»Ê¼Ò»ªÈË

What is the 10 Year Health Plan?

In October 2024, the UK Government announced a new ‘10 Year Health Plan’ for the NHS in England and launched a major public engagement initiative to help shape it. The Prime Minister set out the government’s intention for this to be ‘the biggest national conversation about the future of the NHS since its birth.’

Members of the public and everyone who works in health services in England are invited to contribute through the online portal, Change NHS, as well as through local and Trust-based ‘deliberative events’.

The 10 Year Health Plan is focused on making the NHS fit for the future, and follows findings from the Darzi Independent Review of the NHS which laid bare the challenges for health services, including worsening child health outcomes and increased pressures across paediatric services.

Three shifts

As well as overarching questions about what is working well and what needs to change in order to deliver better care and reduce waiting times, the Plan will be underlined by ‘three big shifts in healthcare’. On 21 November 2024, we published a briefing on each of these shifts:

• A community shift that works for children
• Making better use of technology in health and care
• Focusing on preventing sickness, not just treating it

What members can do

Far too often, major national health policy is adult-focused, with children and child health services either an afterthought or entirely forgotten. The 10 Year Health Plan is a significant opportunity for change, and we want to ensure that children are at its centre.

We are calling on all RCPCH members in England to engage whenever possible: to take up any Trust or regional opportunities and to spend a few minutes filling in the Change NHS portal. This is your opportunity to make the case for the direction of health services over the next ten years, and to ensure children and the child health workforce are fully considered.

The Change NHS portal includes specific questions about what is working well in the NHS, the biggest challenges, your personal experiences and questions about each of the three shifts. It also has a section to submit your overarching ideas for change.

We would love to see the Change NHS portal flooded with suggestions related to children’s health! Please look at our key messages and recommendations, and add your voice to Change NHS. Go to 'In case you missed it' section of the website and see:

Why we need change – the evidence and key messages

Child health outcomes have worsened and demand for health services has increased due to preventable and non-preventable causes of childhood illness

These include: 

• Respiratory illness - Around one in 11 children live with asthma, and the UK has one of the highest rates of emergency admission for childhood asthma.Ìý
• Medical complexity - There has been an increase in the number of children with multiple conditions and life-limiting conditions, including a 250% rise in the prevalence of life-limiting and life-threatening conditions in childhood between 2001 and 2018.
• °¿²ú±ð²õ¾±³Ù²âÌý- Two and a half million children in England are affected by excess weight and obesity, and 1.2 million are living with complications from obesity. 23.4% of Year 6 children were obese in 2021/22, 80% of whom are predicted to remain obese as adults.
• Mental health - Almost one in five (18%) children aged 7-17 now has a probable mental disorder, a 50% increase from one in nine (12%) in 2017.

The gap between demand and service capacity has widened

While the paediatric waiting list has increased by 166,740 patients since 2020, there are just 462 more paediatric consultants: a 67% increase in patients waiting for care versus a 15% increase in consultants.

Four-fifths of members who responded to our recent survey stated that there is no longer the appropriate level of capacity to meet local demand for child health services.

Underinvestment in children’s health

Children and young people make up around a quarter of the population and are high users of health services but receive just 11% of health funding. This inequity is even clearer in mental health spending, where only 8% of ICB funding for mental health care is allocated to children and young people, despite the high levels of need

This is not equitable based on population split or demand for services.Ìý

Children are now waiting longer than adults to access healthcare

The number of children waiting for over 52 weeks for an appointment increased by 60% for elective paediatric services, and 94% for community health services in just two years. Over 50,000 children are waiting for more than a year.

Long waits for care can be harmful for any patient but are particularly damaging for children and young people

Many interventions need to be given by a particular age or developmental stage, and year-long delays for surgery, speech and language therapy or paediatric input can be irreversible for children.

Investment in child health services offers significant return

It provides both long term returns (cost savings across the life course) and cross-sector returns (saving money in school absence, mental health, youth justice, labour market inactivity as well as within the health system).

Investing in children’s health now is vital for the future economic wellbeing and health of the country.

What needs to change - RCPCH priorities

Paediatricians and the wider child health workforce are working hard to deliver safe and high-quality services for children and to implement innovative models of care. But they cannot do this alone. We need a rebalancing of the health system so there is a greater focus on meeting the needs of children and young people.

This is partly a call for equity: it is unacceptable that children’s health services have been deprioritised and underfunded compared to adult care. It is also good economic sense: investing in children’s health offers high economic returns and is essential if we want to have a healthy nation.

While RCPCH supports the proposed shifts from hospital to community, analogue to digital, and towards prevention, there are some foundational changes that need to be put in place to ensure the NHS as a whole works better for children. Without these, child health services will not meaningfully benefit from any of the proposed shifts.

RCPCH is calling on the Government to implement the following recommendations: 

1. Prioritise children’s health in national plans

• Children, young people and child health services must be specifically considered throughout the 10 Year Plan, including in proposals for each of the three shifts. The Plan must recognise that children have distinct needs, interact with the health system differently and often encounter a wider range of services than adults.Ìý
• Rebalance away from acute metrics against which systems have historically been assessed, towards metrics which consider community provision, holistic care, and health outcomes.ÌýWhile we accept the need for a reduction in the overall number of targets, there should nevertheless be clear metrics which capture how services and ICBs are meeting the physical and mental health needs of children and young people.
• National prioritisation categories and risk frameworks must take into account the differential risks experienced by CYP (children and young people), including the impact of long waits on children’s healthy development and ability to participate in education.

2. Ensure fair funding for children

• Introduce a Children’s Health Investment Standard to address the investment gap between child and adult health services. Similar to the Mental Health Investment Standard, this would require ICBs to increase their spending on children’s health services at a faster rate than their spending on other services, and gradually move towards more equitable service funding.

3. Make devolution to Integrated Care Systems work better for children

• Establish clear national oversight of Integrated Care System performance for children and young people.
• Set clearer expectations for Integrated Care Systems through a CYP waiting times standard, and offer dedicated support and guidance to Integrated Care Boards to tackle long waits in childhood and ensure no child is left waiting for over 18 weeks for care.

4. Support a sustainable child health workforce

• Review the modelling on children’s health which underpins the NHSE Long Term Workforce Plan. Investment in the workforce should be evidence-based and fair, and should consider the increased demand and complexity of child health.
• Develop a national child health workforce strategy which takes a whole system approach to recruitment and retention.
• Commit to expanding training places for paediatricians and the wider child health workforce, with a focus on the community child health workforce.

On 2 December, the RCPCH Health Policy team (with insight from our senior clinical leaders) and the RCPCH &Us team (representing the voice of children, young people and families) each submitted an organisational response to the Change NHS portal - see these responses.Ìý

Our Blueprint for transforming child health services, published in September 2024, sets out these recommendations and the evidence for them in more detail.