Adults will soon have the chance to vote for the party they think will give them the best National Health Service, but children will not have this privilege. Perhaps that's why they appear to be getting such a raw deal from health services - their special health needs are often not acknowledged in a system where there is a shortage of paediatric doctors and nurses, and a lack of people willing to speaking up for children.
A hard-hitting report published in the British Medical Journal (BMJ) in July last year, entitled 'Who is speaking for children and adolescents and for their health at the policy level?' says that basic principles in the health care of children are being ignored. It reveals that:
* there is no plan for the proper coordination of children's services - few English health authorities have health purchasing commissioners dedicated exclusively to children
* children's needs are found in only 16 per cent of health improvement plans
* only one in ten health authorities has any policies on adolescent physical health
* specific services for children are still not available in 40 per cent of the country.
This lack of priority in many health authorities means the attention given to children's health is fragmented. Where a child lives also makes a substantial difference to the health care they receive.
The report states, 'There would seem to be an irrefutable case for giving child health high priority in the Government's philosophy, policy and strategy, and in allocating resources.
'It seems perverse that so much resource is currently being targeted to the palliation of adult disease, with so little focus on addressing the antecedents of adult health in childhood and adolescence.'
Following the report, the Government has established a National Taskforce for Children, chaired by Professor Al Aynsley-Green, one of the report authors. It is still in its early days, but Professor Aynsley-Green believes the Government is now committed to addressing the inequalities between adult and child health. However, there is much work to be done.
'Child health is an aspect the Government often forgets,' says Sue Burr, advisor in paediatric nursing to the Royal College of Nursing (RCN) and another of the report's authors.
'It talks about poverty and educating parents, but when it comes to children, it's only the ones who cause problems, such as vandalism and teenage pregnancy. Children with long-term chronic health disorders are never addressed, but they are the ones likely to be in poverty, abused or socially excluded.'
Different from adults
The report says that child health is regarded as a tag-on to adult health services and resources need to be specifically targeted to children's requirements. 'We have some of the best child health guidance documents in the world, but it is only guidance,' says Sue Burr. 'A lot of these suggested measures would not cost extra, but it all falls on the attitude that children are just small adults, which they are not.' She says it is important to tailor services specifically for children, because at each stage of childhood there is different emotional, neurological and physical development.
'Children are very different from adults,' adds Peg Belson, advisor to Action for Sick Children. 'Not only are their bodies smaller, but they suffer from very different conditions. They are still developing and do not necessarily have the same reactions as adults. They also have illnesses that some adults do not have, and those not trained in paediatrics do not necessarily recognise them. Children's reactions to illness are also different.'
Harvey Gallagher, public affairs manager at mental health charity Young Minds, says that ten per cent of children aged from five to ten years old have a mental health disorder. Despite this, Gallagher says that child mental health services remain a 'Cinderella add-on'. 'Historically, within mental health services, children are a low priority because, even five to six years' ago, people did not think that children had mental health problems, so they did not believe a specialist service was needed,' he explains.
'There is a shortage of child psychologists and professionals trained to identify child mental health. Social workers, GPs and people working with children also need training in mental health problems, because front line workers can make a difference. Tackling child mental health is not just about money, but awareness and understanding. If it is left unrecognised, it will cost society a heck of a lot of money in time, services and support, which would be saved if it were spotted earlier on.'
Peg Belson also wants there to be more paediatric doctors and nurses, because many children are cared for by specifically-trained medical professionals. 'It tends to be only those trained to deal with children who are capable of communicating with children and their parents when they are at their most vulnerable,' she says. 'They are trained to take account of children and their families from a psycho-social and clinical point of view.'
Home and hospital
The RCN's Sue Burr argues, 'At one end of the scale you have the child in Accident and Emergency - it is very short and minor, but they are there with no suitable facilities. At the other end, there are very seriously ill children at home with parents struggling to cope with little professional help.
'One of the biggest inequalities in child health is that we still have 40 per cent of the country without access to child community nursing services. So there are children kept in hospitals longer than they should be and many at home whose families provide 24-hour care with very little assistance from health care services.
'To expect parents to care for their seriously ill children without training or the back-up of trained professionals who understand children is unethical,' she adds.
Drugs in childhood
The report in the BMJ also reveals that children are denied effective treatment because not all drugs are tested for their efficacy and safety. 'Thus, 50 per cent of drugs given to children in general hospitals, 60 per cent given to them in specialist centres, and 90 per cent given to seriously ill neonates (newborn children) are not licensed for use in childhood,' the report states.
Sue Burr thinks this is the case. 'One of the long-term difficulties is that children have no voice and many parents are so worried about looking after their children that it is very difficult for them to get their voice heard,' she says. 'They are too exhausted to go marching on the streets.'
The report, 'Who is speaking for children and adolescents and for their health at the policy level?', can be found on the Internet at the BMJ website -www.bmj.com.