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§ Mrs. Marion Roe (Broxbourne)The Minister will know that I served as Chairman of the Select Committee on Health for five years and that, in 1996–97, that Committee undertook an inquiry into children's health. I have maintained my interest in the matter and I am delighted to have this opportunity to raise matters of concern with her.
First, I seek an assurance from the Minister on the needs of children explicitly described in the booklet, "Your Guide to the NHS", which bears little resemblance to the old patients charter. It emphasises patients' responsibilities to the NHS, as well as their rights. However, the guide makes no explicit reference to the health needs of children, unlike the "Charter for Children and Young People", which was issued in 1996 during the Select Committee's inquiry into services for children and young people. I should welcome the hon. Lady's comments on whether there has been an omission and whether the Government are prepared to rectify it.
Another matter that causes concern relates to children in adult wards and intensive care units. What assurance can the Government give that the needs of children who are ill and in hospital are not being ignored? Unfortunately, basic principles of care that have been acknowledged by all Governments since 1959 and highlighted by the Select Committee's inquiries into services for children and young people, such as children on adult wards, are still being ignored.
The Government have increased finance for paediatric intensive care, but children are still being routinely admitted to adult intensive care units following elective surgery, because some surgeons still ignore Department of Health guidance and undertake specialist surgery on children in hospitals without the appropriate facilities. Careful monitoring of paediatric intensive care, as promised in the Department of Health guidance in 1997, seems to have omissions because children who are admitted following elective surgery do not seem to be identified.
The Select Committee was shocked to discover that children's community services, which have been supported by every Government since the Platt report in 1959, are still not universally available, with about 40 per cent. of the United Kingdom being without a service. I welcome the Diana, Princess of Wales children's community teams for children with life-threatening or terminal conditions, but eight teams for England, although important, is a small contribution compared with what is needed. Many children with acute illness or following surgery remain in hospital because no children's community nursing service is available locally.
I shall quote from the Select Committee's third report, which states in paragraph 49:
The overall intention must be to introduce as soon as possible a home nursing service provided by appropriately qualified staff and available to all children requiring nursing interventions and their families. For many years there has been such a nursing service for adults in their own homes. We consider that, as a matter of principle, sick children need and deserve no less.286WH I would welcome the Minister's response on that.As for child and adolescent mental health, following the Select Committee's fourth report, the Government allocated money to that wholly inadequate service. However, the removal of child and adolescent mental health services from children's services, which has links with children's social services, education and children's health services, into newly-established mental health trusts, which are focused on the needs of adults and are unconnected with the range of agencies concerned with children, causes some concern. Unfortunately, the reality is that a stigma is still attached to mental health services, so some families may not wish to have the stigma of services from a mental health trust.
In addition, due to the paucity of services, children with mental health difficulties are admitted to acute paediatric wards, which are in a different trust. I ask the Minister, is this shift to services focused primarily on the needs of adults for the convenience of managerial organisation and professionals rather than the needs of children and their families?
There is a role for a children's commissioner—we now have a Children's Commissioner for Wales—although only one with a clearly defined role. The children's commissioner should be entitled to monitor the interests of children looked after by statutory services. He or she should also have a wider function in relation to the work that affects children that the Government carry out across all Departments.
Children—almost uniquely in society—are unable to participate in the democratic process. Adults make legislation and regulations that affect them, both directly in terms of provisions dealing with children and indirectly through the way in which we legislate to support the family. It is therefore right that an independent person should have the remit to examine legislative proposals across the range of Departments and to represent the interests of the children who will be affected by them. In that way, those interests will properly be taken into account in the workings of government and the legislative process.
I welcome the children's taskforce, but I have concerns about the needs of children who are sick within the NHS. The children's taskforce appears to focus on prevention and young people who cause specific difficulties, such as pregnant teenagers. Of course, I acknowledge the importance of prevention. Indeed, the Select Committee second report states:
The rewards of good health care in childhood, especially health promotion and preventative interventions, are unique because the benefits may last a life time, and may be passed on to future generations.There is, however, considerable concern that the needs of children who are ill are not being appropriately considered, but lumped together with adult services.As a Member of Parliament who is interested in the issue, I must inform the Minister that I have been unable to obtain more than a photostat copy of the children's taskforce booklet and introduction. I should be grateful if I could have some copies of it in its true form, rather than having to rely upon that. I telephoned the lady whose name appears in the booklet to ask for copies, but unfortunately I received no reply. I should be most grateful if the Minister could help.
