Health bill and budget cuts imperil vulnerable children
I have been grappling with the potential consequences of last month’s Budget, and of the Health and Social Care Bill, for children who are vulnerable. Children’s success or failure relies on how well adults – those close to the child and those working in services for them – bring up, educate and care for them. By Maggie Atkinson
We know that children’s lives that are well supported and financially comfortable may be relatively unaffected by changes in public services policy and funding. Vulnerable and less well-supported children rely more on the ability of services to work as children’s champions. The Chancellor told us in the Budget that for the foreseeable future, services and champions alike will continue to be squeezed. Given this forecast, we can predict that the gaps in life chances already so evident between different groups of children in England will continue to grow.
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Let’s look at some practical – albeit fictionalised – examples of what could happen in some lives in light of the Budget and the act. I could of course have described any number of different examples, but here are two.
The first example relates to the present day. So let’s take the case of Annie, a physically disabled teenager with special educational needs, who is from a poor family of six children. Her mum earns a low wage in the public sector. Dad is Annie’s principal carer. They live in a sparsely populated rural area in social housing. Public transport is scant and expensive, a serious issue for the family as a whole. Annie’s doctor, dentist, school and social worker are all several miles away. She is 18 in December and in transition towards adult services. All the services Annie needs are facing further reductions in funding and continuous reorganisation.
The Care Quality Commission’s recent report on services for disabled children tells us what Annie already knows: that all too often services are unresponsive and disconnected from each other, and Annie waits too long for the things she needs. Neither the new health act, nor the continued strictures on services confirmed in the Budget, look likely to address Annie’s problems.
Mental health problems
Now let’s skip ahead to late 2013. Here’s Ben, a studious adolescent. His emerging emotional and mental health problems have caused concern for months. His school seems unable to get the help he needs. He is 14, about to choose exam options and general anxiety is making his condition worse while he waits for help in the “new” NHS. Nobody at his GP surgery seems able to help him after the clinical commissioning group looked at the locality’s data and now only commissions mental health support for young people with far more serious conditions. His local youth club provided access to someone Ben could talk to about his earliest mood difficulties, but it closed last year.
He is too anxious to travel to the next nearest support service, in a community where he knows nobody. Ben, waiting for a specialist appointment, is unsure how long the queue is or how close to the front he may be.
These examples may be deemed exaggerated, although, like me, many readers will know an Annie or a Ben. I do not doubt the government’s ambition is that Annie’s and Ben’s lives are never played out in reality. But translating that ambition into practice is the issue. How well professionals understand the Budget and the new health act, then respond to the implications of both, will make the difference for these and countless other young people.
Maggie Atkinson is the children’s commissioner for England
