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Children and young people are being let down by a lack of joined-up care when it comes to their health needs €“ but community pharmacy can be part of the solution

Child health outcomes in the UK are among the worst in Europe, according to a recent report.

The first Annual Report of the Children and Young People's Health Outcomes Forum, drawn up by an independent advisory group of professionals and representatives from across the children's sector, found that, despite a small improvement since 2010, Britain still has one of the highest child mortality rates in Europe. On average, five more children aged 14 years and under die each day in the UK compared with Sweden, which has the lowest child mortality rate.

According to report author Christine Lenehan, co-chair of the forum, there are three main areas where child health is being compromised in the UK:

• A lack of focus on healthy pregnancies and early years
• Insufficient support for vulnerable adolescents
• Poor management of long-term conditions in childhood

Widespread variations

Using data from the Atlas of Variation in Healthcare for Children and Young People, the report highlights wide variations in child health outcomes around the UK.

For example, hospital admissions for bronchiolitis or asthma are four times more common in some parts of the country than in others, while there is a three-fold variation in child deaths from accidental injury. In addition, regional MMR take-up rates range from between 69.7 to 95.3 per cent, while HPV vaccination rates in girls vary from 62.3 to 97.2 per cent by local authority.

Christine Lenehan believes that the variations in health outcomes can't be fully understood in terms of social or economic deprivation, and argues that lack of joined-up care in certain areas and a culture of failing to engage with children is mainly to blame.

€The figures show huge variations in hospital admissions for conditions like asthma, diabetes and epilepsy where children are not engaged within the community,€ she says. €Creating joinedup provision of care across schools, hospitals and primary care, including community pharmacy, is the big challenge.€

Communication failure

Care providers often fail to communicate effectively with children due to culturally ingrained beliefs that €children don't have a voice or anything to say€ and tend to conduct conversations via a child's parents instead, says Lenehan.

Failing to engage children and young people with their care leads to particularly poor health outcomes when young adults make the transition from child to adult health services. Young adults are suddenly expected to take responsibility for managing their condition and showing up to appointments on time, when their views have not previously been sought.

Another factor that makes this transition difficult, she says, is that the €profiling of diseases in children and adults is different€, and that €children with long-term conditions are cared for by a primary paediatrician but once they reach adulthood their care is led by their condition€. Fragmented care can also result in children frequently missing out on school or having to travel widely between different care providers.

To overcome these problems, the report calls for better training of healthcare professionals involved in the care of children and young people, and for schools to be given a greater role in the care of children with long-term conditions in line with the new Children and Families Act, which comes into force this month. The law places a statutory duty on schools to have formal arrangements in place for pupils with medical conditions.

€There is a relationship between good health outcomes and good educational outcomes, and children are not going to get good educational outcomes if they are hardly ever in school,€ says Lenehan. The report also calls for appropriate sharing and integrating of information, as well as ensuring that services for children and young people are accountable.

Early interventions

The report recognises that engaging children with their health early is essential for promoting prevention and closing the gap between the UK and other European nations. Five of the top 10 risk factors for the biggest diseases affecting adults have their roots in adolescence. For example, over 80 per cent of adult smokers picked up the habit before the age of 19 years, while eight out of 10 obese teenagers grow up to be obese adults.

Mental health is one area where early intervention is crucial. ONS data suggest that at least 10 per cent of adolescents suffer from a mental health problem at any one time, and that half of all lifetime mental illness cases begin before the age of 15 years. However a recent survey of over 2,000 adults on behalf of MindEd (a consortium of doctors and charities) found that more than a third (38 per cent) cannot spot the signs and symptoms of a mental health problem in children. Furthermore, more than half said that if they did suspect a problem, they would be hesitant about discussing the matter with the child, or their parents, in case they were wrong.

The consortium has developed an e-learning portal (www.minded.org.uk), funded by the Department of Health, to give professionals and volunteers working with children the confidence to identify mental health problems and tackle the stigma of poor mental health.

Children should be encouraged to take an interest in their own health

Accessible services

As mothers are key pharmacy customers and adolescents are increasingly using pharmacies to access services like chlamydia screening, EHC, the C-Card scheme and smoking cessation, the sector is well placed to improve child health outcomes.

Lenehan argues that schools should be able to signpost children to online and community health services, including community pharmacies, while pharmacists could even visit schools to deliver public health messages to pupils. It is also vital that pharmacies create an accessible, non-judgemental environment where youngsters can ask questions in confidence.

The report also calls for the standards of the 'You're Welcome' accreditation scheme to be updated. Originally produced by the Department of Health six years ago, the scheme sets out criteria that make a service 'young person friendly' and encourages young people to become life-long users of NHS services. To gain accreditation, health services, including community pharmacies, must meet a set of quality criteria, which include accessibility, publicity, and confidentiality and consent policies.

Meanwhile, Public Health England is in the process of developing a framework for public health services to improve young people's health and wellbeing, which will inform local prevention services and commissioning.

To make themselves more welcoming to young people and ensure that they are not overlooked by commissioners, community pharmacies should ensure that their relevant services are clearly promoted and interlinked with other youth service providers and schools, as well as making sure that their staff are comfortable speaking with youngsters.

€We want to make the NHS live and breathe for children and give young people the confidence to take control of their health,€ says Christine Lenehan.