One aspect of quality health care that the Select Committee praised was integrated services for children without traditional barriers between hospital and 287WH community services. They included acute services, such as neo-natal intensive care and hospital in-patient and out-patient care, and school nursing and community services, such as community children's nursing services and services for children with learning disabilities or mental health problems. As the staff involved include therapists, a child receiving, say, physiotherapy in the community for his cerebral palsy would, following surgery, receive treatment from the same physiotherapist while he was an in-patient in the acute hospital.
One of the themes identified was that services are too often organised for the convenience of staff and, sadly, such services are now being broken up to fit managerial convenience instead of children's needs. The emphasis on primary care trusts is resulting in community aspects of children's services going into the primary care trust, in mental health going into adult-focused adult mental health trusts, and in acute services going into adult-focused acute hospital trusts. Children therefore become a small part in adult-focused services, with staff that are educated and experienced in children's needs divided and increasingly isolated.
The Government recently announced their intention to set national standards for children's services, which is to be welcomed. I hope that early dates for the publication and implementation of those standards will be announced, as that would ensure that children's needs are not overlooked in services designed primarily for adults. A national service framework for all children would ensure that children's needs are not overlooked through services designed for adults, with children fitted in or, on a disease basis, tagged on to services that are geared primarily toward adults.
I am most grateful for the opportunity to place on record the anxieties that I and many others have about children's health. We look forward to the Minister's response and the addition of more information to that which we already have on the policies that the Department of Health, the hon. Lady and her colleagues will implement.
§ The Minister for Public Health (Yvette Cooper)I congratulate the hon. Member for Broxbourne (Mrs. Roe) on having secured the debate and choosing it to discuss an issue about which I feel especially strongly and which is extremely important for both the Government and the House. I pay tribute to the work that she has done with the Select Committee on Health and subsequently on children's health, an issue on which she has campaigned and worked for a long time.
The matter is extremely important to the Government, not simply from the point of view of children's health, but because children's health is so closely linked with other aspects of children's lives. Perhaps more tangibly than at any other stage in life, social, emotional and educational development are closely linked to health. That is especially true in the years when children are very young Health in the early years can affect health throughout life, and health problems that develop in childhood can haunt people throughout their lives. The deep-rooted health inequalities in society often stem not simply from childhood but from pregnancy. The Government therefore regard children's health as a priority.
288WH In responding to the points raised by the hon. Lady, I shall set out some of the progress that has been made and some of the measures that are already under way. I shall also outline some of the work that is being planned for the future in relation to the children's taskforce and the standards she mentioned towards the end of her speech.
A major programme of work is being planned to draw together many of the individual strands of children's health into a single national service framework for children. The national service frameworks have been developed as major programmes across the health service. NSFs are currently in place for mental health and coronary heart disease, and although the cancer plan had a slightly different genesis than NSFs, it sets out comprehensive standards of care and treatment in a similar fashion. The full range of care, from prevention to treatment to palliative care, is covered for conditions that are the big killers in society. We are keen to apply the same comprehensive approach to children's health. I strongly believe that the national service framework should not only be about children's heath services, but that it should include prevention and health promotion and cover many of the service issues raised by the hon. Lady.
We are still at an early stage in developing and determining the scope of the national service framework. A major consultation will be needed: parents, children and young people will be subject to extensive consultation as part of the process. The children's taskforce will play a major role in that work. We are currently at the stage of determining what issues should be included. I shall outline a few of the areas in which work is already under way, which will need to be fed into the national service framework, and cover some of the other areas that the national service framework will have to address in more detail.
We have taken considerable action on prevention, which, as the hon. Lady said, is extremely important. The rolling-out of the meningitis C vaccine programme is an example: we are the first country in the world to introduce a nationwide meningitis C programme. Managing to introduce it and offer the vaccine to everyone under the age of 18 in the space of 15 months is a huge tribute to the NHS, especially school nurses and those working in primary care who implemented the programme.
Work has also been done on promoting healthy living for children, especially in relation to access to fruit and vegetables and a healthy diet. Today, we roll out the next wave of the programme to provide free fruit in infants schools. Experts recommend five portions of fruit and vegetables a day to help to prevent cancer, heart disease and asthma in children. Research shows that, on average, children only have about two portions a day and children in low-income areas have considerably fewer. The provision of free fruit in infants schools across the country will make a major contribution to increased access to fruit and vegetables and a healthy diet, and to improving children's nutrition and long-term health.
Work has been done in relation to maternity services, and the sure start programme is tackling ill health and promoting health among families and children in the early years—for those under four—ensuring proper access to immunisation programmes and health care 289WH and, importantly, signposting to specialist services when health problems arise, ensuring diagnosis at the earliest possible moment, and proper support and provision of the expert services required in low-income areas.
