More focus needed to ensure Integrated Care Systems meet children’s needs

Inconsistency in how the needs of babies, children and young people are addressed in local health plans highlights the need for better national guidance and support, a new report says.

The report, commissioned by the Children and Young People’s Health Policy Influencing Group (HPIG), analysed strategies and plans produced by Integrated Care Systems (ICSs), and how well they reflected different aspects of children’s health.

The group monitored the publication of ICP strategies and ICB JFPs throughout the year and, as of September 2023, completed a review of those ICSs that had publicly published their strategies and JFPs.

Investigating the first year of the new ICSs, introduced by the Health and Care Act 2022, the report also acknowledged good work being developed in the challenging context of increased demand and stretched budgets. Researchers said, however, that too few ICSs consider integration with other key services in children’s lives – such as education settings (only 32% of ICSs) and children’s social care (42%) – a critical component to improving children’s health outcomes.

While ICSs did generally identify priorities for children’s mental health, obesity, early development, special educational needs and disabilities (SEND), and inequalities, the rationale for these decisions was often not articulated. Furthermore, children with major and long-term conditions were absent in the majority (59%) of strategies and almost a third of Joint Forward Plans (27%) did not set specific targets to address inequalities to improve health outcomes.

Clearly identified leadership and accountability for the health outcomes of babies, children and young people was also found to be lacking. Despite a requirement to identify named board members to lead work for children and young people’s services, safeguarding, and SEND, over half (57%) of Joint Forward Plans failed to do so.

Key elements of a clear implementation strategy were also often missing, with less than two-fifths (39%) of strategies addressing capacity in the children’s workforce, and over half (59%) of JFPs failing to address the challenges around data and information sharing about babies, children and young people.

The Health and Care Act 2022 requires Integrated Care Boards (ICBs) to set out the steps they will take to address the needs of children and young people under the age of 25 in their five-year Joint Forward Plans (JFPs). Integrated Care Partnerships (ICPs) are also required to develop an integrated care strategy.

To effectively meet children and young people’s needs, their voices must be central when planning and designing services, yet the report discovered that they were rarely consulted in strategic planning. Only 6% of strategies and 17% of JFPs stated how babies, children and young people had influenced their work.

Evidence shows that to improve population health, tackle health inequalities, and prevent poor health later in life, there must be a stronger focus on babies, children and young people. As political parties outline their plans to shift the health system towards prevention, this report provides useful insights on where greater action is needed to ensure ICSs plan effectively to address child health outcomes.

In a statement releasing the report, Matthew Dodd and Amanda Allard, Co-Chairs of the Children and Young People’s Health Policy Influencing Group, said children and young people are “too often an afterthought in conversations about addressing inequalities and improving overall life expectancy and wellbeing,” adding that the Health and Care Act 2022 was “a step in the right direction” but that more needed to be done.

“Legislation is only part of the puzzle, and we must not become complacent about ensuring children’s needs are met in practice.

“We know that integrated and co-produced services across health, children’s social care and education can improve children’s outcomes and prevent costlier interventions further down the line and we look forward to continuing our work with national government and local systems to ensure this becomes a reality.”

The report makes a number of recommendations for national government and ICSs, including setting greater requirements for ICSs to outline who is responsible for delivering on commitments made around babies, children and young people’s health and how they can be contacted.

The HPIG is also calling for clear guidance to be provided to ICSs on addressing the needs of children with major and long-term conditions, as well as other minority and vulnerable groups.