NHS England » Children and young people update

Organisation objective

NHS Long Term Plan

Working with people and communities

What approaches have been used to ensure people and communities have informed this programme of work?

recruited Patient and Public Voice (PPV) Partners
consultation / engagement
qualitative data and insight, for example, national surveys; complaints
quantitative data and insight, for example national surveys
partnership working with voluntary, community and social enterprise organisation

The Children and Young People’s (CYP) Programme engages widely with children, young people, parents and carers. We recruit six young board members (YBMs) on a biennial term as Patient and Public Voice (PPV) partners, who sit on the NHSE England CYP Board. The YBMs, aged 15 – 20 years old, input into strategy development and decision-making, such as the 10-Year Health Plan. Additionally, in partnership with Barnardo’s, we deliver the NHS Youth Forum. This is a network of around 70 active members aged 11 – 25 years old. These individuals are offered various opportunities including monthly consultations and yearly research projects in partnership with NHSE policy teams. We also oversee the Parent, Carers and Families Network. Members are leads from various organisations, who help share the collective lived experience of families, identifying common themes, risks, and issues.

Action required

This paper:

updates the Board on key challenges impacting children and young people
asks the Board to approve the strategic priorities led by the Children and Young People’s Programme
asks the board to recommit to hear the voice of young people and ensure children and young people are considered in strategic development, including the 10YHP

The recommendations set out in this paper have previously been considered by the national Children and Young People’s Board and most recently by the Quality and Performance Committee and the Quality Committee.

Background

NHS England is committed to improving the health outcomes and wellbeing of children and young people, and ensuring they are given the best start in life.
NHS England’s Children and Young People Transformation Programme is responsible for delivering on specific programmes to improve services for CYP.
In addition, the CYP Transformation Programme has strategic oversight on policy relating to children and young people across NHS England programmes, such as mental health, urgent and emergency care, and digital. Key programmes are brought together via the NHS England Children and Young People Board which works collaboratively across NHS England to ensure delivery of key priorities for children and young people.
Key areas of focus for the Children and Young People Board this year include:
1. Improving care and outcomes for CYP with long term or life long conditions
2. Elective recovery, including a focus on equitable recovery for CYP;
3. Improving access to community services, including data quality enhancements and pathway redesign.
4. Urgent and Emergency Care, including scaling up initiatives that divert low-acuity CYP presentations to more appropriate care settings;
5. Supporting the development of integrated community-based models of care.
Progress has been made in delivering on these key priorities however, there are still challenges to outcomes, experience and services.

Key challenges

Some of the key challenges currently impacting the health and wellbeing of children and young people include:

Health and care needs of children are becoming increasingly more complex. The number of children with eight or more chronic conditions were found to have nearly doubled between 2012 and 20191.
5 million children in England are affected by excess weight or obesity and health inequalities begin at a very young age, for example, children from the most deprived decile are 2.1 times as likely to be obese in Reception than children from the least deprived decile, and this extends to 2.3 times by Year 6 [1].
Prevalence of mental health disorders has increased. In 2023, around 1 in 5 children and young people aged 8-16 had a probable mental disorder, compared to around 1 in 9 in 2017[2].
There has been an exponential growth in demand for ADHD and autism assessments since 2019.[3]
There has been a rising trend in the numbers of children living in poverty since 2018/19[4]

The Independent Investigation of the National Health Service in England, Darzi 2024 highlighted pressures across both community and acute services for children and young people for mental and physical health. In addition, there has been a decline in uptake of the childhood vaccination programme over the last decade, as well as regional variation in uptake. Coverage decreased for all of the 14 vaccine coverage measures reported in 2023-24 with decreases between 0.1 and 1.0 percentage points compared to the previous year[5].

Current programme priorities

The current Children and Young People’s Transformation programme’s strategic priorites, summarised below, are aligned to the Government’s goal of reducing waiting times and of delivering reform against three stated shifts; to move care from hospital to community, from treatment to prevention and from digital to analogue.

9. Reducing elective waiting times:

a. Over the last two years, the CYP Transformation, Elective Recovery and Getting It Right First Time (GIRFT) programmes have set up dedicated governance through a national CYP Elective Recovery Delivery Group to drive elective recovery for children and young people, with similar governance arrangements across all NHSE regions. They have published a national CYP Elective Recovery toolkit and a GIRFT Closing the Gap guidance to share existing positive practice, set out minimum expectations and drive progress on access and use of CYP data.

b. The Reforming elective care for patients plan, published on 6 January 2025, set out commitments including: greater transparency, with a commitment that NHS England will publish a suite of adult and children’s elective performance metrics (including 18-week performance, long waits and waiting times) that can be used by both NHS staff and the public; an ask that ICBs and providers ensure interventions are in place to reduce disparities for groups who face additional waiting list challenges and undertake quarterly reviews of local waiting list data (CYP and adults); reviewing and embedding waiting list prioritisation tools, including those for children and young people.

