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Proposed shift

The ‘treatment to prevention’ shift aims to move the NHS away from being a service that focuses on treating illnesses to spotting them earlier and tackles the causes of ill health to help people stay healthy and independent for longer.Ìý

The RCPCH supports embedding a greater focus on prevention throughout the healthcare system to improve child health outcomes and help reduce pressure on health and care services.Ìý

Child health challenge

We welcome the shift to prevent illnesses before they happen and to shorten the amount of time people spend in ill health. However, we are concerned that a focus on early detection of illness and enabling people to live independently for longer risks framing the NHS 10-year plan around adults' health needs.

To support this shift, we believe the key window for prevention and addressing poor health outcomes is in childhood, starting from pregnancy. Many lifelong health issues are established in childhood and adolescence; therefore, the NHS 10-year plan must adopt a life course approach to prevention. If not, more children will grow up with unaddressed ill health issues, multiple morbidities and poor health outcomes, which are harder to reverse in adulthood.Ìý

The climate emergency is an additional significant challenge to health and prioritising a life course approach to prevention and the health of children will reduce the requirement for carbon-intensive interventions later in life, producing a sustainable health service 1 . ÌýÌý

The state of child health in England

Children and young people in England currently experience some of the worst health outcomes with widening health inequalities compared with other similarly developed countries2 . Many of these outcomes are preventable, and if left untreated will develop into complex health conditions.

• The prevalence of obesity in Reception-aged children in 2023/24 was 9.6%, and it more than doubles to 22.1% for year six children. For children living in the most deprived areas, obesity prevalence was over twice as high compared with those living in the least deprived areas 3 .Ìý
• Uptake for all routine childhood vaccinations decreased in 2023-24 and no vaccines met the 95% coverage target4 .
• Nearly 1 in 3 (29.3%) of 5-year-old children had tooth decay in 20225 . Tooth decay is the leading cause of hospital admission in 5-9 year olds, however children living in the most deprived communities are over three times more likely to be admitted to hospital for tooth decay than those living in the least deprived 6 .Ìý
• Rates of poor mental health for children and young people are rising: 15.7% of 8-10s, 22.6% of 11 to 16s and 23.3% of 17-19 year olds had a probable mental health disorder in 20237 . For children living in the poorest 20% of households, they are four times more likely to develop a mental disorder than those from the wealthiest 20%8 .
• Air pollution has overtaken high blood pressure and smoking as the leading contributor to global disease9 . ÌýExposure to air pollution is the second leading risk factor for death in children under 5, both globally and in the UK10 .ÌýExposure to air pollution during gestation, infancy, childhood and adolescence affects developing organs and increases the risk for chronic disease in adulthood11 .Ìý
• The current long waiting lists for health services mean children and young people do not have timely access to care, which is preventing early diagnosis of illnesses and further exacerbating health problems. This can have a significant impact on their lifelong healthy development12 .

A distinct focus on addressing prevention for children and young people’s health is therefore key to the success of the NHS 10-year plan. However, without addressing the role of the wider determinants of health alongside, success in improving the health of the population and reducing demand on the NHS will be limited and will risk further widening health inequalities.Ìý

RCPCH recommendations

To ensure a life course approach in the shift to prevention in the NHS, we recommend:Ìý

Invest in health visiting and school nurses

Provide sufficient resource to increase the capacity of health visitors and schools nurses to enable them to provide vital early intervention and prevention services to children and families, which will reduce the reliance on specialist or urgent health services.Ìý

Expand access to vaccine appointments

Remove barriers to vaccination uptake by expanding access to and capacity of vaccine appointments to provide more flexible options to families.

Expand children’s oral health services

Ensure all children are seen by a dentist by the age of one to support good oral health development.

Invest in Child and Adolescent Mental Health Services (CAMHS)

Provide greater investment in CAMHS to improve access to mental health support, reduce the long waits for care, and reduce the growing number of children and young people who are reaching crisis point and ending up in emergency care settings while waiting for mental health support.

PrioritiseÌýa clean air future

The NHS should lead by example by mandating the implementation of the Clean Air Hospital Framework across all NHS organisations.Ìý

Apply a sustainability lens to preventionÌý

We support the UK Health Alliance on Climate Change recommendation: A sustainability lens should be applied to prevention giving particular emphasis to preventative interventions that deliver combined health, environmental, financial and social benefits and ensuring that these wider benefits are measured, tracked and reported to inform future decision-making and prioritisation.

• 1ÌýUKHACC, Centre for Sustainable Healthcare and the Sustainable Healthcare Coalition (2024) Sustainability in the 10-year plan Ìý
• 2ÌýCheung, R. (2018) International comparisons of health and wellbeing in early childhood. Available at
• 3ÌýNHS Digital (2024) National Child Measurement Programme, England, 2023/24 School Year. Available at
• 4ÌýNHS Digital (2024) Childhood Vaccination Coverage Statistics, England, 2023-24. Available at
• 5ÌýOffice for Health Improvement & Disparities (2023) National Dental Epidemiology Programme (NDEP) for England: oral health survey of 5 year old children 2022. Available at
• 6ÌýOffice for Health Improvement & Disparities (2024) Hospital tooth extractions in 0-19 year olds: short statistical commentary 2023. Available at
• 7ÌýNHS Digital (2023) Mental Health of Children and Young People in England, 2023 – wave 4 follow up to the 2017 survey. Available at
• 8ÌýCentre for Mental Health (2020) Mental health inequalities: Factsheet. Available at
• 9GBD 2021 Risk Factors Collaborators (2024) Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: A systematic analysis for the Global Burden of Disease Study 2021’ Lancet 403:2162–2203Ìý
• 10Institute for Health Metrics and Evaluation (IHME).ÌýGlobal Burden of Disease 2021: Findings from the GBD 2021 Study.ÌýSeattle, WA: IHME, 2024. Available atÌý
• 11Royal College of Paediatrics and Child Health (2024) Air pollution in the UK – position statement. Available at www.rcpch.ac.uk/resources/air-pollution-uk-position-statement Ìý
• 12ÌýRoyal College of Paediatrics and Child Health (2024) Transforming child health services in England: a blueprint. Available at www.rcpch.ac.uk/resources/transforming-child-health-services-england-blueprint