The hon. Member for Broxbourne referred to acute care and community care. She is right to say that we introduced additional funding in 1997 to improve paediatric intensive care. To date, an additional £51 million has gone into building up the strengths of centres providing the highest level of care to the most critically ill children to ensure ready access, to develop specialist retrieval teams and to ncrease funding for specialist skills, especially nursing skills. We are now considering what further improvements we need to make to the level of local hospital support for that system to meet the needs of children who require high-dependency care. We must also consider neo-natal intensive care, in which expert work is under way that we can feed into the national service framework. We have made clear our intention to expand critical care—we have made major improvements during the past few years—but we need to be especially sensitive to the issues of neo-natal and paediatric intensive care.
The hon. Lady asked whether particular areas or consultants were following best practice. We know that that is in place in many areas—there are some excellent examples—but we also know that there is wide variation in the care provided, which is unacceptable. That is what drives the national service framework. In coronary heart disease, cancer and other areas, the national service framework has set national standards that every area must follow, which can be followed up through clinical governance and inspection mechanisms and the NHS performance management framework to ensure that they are properly implemented. The national service framework for children's services will provide us with the levers to ensure that every area is able to adapt and start to follow best practice, which we know is in place in some areas. That will take some time and we should be realistic: identifying best practice and developing the right standards will take time, but it will provide us with a powerful mechanism as the work takes place.
The hon. Lady also mentioned community care for children. That is especially important because, no matter how ill children become, most families want to care for them at home and most children will always be more comfortable at home. We should provide whatever services we can in the community. Through the national service framework, we shall need to consider the developing role of health visitors and school nurses, work on which has already begun as a result of the "Saving Lives" White Paper to improve the public and family health role of such services. Again, we need to consider what further work can be done and what further role such services can play as part of the national service framework.
We also need to consider support not just for prevention but for those children who become sick or have problems, whatever they may be. The hon. Lady referred to Diana nurses—we strongly support their work and are keen to learn lessons from it when providing care across the country. We are also keen to ensure proper palliative care support for children in the tragic circumstances in which it is needed. That is being 290WH considered as part of the current wave of consultation on the new opportunities fund to determine what additional care and support can be provided.
The hon. Lady referred to child and adolescent mental health services. A considerable amount of work has been done; national targets in health and social care for child and adolescent mental health services were introduced for the first time in 1999, under the national priorities guidance In the past two years, we have invested £50 million of additional funds in the modernisation fund and the mental health grant to help to achieve those targets. For a long time, mental health was not regarded as a serious problem for children, because it was felt that they would simply grow out of it, which is not the case. More work must be done to extend the best practice in some areas to the whole country. Capacity, reform and the provision of services must be considered.
We are committed to the growth of NHS capacity across the board as part of the NHS plan, putting extra investment and extra staffing in place to deliver services, although we must be realistic about the time it will take to deliver necessary improvements. However, we need not simply to expand capacity, but to reform the way we do things by setting national standards and focusing on children's needs. We need to focus on prevention, not simply on treating the sick, and to work in partnership with schools, families and the community. Work with children cannot be done by the NHS alone.
A theme from the NHS plan that we must consider in the context of children's services and children's health is that current professional roles may have to change and professional barriers that have been in place for a long time may have to come down. Much work is being done in that sector at present, and we are keen to ensure that it links with other action across Government. The health service should not work in isolation; we must consider social services, the obvious area of support, but also education and support for those with learning difficulties.
We must acknowledge that inequality and poverty are the root causes of children's ill health. My view is that a commitment to abolish child poverty will have more impact on children's health than any other Government measure. We have already made progress in that respect by taking 1 million children out of poverty in the course of this Parliament, which is a huge step forward, but there is an awful lot left to do. Many children still need help and support, but in the long run, action on child poverty will improve children's health. Health inequalities are partly to do with the causes of ill health, but also relate to children's and health services. Services for children in low-income areas must be as good as the best in the country, which has, too often, not been the case.
A huge programme of work is under way on the lines suggested by the hon. Lady, and we have an amazing opportunity, through the national service framework, to take matters further in the next few years. We want to ensure that there is post-natal and maternity support, as well as support for children throughout their childhood. We have an ambitious programme, which will make for an interesting time in the next few years. I welcome the hon. Lady's contribution to the debate and thank her for raising these issues. I am sure that she will continue to do so as this work carries on over the next few years.
§ Mr. John McWilliam (in the Chair)Before I call the hon. Member for Kilmarnock and Loudoun (Mr. Browne), may I compliment him on where he has chosen to sit? It was intended that Members should not split and sit according to their party. A debate across the Floor is much more helpful than trying to talk to the back of someone's head.