting
and children's mental and physical health; and
(ii) develop standards for health and other
professionals working with children to ensure they have a good
understanding both of child development, and of child protection
and their role in preventing and alleviating this.
4. THE INVOLVEMENT
OF THE
VOLUNTARY SECTOR
IN IMPROVING
PUBLIC HEALTH
4.1 The provider role of the voluntary sector
should be recognised when considering the extent and nature of
work to improve public health. The NSPCC is working with an average
of 6,000 children at any one time. Approximately one third of
the NPSCCs projects has direct involvement with either health
authorities or health professionals: we are currently the lead
agency in three Sure Start areas, and a partner in 12 others.
NSPCC is also represented in some Health Action Zones, and is
thus a significant partner in several programmes to improve the
health of children.
4.2 In addition, the voluntary sector is
often able to play a useful role in consulting with "hard
to reach" groups, such as minority ethnic and disabled groups
and those who do not use statutory services.
5. AREA-BOUND
PROGRAMMES
5.1 While the NSPCC welcomes the Government's
focus on reducing health inequalities and tackling mortality and
morbidity rates in the most deprived areas of the country, it
should not lose sight of the very many children in need of extra
services who do not live within the boundaries of a designated
"zone" of public health activity. It is important that
their needs are not neglected. A National Service Framework for
children's health would help to address this issue, as would an
over-arching Children's Plan, developed jointly by local and health
authorities.
Copies of NSPCC documents can be provided on
request. For further information please contact Lucy Thorpe, Policy
Adviser, on 020 7825 2537, e-mail: lthorpe@nspcc.org.uk.
REFERENCES
Sir Donald Acheson (1998) Independent Inquiry
into Inequalities in Health. HMSO, London.
Department of Health (1999) Saving Lives:
Our Healthier Nation.
Growing up in Britain: Ensuring a healthy
future for our children, British Medical Association 1999.
Improving Children's health: a Survey of
1999-2000 Health Improvement Programmes. S Brunt, NSPCC, Children's
Society and National Children's Bureau, 1999.
Children in Mind: Child and Adolescent Mental
Health Services, Audit Commission National Report, 1999.
Community Practitioners and Health Visitors
Association (June 2000) School Nursing: a National Framework
for Practice. Consultation Document.
NSPCC response to consultation draft of new
guidance on children's services planning. June 2000.
The United Nations Convention on the Rights
of the Child. www.unicef.ord/crc/crc/.htm.
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