10. Community and Mental health Services Waiting Times

The ADHD Programme and ADHD Taskforce are exploring what an effective pathway for ADHD assessment should look like, identifying the service transformation needs that may emerge from such a pathway.
NHS England continues to work in partnership with DfE on opportunities to provide in school offers to better meet children’s needs and improve early intervention.
NHS England has developed a metric for measuring waiting times in CYP community mental health services (as well as in adult and older adult community MH), which looks at the length of time it takes for someone to start receiving meaningful help. In 2024/25 systems have implemented the new metric and focused on data quality improvement to support improvement to addressing waiting lists and tackling the longest waits.
Work through the 10 Year Plan will further consider the demand and capacity imbalance including opportunities for workforce improvements, data quality enhancement, pathway redesign, and quality standards for CYP community services and mental health services

11. From hospital to community care

Working with ICBs to support establishment of community based Multidisciplinary Teams (MDTs) for CYP to embed paediatric expertise in the community by;
1. Developing guidance on Neighbourhood MDTs for CYP that sets out key principles and highlight best practices in delivering this model.
2. This model aligns to one of the six core components of Neighbourhood Health guidelines which have been published alongside the operational planning guidance.
NHS111 Paediatric Clinical Assessment Service (PCAS)
1. PCAS embeds paediatric clinicians within NHS111 Clinical Assessment Service. During 2024, referrals to PCAS proportionately had a lower outcome of A&E attendance, and higher self-care/pharmacy outcome than for the National CAS.[6]
2. We are working to review learning and refine the PCAS model to maximise impact.

From treating sickness to prevention:

Piloting Complications from Excess Weight clinics (CEWs):
1. We have been piloting a number of specialised Complications from Excess Weight (CEW) clinics across England with the objective of early identification and treatment for the range of complications associated with obesity, such as type 2 diabetes, obstructive sleep apnoea and mental health conditions. Over 3,500 patients have been seen in the clinics so far.
2. In addition to providing holistic and personalised care through multidisciplinary teams, these clinics are testing an innovative MedTech solution for daily weight measurements.
3. The pilot is being independently evaluated by the National Institute of Health Research, with findings expected by March 2026.

Managing deteriorating patients

We have created a national Paediatric Early Warning System (PEWS) that facilitates a standardised and interoperable method of tracking and detecting the deteriorating child, and links with the implementation of Martha’s Rule.
All hospitals with a paediatric inpatient setting are transitioning to the NPEWS with rapid uptake since its launch in November 2023.
While standardised scoring systems have been used in some States in Australia, and notably country-wide in Denmark, the scale of the roll-out in England would make it the largest standardised scoring system in the world.
Building on work to date to implement PEWS in inpatient settings, an Emergency Department PEWS is currently being piloted and consideration is being given to Ambulance and community PEWS in successive years.

National standards and tools for long term and lifelong conditions

Over 1.7 million children and young people live with a long-term condition including asthma, diabetes and epilepsy. Taking a clinically-led approach, we have developed key standards and recommendations for Integrated Care Boards (ICBs) to improve the outcomes for children and young people living with common long-term conditions. The National Bundle of Care for Asthma and Epilepsy, as well as the RightCare Diabetes Toolkit, set out key actions that ICBs can take to deliver high-quality care.
We are developing guidance on services for children and young people living with cerebral palsy, which has a prevalence of 1.6 per 1000 live births in high-income countries. This includes key actions that ICBs can take to support early identification and diagnosis, minimise secondary complications, help people achieve their maximum quality of life, and avoid costly interventions.

From analogue to digital: by March 2027, the NHS App will be significantly expanded to improve information for patients in elective care, as well as their parents and carers through proxy access.
Continued focus on reducing health inequalities through continuing to embed the Core20PLUS5 approach for children and young people and support systems to deliver targeted action to reduce healthcare inequalities.

Next steps

The Government has set out their ambition to raise the healthiest generation of children in our history. The Children and Young People’s Transformation are currently working with DHSC, as well as other national NHS England programmes, to support engagement and develop options to inform strategic direction including through the 10YHP.

Recommendations

The Board notes the challenges affecting children and young people’s experience and outcomes and work being undertaken to make improvements to NHS services.
The Board supports the strategic priorities noted in this paper.
The Board supports the work of the Children and Young People Board to coordinate and include consideration of children and young people within strategic development, including the 10YHP

Publication reference: Public Board paper (BM/25/04(Pu)

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