Children, young people and families’ health and wellbeing across the health system in England

Suzy Cooke

Consultant in Public Health, NHS Lothian

Ann Hoskins

FPH Children & Young People SIG Chair 
FPH Yemen SIG Chair

The creation of integrated care systems (ICSs) in 2021 changed the health and care architecture in England. These changes provide a significant opportunity to embed children, young people and families (CYPF) public health approaches widely across the health system and society. It is also paramount that we consider how CYPF health and wellbeing can remain a priority in a context of significant challenges on services.

A Delphi methods approach was undertaken between March and July 2024 to develop a consensus view of CYPF leaders across the system in England. This work was led by the British Association for Child and Adolescent Public Health (BACAPH) with support from the Faculty of Public Health (FPH) and the Royal College of Paediatrics and Child Health (RCPCH).

We spoke with seven key leaders across the CYPF system to identify gaps where a Delphi could support the provision of a consensus view. Identified questions were posed, with 13 CYPF stakeholders across England sharing their insights. These views were summarised and shared through a second questionnaire, where 11 respondents helped to reach a shared position on CYPF priorities.  

Clear system leadership for CYPF was considered to involve strong visibility across the system, co-production, joined up working and advocacy, with a consistent narrative around prevention. Utilising the powerful voice of CYPF and carers was felt to be key, using asset-based approaches to build on community strengths and knowledge.

There are opportunities to strengthen CYPF partnership working by:

• A clear national strategy and voice that incorporates prevention, health inequalities and treating ill-health priorities

• ICSs and integrated care boards (ICBs) identify named leads for CYPF to allow for consistent championing for CYPF needs in strategic planning and commissioning

• Strengthen links between CYPF colleagues at NHS England, local authorities, UK Health Security Agency, RCPCH and other stakeholders

• CYPF rights and values to underpin partnership working

The new system architecture provides an opportunity to improve joined up working, with shared data platforms, integrated commissioning and data sharing between education and health sectors. Financing mechanisms can be developed, using linked data to support a focus on prevention and early intervention. Data linkage and a joined up working approach ensures the sharing of best practice, increasing efficiency by avoiding duplication.

To prioritise the needs of CYPF, system leadership advocacy must present a strong narrative that emphasises the longer-term return on investment for prevention. Within this, CYPF health and wellbeing needs to be listed in key performance indicators.

A life course approach is required, that takes a systematic lens, incorporating a population health management framework with robust evaluation measures embedded from the planning stages. BACAPH have developed a Population Health Management framework to support work with this population in ICSs. This provides a work-through template and guidance for CYPF priority identification and a systematic approach to ensure an efficient and robust approach to improving CYPF outcomes in a context of finite resources.