With rising rates of neurodiversity, mental illness and development problems, leading public health director Alice Wiseman sets out how the 0-19 service needs the help of the rest of the local government family along with the NHS and voluntary sector to improve the health and wellbeing of children.
Association of Directors of Public Health Vice President Alice Wiseman believes the move of children’s public health into local government has coincided with one of the toughest ever periods for children to grow up in.
“There’s probably no generation in recent history who have had it so difficult. Others have had it tough. I grew up in the 1980s – we saw the decline in traditional industries such as coalmining which had a devastating impact on families. But the scale and breadth of what we have seen over the past decade has been different,” said Ms Wiseman, who is now the Director of Public Health for both Newcastle and Gateshead.
“The children who are turning 18 were born just as the financial crash happened. They grew up during a period of stark government austerity, which meant that vital support and services were stretched thin or, in many cases, removed altogether.
“Alongside this came a sweeping programme of welfare reform, leaving many families worse off financially. During Covid, while children and young people were thankfully at lower clinical risk, they made some of the greatest sacrifices to protect older and more vulnerable members of society. They missed school and socialising with their friends.
“At the time, these measures were deemed necessary, but we are still uncovering the long-term impacts of such significant disruptions to their formative years. And as if that wasn’t enough, they have faced the ongoing cost-of-living crisis, which has placed even greater strain and stress on overstretched parents, public services, and the voluntary and community sector.
“Already we can see the consequences of this. We have significant numbers of children not ready to start school, we have rising levels of neurodiversity and rising levels of mental health problems.
“It is against this backdrop that children’s public health services have moved and become embedded in local government. It would have been incredibly difficult for health visitors, school nurses and the other members of the 0-19 teams at any point to rise to the challenge, but given the cuts to the budget it has been doubly so.”
‘We all have to step up’
So how can they respond? Ms Wiseman believes the answer lies outside the core 0-19 teams, arguing there is only so much they can do in isolation. Her annual report for Newcastle this year is called “It takes a city to raise a child”. The phrase is borrowed from an African proverb “it takes a village to raise a child”, which emphasises the vital role of collective community effort in nurturing a child and enabling them to thrive.
“Its message is clear - raising a child is a profound responsibility that resonates beyond the parents and immediate family. In practice, that means we need a strong heath visiting and school nursing workforce, but we also need other parts of local government and our partners playing a role. We all have to step up.
“That includes youth workers, community leaders, educators, but it goes even wider that – it applies to the whole council. In local government we cannot just think of this as a job for public health and children’s services.
“For example, we know planning is important – in Gateshead we introduced a policy in 2015 not to approve new takeaways in areas with high levels of obesity. We also need good quality public places and park.
“We need to make roads safe to encourage active travel and we need tough licensing approaches. In England we cannot take into account health when it comes to licensing, which I would like to see change, but we can take into account protecting the child from harm.
“The voluntary sector has been playing a vital role too. Often picking up where we have been unable to step in. We need to build support in communities, particularly in the most deprived.”
Influencing the NHS
But to meet this challenge, Ms Wiseman believes there needs to be a more nuanced approach to providing support than has previously happened, pointing to the experience of Sure Start centres, which were rolled out during the 2000s to provide support to the under-fives.
“Research has shown that the most disadvantaged families did not always access them and when they closed the richest families were able to weather the lost resource. It was then those in the middle who lost out. We have to learn from that going forward with the family hubs. We need to do better to ensure those who need the support the most benefit. There are a lot of families out there struggling.
She also said public health needs to use its voice to influence the NHS more. “We need to the health service to engage and prioritise children more. There are some fantastic services – great children’s hospitals for example - but when it comes to mental health or other services such as occupational therapy or speech and language therapy services are severely lacking.
“Waiting lists for autism and ADHD are huge – we know the majority on them will get diagnosed, but we are doing nothing to support those while they are on the waiting list, even we though we know that they are likely to get diagnosed in the future.”
Please note this is an independent article. The content and views reflected within are those of the named contributor and not necessarily those of the LGA.
