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A recent report by Ofsted suggests children's trusts still have a long way to go to deliver healthcare provision for children. Petra Barnby reports. Childhood obesity and drug misuse are causing children's care watchdog Ofsted ‘considerable concern'. But it is not the social ills themselves that are of greatest concern to some experts on children, but the lack of local services to tackle them. ‘I'm concerned that children's health provision could be reduced to children only getting the right inoculations at the right time.' These are the words of the deputy chief executive at children's charity 4Children, Geethika Jayatilaka. She believes children's health provision is lacking in some areas because of ineffective partnership working on children's trust boards. The provision for children's health services is decided on local children's trust boards, where the primary care trust (PCT) holds the purse strings for all public health services – it is left to directors of children's services to make sure children get the cash needed to improve their health. Last year, Ofsted's annual report into children's health provision coming out of children's boards found partnership working was ‘good', but ‘weaknesses remain in some children's and adolescent's mental health service provision, and the decline in teenage pregnancy rates is slow.' But is ‘good' good enough? Ofsted's 2005/6 review of 37 local authorities showed that not one children's trust partnership's contribution to healthy outcomes had been judged to be ‘very good' – 67% were deemed ‘good' and 32% were ‘inadequate'. Ms Jayatilaka believes this must improve, given the need to tackle the widespread and complex issues of childhood obesity and drug misuse. It is hoped that the Government's forthcoming child health strategy, expected this month, will address these issues. The problem is simple. Funding allocation for children's health is agreed on the children's trust board, where the PCT, which holds the cash, does not currently have to set aside a children's health budget from the general health budget. This means when cuts are made to children's health provision, no one knows. The director of children's services at Bexley LBC, Deborah Absalom, knew there would be resistance from the PCT when she pushed to have the children's health budget disaggregated from the general health budget, but she persevered. She says: ‘It is not in their interests to set aside a budget. But it is hard to get a handle on improvements if you can't get a handle on how much money you have to spend.' In order to improve the relationship between the PCT and the council, Mrs Absalom employed a children's health champion to work with the PCT two days a week, and with her for two days a week. ‘We built a bridge, and that has been very helpful,' she says. ‘You have to have a good children's health champion.' Each children's trust must agree on a plan for their area. How much it provides for children's health is left to chance, as Ms Jayatilaka, explains: ‘Children's health provision in an area depends on commitment from PCTs and directors from children's services. If there is strong local commitment, good joint working can often overcome challenges and deliver effective services on the ground.' Part of the problem is that there is no equivalent role to director of children's services on the PCT board. This is something Ms Jayatilaka thinks needs to change. ‘It is important to have a children's health champion on the PCT to ensure there is multi-agency, joined-up thinking and referral mechanisms in place. Centrally and locally there needs to be a greater emphasis placed on children's health, as previously it has not been a high enough priority on the public health agenda.' On a more positive note, it seems the Department for Children, Schools and Families is already on the case. Their next piece of advice, expected later this year, is snappily called ‘Delivering the Children's Plan – Strengthening Children's Trusts: legislative options'. It will include the following proposals: *to require all areas to have a children and young people's plan (CYPP) and extend ownership of the plan to all statutory partners, including the PCT *to strengthen the statutory framework for the CYPP through secondary legislation. This could include clarifying some of the rules on intervention and joint commissioning, and specifying the spend of each partner *to establish a stronger statutory basis for children's trust boards. Consultation closes on 25 September. To respond online, go to: www.dcsf.gov.uk/consultations /conRespond.cfm?consultationId=1568

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CHILDREN AND YOUNG PEOPLE

Kids' healthcare must improve

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