Has the Chancellor delivered for child health?

Love him or loathe him, if there is one thing to be said for the Chancellor, Rishi Sunak, it is that he certainly understands the power of sleek PR. Last week, that came in the form of the latest UK Budget.

Eye-catching teasers were leaked — from an increase in the minimum wage to investment to support the NHS and families — and dominated the press agenda ahead of the Budget. Traditionally, a Chancellor would never dream of leaking a budget. However, the inevitable telling off from a furious Commons Speaker seemed a price worth paying to enable the Chancellor to own the narrative and frame his Budget as a heralding a “new age of optimism”.

But just how optimistic can we be about the Budget and what it delivers for child health?

The Chancellor’s driving theme of optimism was given a boost by better-than-expected economic outlook. The Office of Budget Responsibility (OBR) forecasts the economy is set to grow for the next two years, that two million fewer people will be unemployed than previously believed and that long-term damage from COVID-19 is also not as bad as thought.

The Budget is decidedly vague on this simply stating “the settlement will keep building a bigger, better trained NHS workforce” with “hundreds of millions of pounds in additional funding”.

Practically, the budget translates into increased investment in public services of which the lions share is going to the NHS. A 3.8% rise investment over three years is expected to go towards helping the NHS deliver the Long-Term Plan for England, upgrades to equipment and facilities, including diagnostics, tackle COVID-19 and, vitally, address the elective backlog.

Over 283,000 children and young people are waiting for NHS treatment, with significant variety between areas, so the investment is sorely needed and very much welcome. However, there remain concerns the £8bn it still is not enough. Analysis from the Health Foundation shows that it will actually cost almost £17bn to clear the backlog and treat an expected rise in patients needing hospital care, including children and young people presenting with increasingly complex health needs.

There are concerns too about the lack of detail to address pressures on the workforce. The Budget is decidedly vague on this simply stating “the settlement will keep building a bigger, better trained NHS workforce” with “hundreds of millions of pounds in additional funding”. The Royal College of Paediatrics and Child Health (RCPCH) will continue to call for the Government to support the paediatrics and child health workforce with a fully costed and evidence based national recruitment, retention and workforce plan.

Children and young people in England have some of the worst outcomes in Europe.

Turning to the positives for child health, the Chancellor provided funding to implement some of the recommendations set out in the Early Years Policy Review chaired by the Rt. Hon Dame Andrea Leadsom MP. An investment of £500m will go towards a network of Family Hubs, Start for Life services, perinatal mental health support, breastfeeding services and parenting programmes.

Children and young people in England have some of the worst outcomes in Europe. Take just one indicator — say breastfeeding — from the RCPCH State of Child Health 2020 report and you see that initiation rates are lower than that in many comparable high-income countries. Not only this, but mothers in the most deprived areas have consistently lower rates of initiating and continuing breastfeeding than compared to those in the least.

The Budget is awash with… funding that goes some way to support families and children experiencing poverty and deprivation but are still not at the level of ambition needed…

Across the board, there is a widening gap between the health of children from high- and low- income backgrounds. It is precisely for this reason the College participated in Dame Andrea’s review. COVID-19 only looks set to worsen existing inequalities and this commitment from the Government to early years intervention is especially crucial. So too is the confirmation of £200m to support the existing Holiday Activities and Food programme to support disadvantaged children during the school holidays. Though this is welcome, according to the Children’s Food Campaign it will still mean millions of children in poverty slip through the nutritional safety net.

The Budget is awash with announcements such as these — funding that goes some way to support families and children experiencing poverty and deprivation but are still not the level of ambition needed to truly improve the health and wellbeing of children and young people across the country and for the long term.

This was certainly the case when it comes to the Chancellor’s announcement that he will cut the Universal Credit taper — the rate at which it is withdrawn as earnings rise — from 63p to 55p.

In practical terms, this goes some way to reversing the £20-a-week Universal Credit cut the Chancellor went ahead with despite significant public and political pressure, including from RCPCH, just a month ago. This move is good news for the 2.2 million people in families receiving Universal Credit who are in work but will be cold comfort for almost 4 million others, and their children, unable to work, for example people with disabilities or cancer patients, faced with the loss of £20-a-week and rising household bills.

We needed a budget that was clear in its ambition to support children and address existing health inequalities.

Just last month, the Care Quality Commission outlined the devastating impact of the pandemic on young people, with data revealing an increase in young people self-harming and having panic attacks or suicidal thoughts. We have also seen a doubling in the number of paediatric beds filled by children and young people in hospital because of severe mental ill health. It is disappointing the Government failed to take meaningful action to address this despite the College’s own submission to the Spending Review consultation clearly calling for ring-fenced funding to Children and Adolescent Mental Health Services (CAMHS).

Elsewhere, the Chancellor pulled out a surprise when he made an unexpected announcement to return spending on overseas aid to 0.7% of national income by 2024/25. This shows intense political and public pressure, which the College added its voice to, can pay off. This funding has a transformative impact on child health overseas and it was estimated the cut to 0.5% of national income could lead to a million excess deaths.

We needed a budget that was clear in its ambition to support children and address existing health inequalities. Instead, we have a decidedly mixed bag and a lingering sense that ongoing COVID-19 uncertainty plus serious pressures on the NHS workforce and household budgets could have a huge bearing on millions of children. Bold action is needed and without an overarching child health strategy that embeds a child health approach across all policymaking, it is hard to get on board with the “new age of optimism”.

This blog largely refers to spending on funding initiatives spanning health and education in England, as these areas are devolved. Information on Universal Credit is UK-wide. The Budget outlines how overall spending is impacted in Scotland, Wales, and Northern Ireland as a result of the UK Chancellor’s spending decisions. Though specific policy on schools, housing, health and social care and transport is in the power of the devolved parliaments and assemblies. RCPCH teams across the nations continue to monitor these.