Memorandum by the National Children's
Bureau (WP 83)
1. The National Children's Bureau (NCB)
promotes the voices, interests and well-being of all children
and young people across every aspect of their lives.
1.1 As an umbrella body for the children's
sector in England and Northern Ireland, we provide essential information
on policy, research and best practice for our members and other
partners.
1.2 NCB has been heavily involved in the
development of the Public Health White Paper, with our Chief Executive
chairing the taskgroup charged with developing Chapter 3 "children
and young people, starting on the right path". We were also
key partners in the development of the National Service Framework
(NSF) for Children, Young People and Maternity Services (Department
of Health, 2004), and continue to work on the implementation of
that framework. Furthermore, NCB runs a National Network of Primary
Care Trusts (PCTs), with over 50 PCTs in membership the network
which gives us a unique opportunity to consult with and listen
to children's leads from across the country.
2. GENERAL
2.1 NCB welcomes the Public Health White
Paper with its particular focus on children and we very much welcome
the range of measures set out to improve children's health. However
we believe the government needs to be more prescriptive in its
actions, building on previous public health policy and evidence.
We would have preferred more immediate action rather than further
deliberation in some areas, for example food advertising to children.
2.2 We would welcome the opportunity to
be consulted on the development of a comprehensive and integrated
prevention framework for the NSF for children, young people and
maternity services as described in Chapter 6.
3. Will the proposals enable government to
achieve its public health goals?
3.1 Although we welcome many of the new
proposals to help reach the public health goals, we are still
concerned that there are key areas that need to be addressed.
These include marketing of food to children, marketing and consistency
of health information, mental health promotion, and the role of
parenting.
3.2 The white paper acknowledges the need
to influence market provision as one way of changing consumer
demand. NCB is signed up to Sustain's Food Campaign (Sustain,
2004), which demonstrates that a voluntary ban on the advertising
of unhealthy food to children will not produce the desired effects
and reduce levels of childhood obesity; the government needs to
impose a compulsory ban in order to fulfil its duty to protect
children and improve their well-being.
3.3 There is plenty of health related information
available to children, and—although NCB agrees that messages
need to be consistent, in line with the proposals in Chapter 2—it
is important that this information is better marketed. There are
two key points here. First, NCB is concerned that government attempts
to generate consistent, evidence based messages will be undermined
by the food industry as has happened in the past. It must also
be recognised that the public often don't trust information from
the government. The body charged with producing consistent messages
need to be independent from the government. Second, NCB is seeking
clarification as to how the new body charged with implementing
the health promotion strategy (paragraph 13) will work. It is
essential that children's views are taken onboard in the design
and implementation of such a strategy to ensure its effectiveness
in getting health messages across to children and to ensure it
operates in line with Article 12 of the United Nations Convention
on the Rights of the Child.
3.4 Although there is a Summary of Intelligence
on Mental Health included in the Choosing Health pack, there is
a distinct lack of information as to how the Government will ensure
local organisations support children in the promotion of their
mental health. NCB would like to see more, and clearer, suggestions
as to how children's mental health will be promoted, in line with
the 3-levelled model described in paragraph 38—strengthening
individuals, strengthening communities and reducing structural
barriers.
3.5 Parental relationships, particularly
in infancy and the early years, is critical and a key influence
on the nature and quality of the other relationships children
will form in their future lives (S Stewart-Brown, 2004). Although
this white paper proposes to provide additional information and
support to parents, NCB is seeking further clarity on what this
information and support will entail. The first chapter of Every
Child Matters (DfES, 2004) focuses on supporting parents and families
which shows the government's willingness to take action in this
area (not just in relation to public health), though specific
recommendations as to how this will happen have not been made.
4. Are the proposals appropriate, will they
be effective and do they represent value for money?
4.1 We are pleased to see a range of measures
to recruit new staff to improve the nation's health, however we
are seeking further clarification as to how Health Trainers (Chapter
5) will integrate with sexual health email experts and School
Nurses (Chapter 3) and with Health Direct Staff (Chapter 2). With
the current recruitment crisis in the public services, and the
limited pool of staff available, we are concerned that these new
roles will be filled by staff who already fill crucial roles.
The government must demonstrate that it values existing staff
working with children (for example school nurses), and focus attention
on offering training and incentives for such staff, rather than
creating new posts.
5. Do the necessary public health infrastructure
and mechanisms exist to ensure that the proposals will be implemented
and goals achieved?
5.1 We welcome the recognition of School
Nurses as essential in the promotion of health and support of
learning about health choices, however are aware that it is estimated
that there are currently 2,500 school nurses serving almost 26,000
secondary and primary schools (Chief Nursing Officers Review,
2004). NCB's own research with around 3,000 pupils across the
country shows that school nurses play an increasingly important
role in health promotion, but that the service is over-stretched.
This was echoed by the Royal College of Nurses in 2004. To set
a target for a school nurse in every school cluster by 2010 is
a good step towards addressing this, however NCB would like to
see more immediate action to better recruit and value school nurses.
One way of achieving this would be through Extended Schools. School
Nurses should be an integral part of this new programme, and the
DfES guidance on extended schools should reflect that. In addition,
we would welcome clarification on what definition of school clusters
is being used in this paper.
5.2 Article 12 of the UNCRC states that
children have the right to be involved in decisions affecting
them. A key component of the NSF is the participation of children
in their own care and in service design (in particular laid out
in Chapter 3). The infrastructure for involving children in the
work of public health agencies doesn't yet exist, except through
one-off pieces of work. Patient and Public Involvement (PPI) Forums
could be one of the vehicles through which children are involved
in the shaping of local public health services, however anecdotally
we know they are currently failing to engage children and their
parents. It should be a requirement of PPI Forums to engage with
children and their parents, particularly given that Joint Area
Reviews (Children Act 2004) are likely to inspect organisations
in relation to how far they are achieving this.
5.3 We are pleased to see targets set in
relation to Healthy Schools—that by 2009 every school will
have healthy school status. However with the status of Personal,
Social, and Health Education being non statutory, and not being
delivered consistently across the country, we question the strength
of these proposals. We are aware that Ofsted's Framework for Inspection
of Schools (DfES, 2005) will include benchmarking against the
Children Act (2004) five outcomes, of which one is "being
healthy", however we believe the government needs to create
additional incentives to ensure every school becomes healthy.
Furthermore, the Health Scrutiny Committee (Local Government Act
2000) and children's service planning groups (as laid out in the
Children Act 2004) should have a key role in ensuring Schools
are working to the partnership agenda, and meeting their communities'
health needs.
5.4 We welcome the proposal to offer a sexual
health email service (chapter 3), however this must only be part
of the package to improve sexual health. We are concerned at the
quality of advice on offer through this service, and how confidential
it will be for those using it. We are therefore seeking clarity
as to the skills and training staff delivering this service will
have, whether it will be delivered nationally, or locally, and
in what ways children with no private PC can gain access to this
kind of valuable, anonymous advice.
5.5 NCB is extremely pleased that under
the Children Act 2004, Children's Services Authorities are charged
with developing a single Children and Young People's Plan. This
is to be the overarching plan for all children, and to bring together
all other plans, such as the Youth Justice Plan, and the Early
Years Development and Childcare Plan. The Public Health Observatories'
investigations into health patterns and trends (the first of which
reports are due from every observatory in 2006 as specified in
Chapter 4) will be crucial in informing priorities for children's
services as a whole, and monitoring local need. NCB is seeking
assurance that the government will require Public Health Observatories
and Local Authorities to work together to make the best use of
this information in developing strategy and ensuring the accurate
forecast of children's future health needs.
February 2005
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