Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by the National Society for the Prevention of Cruelty to Children (PH 39)


  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.


  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.

  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.


  2.1  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.


  3.1  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.


  4.1  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.


  5.1  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:


  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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