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  • Writer's pictureOwen O'Sullivan

Making an impact on children’s health inequalities requires a new form of place leadership

Owen O’Sullivan and Andrew Laird argue that making an impact in children’s health requires a new and radical form of place leadership. Integrated Care Boards must empower and enable councils and local communities to work with them.

Improving children’s health is a critical priority for Integrated Care Systems across the country.

Integrated Care Boards (ICBs) produced their five year ‘joint forward plans’ in the summer, which set out their ambitions and priorities for the coming years. Amongst these priorities are a common commitment to helping children and young people to ‘grow up well’ or have the ‘best start in life’.

But what does this mean in practice? And what can ICBs do to make sure it happens?

Stark health inequalities

More than one in four (27%) children live in poverty, which impact their health and development. Children living in the most deprived areas are twice as likely to die in infancy, four times more likely to develop a mental disorder, and have twice the level of dental decay.

The 2023 Hewitt Review of integrated care systems recognised the scale of this problem and argued that every ICS should ensure ‘a clear articulation of the needs of children and young people within their population, and how those needs will be met through collaboration across the system.’

However, children’s health is not always top of the agenda in debates around health inequalities. In its formal response the Hewitt Review, the government’s mentioned children just once. Elsewhere, the 2023/24 NHSE Priorities and Operational Planning Guidance is also light on detail – a point not missed by NHS Providers, which criticised the document saying it ‘could have gone further… particularly in relation to the backlog of care in [children’s] community health.’

The NHS planning process

Set within this context, what do the joint forward plans say about children’s health?

Mutual Ventures has studied a sample across the 42 ICBs and there are common themes. In general, there is a well-articulated ambition to support children to get the best start in life, and a commitment to address long-term conditions. Many of the plans emphasise the role of communities in supporting children, particularly around mental health, and there is a commitment to innovative models for commissioning.

All of this makes sense. But doing it in a way that will achieve lasting impact will require a new way of working. What ICBs must do is to make the pressure on the whole healthcare system to deliver real.

The role of councils

It is widely accepted that 80% of a person’s health outcomes are determined by non-health related inputs. Responsibility for the many of these ‘wider determinants of health’, such as public health, education, children’s social care and housing, sit with local authorities. This is especially true for children.

The Hewitt Review rightly highlights the critical role of councils noting that ‘in several parts of the country, local government with responsibility for children's services has led the way’. In these areas the establishment of Strategic Alliances for Children and Young People ‘bring together all the relevant NHS, education, VCFSE, childcare and other services, partnering with parents and young people themselves to create the most effective and integrated support.’

The key point here is that effective integrated services depend on the NHS’s ability to work well with local government.

Let’s take children’s mental health as an example. Long waiting times and limited availability of Child and Adolescent Mental Health Services (CAMHS) means children and young people who need support are unable to access it. Ensuring these services are available to the children that most need it requires close working between councils and the NHS. This is not always in place.

The Mutual Ventures team saw some of this lack of alignment through our work on children’s adoption service. Unfortunately, many children will have suffered abuse or neglect before they are adopted which can impact their mental health. Funded by the DfE’s National Adoption Team, three Regional Adoption Agencies in the north east have linked with NHS North East and North Cumbria Integrated Care Board (ICB) to put in place multi-disciplinary specialist teams with social workers, psychologists and other specialists working together to speed up assessments and deliver the support a child and their family need.

What next?

ICBs have a clear and unambiguous commitment to improving children’s health. This requires that they are an effective vehicle for collaboration and supporter of joined-up working. Organisations won’t succeed by simply working within their own boundaries.

What we need is a new and radical form of system leadership – building trust, emphasising relationships between partners, and guiding the system.

The recent NHS reforms appreciate the importance of local context and meaningful and effective ‘natural communities’. This is particularly important when considering the support children need and require.

Fundamentally, the creation of these communities relies on building understanding between the NHS and councils in order to transform public services, public spaces and communities. For this to be effective, it must involve and empower local communities and recognise local assets.

To have a real impact on children and young people, and reverse the inequalities that blight their lives, must trust and empower local authorities and communities to support the aims of the NHS.

For more on MV's work on integrated care and health collaboration click here.


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