A decade of children's public health in local government - A timeline

According to Royal College of Paediatrics and Child Health President Professor Steve Turner, many child health measures have worsened over the past decade.

Obesity is often said to be the biggest issue facing children. It increases the risk of developing a range of health conditions in childhood and later life, including heart disease, stroke, high blood pressure, diabetes and some cancers. Latest figures from the National Child Measurement Programme show 22.1 per cent of children starting primary school are overweight or obese and by the end of primary school 35.8 per cent are. Children from the most deprived areas are twice as likely to be obese than those from the least deprived.

Mental ill-health has also increased, with one in five young people now experiencing a probable mental disorder. With three-quarters of life-long mental health problems starting before age 25, these high rates are creating a legacy that are likely to be felt for decades to come.

Tooth decay is also at worrying levels with 22 per cent five-year olds experiencing problems. Meanwhile, NHS vaccination data shows falls in uptake for all 14 childhood vaccinations with none now meeting the World Health Organization’s (WHO) 95 per cent coverage target.

 In terms of unhealthy behaviours, there have been some encouraging signs, however.

Smoking rates among teenagers have fallen steadily from 11 per cent of 15-year-olds in 2011 reporting as regular smokers, to down below 5 per cent – although more young people are vaping. Drinking and drug-taking has also become less common, while teenage pregnancy rates fell by nearly 70 per cent between 2007 and 2021.

There is increasing concern about how rising levels of child poverty are affecting children and young people. Before Covid hit, The Marmot Review – 10 Years On warned about worsening poverty levels and persistent inequalities “blighting the lives of too many children”.  

The pandemic has arguably made things even worse with disruption to schooling, child development and family stress all taking its toll and being felt more acutely in more deprived households. The pandemic was, of course, followed by a cost-of-living crisis. “There’s probably no generation in recent history who have had it so difficult,” according to Gateshead and Newcastle Director of Public Health Alice Wiseman.

The past decade has been tough. LGA analysis has found that, between 2015 and 2024, the Public Health Grant received by councils from central government has been reduced in real terms by £858 million (in 2022/23 prices), with the Health Foundation suggests child health services have been one of the worst hit areas.

Health visitor and school nursing numbers have fallen – both are over a third lower than they were a decade or so ago. It has, in many ways, forced the hand of councils to innovate. The skill-mix of public health nursing teams has changed with family support workers and other staff taken on to perform tasks like supporting families needing advice on weaning, sleep and breastfeeding.

Some councils have adopted new models entirely. In Lincolnshire school nurses have been taken out of schools and moved into locality teams and renamed children’s and young people’s nurses. Many councils now commission specialist health visitors with advanced training in areas such as perinatal and infant mental health. 

But it has been tough. Institute of Health Visiting (IHV) Chief Executive Alison Morton said in some areas services have been “stripped to the bone” with health visitors facing “unmanageable workloads”. It is a similar story for school nurses with Sallyann Sutton, from the School and Public Health Nurses Association, warning the workforce is “really stretched” and that is curtailing their ability to do preventative work.

But both remain optimistic. Why? With talk of a renewed emphasis on prevention and moving care away from hospitals expected in the forthcoming 10-year strategy for the NHS, there is hope the 0-19 service will benefit from increased investment. And there are already encouraging signs – the public health grant allocation for 2025-26 was increased by more than 5 per cent in cash terms.

Despite all the challenges, the overwhelming consensus of those working in public health is that local government is the place to be. It is an argument made clearly by Association of Directors of Public Health National Policy Lead for Children and Young People Sarah Muckle who argues working alongside other local government services from children’s social care and education to planning is enabling public health to address the wider determinants of health in a way that would never have been possible.

There may be much more to do, she said, but there is no reason why everyone involved in children’s public health cannot build on the successes and achievements of the past decade.

• What Good Children and Young People’s Public Health Looks Like
• LGA vision for children, young people and families
• OHID commissioning guidance
• What is the role of a school nurse?
• Giving children the best start in life: Shining a spotlight on health visiting