The NHS 10-year plan doesn’t do enough for children | Al Aynsley-Green

The plan, which is naturally owned by the NHS, has scant regard for how it will relate to schools. Why are teachers and educators not central to it?

The government’s NHS 10-year plan, which launched last month, has been broadly praised by children’s organisations. The Royal College of Paediatrics and Child Health, for one, celebrates that “it lays the foundations for an NHS with infants, children and young people at its core”. But does it?

The plan, which aims to transform an overloaded health service, comes at an important time for children. The need is stark. We have some of the worst outcomes for children’s health, education, social care, youth justice and poverty in the developed world.

Looking at the detail, though, it carries no commitment to fund its uncosted proposals; the capacity and competence of services to respond to new ways of delivering them has not been validated; the metrics to judge success haven’t been defined and, after being battered by remorseless austerity, there are serious concerns for workforce leadership, responsibility and accountability to deliver the proposals.

Al Aynsley-Green.
Al Aynsley-Green. Photograph: Sam Frost/The Guardian

Not only that, but children’s health is buried in an all-embracing plan covering all ages; there is no overall strategy for children. And it seems out of touch with the stark reality of poverty, inequality and disadvantage that blight the land, making no reference to how it will be affected by or address these embedded difficulties.

Another central flaw is that the plan, which is naturally owned by the NHS, has scant regard for how it will relate to schools. Why are teachers and educators not central to it?

Yes, schools feature in the context of improving mental and emotional health but there is little reference to promoting physical health, nor concepts of how teachers can be helped to understand and support children with chronic health conditions and complex needs – at a time when the Royal College of Nursing has exposed the accelerating loss of school nurses, leaving children to be “unsafe in classrooms”. There is little focus on primary prevention of ill-health through schools being the focal point in local communities, nor of children being empowered to take control of their own lives.

The plan talks about links with the Department for Education with the mental health green paper, but little consideration has been given to how the new activities will work in practice. Thus, “mental health support teams” will work in schools on a day-to-day basis but will be managed by clinical commissioning staff. School heads are expected to become leads for mental health, too, but they have little capacity for this with so much preoccupation with the parallel universe of Sats, league tables and improving school performance.

Out in the country there are examples of good practice being conducted by grassroots organisations – despite, rather than because of, government edict. But talking with headteachers, university schools of education, teacher-training establishments and administrators exposes how few understand the implications of the NHS plan for them.

There is a history of betrayal in children’s policy over recent decades. In 2004 the Labour government refused to implement the National Service Framework for children, which followed Sir Ian Kennedy’s report after the scandal over children’s heart surgery in Bristol. The proposed standards were changed from being mandatory, with hard targets for delivery and ringfenced money, to being “aspirational” over a 10-year period.

Then Labour’s Every Child Matters agenda, which aimed to bridge the gap between health and education services for children, was dismantled by the coalition government, leaving the gaping vacuum in policy for children that we see today.

What we need is a long-term, integrated cross-department and cross-party strategy for children’s lives and health and a will to confront the bunkers within and between children’s services. We cannot continue to fail so many of our children.

• Sir Al Aynsley-Green was the first children’s commissioner for England. He is a visiting professor at Nottingham Trent University and author of The British Betrayal of Childhood

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Al Aynsley-Green

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