It’s time to start talking about real prevention – early intervention in children services will pay dividends down the line

It’s time to start talking about real prevention – early intervention in children services will pay dividends down the line
posted 14 October 2015

In recent years, the national focus has been on transforming the way we deliver services for the over 65s, in response to the now well-recognised problem of a growing, ageing population with increasing levels of need. As a result, prevention and early intervention have often be surpassed by the need to respond and react to immediate pressures – especially now as preparations are underway for what many are fearing will be some of the worst winter pressures the NHS has ever had to face.

There is a strong business case for prevention across all segments of the population. Within children’s services, however, preventative care for those children with long-term, complex and multiple needs is arguably where investment has the greatest potential to pay dividends down the line. This requires looking at the bigger picture and what the return on investment would be in terms of health outcomes.

So is the immediate pressure to act as obvious as it is should be? And how do we tackle some of the health problems that arise later in life at their root cause?

Prevention is defined as stopping a problem before it starts, and early intervention as taking action to tackle problems for children and families before they become more difficult to reverse. Many of the complex and long term conditions suffered by adults later in life have their origins in childhood. This is particularly true of mental health conditions; an estimated half of all lifetime cases of diagnosable mental health illness begin by age 14.[1] Early intervention can mean the long term effects are greatly reduced or prevented altogether.  

The benefits of early intervention are not unique to mental health. Over 1/3 of children in England are obese or overweight by the time they are in year 6 of primary school, rendering them more likely to develop complex and costly conditions such as diabetes in adulthood.[2] Furthermore, almost one third of 5 year olds in England suffer from tooth decay, with dental caries being the number one reason for hospital admission among 5-9 year olds.[3] This is despite the fact that it can be largely prevented through regular brushing, exposure to fluoride and reducing sugar consumption. Like tooth decay, many long term problems are avoidable, and supporting healthy behaviours in childhood and teenage years through early intervention can set patterns for later life. Continued support for children and young people can mean that society as a whole will reap the benefits from a healthier, happier and more resilient next generation.

The potential benefits of investing in prevention and early intervention are vast, from a health perspective, but also from a financial one. Diabetes alone costs the NHS an estimated £10 billion per year, a figure which is predicted to rise to £16.9 billion by 2035.[4] It is estimated that reducing obesity by just 1% among children and young people could lead to annual savings of £1 billion, as children would be less likely to end up with long-term health problems requiring NHS treatment.[5] Tooth decay is similarly costly to the NHS - £30 million was spent on hospital-based tooth extractions for children aged 0-18 years in 2012-13 alone.[6] More effective preventative work would enable savings across the health and social care system which could be reinvested elsewhere.

However, to enable a shift towards prevention, certain organisational barriers must be overcome. Pathways between acute and community children’s services can be unclear, with the two often viewed distinctly rather than working in a fully integrated way. In some areas there is inadequate out of hospital provision for specific conditions, and more information and support should be available for children and their parents to better manage their conditions and prevent them worsening, ultimately reducing avoidable A&E attendances and hospital admissions.  

Pathways in children’s services should be co-produced with front line staff and children themselves, to ensure that they respond effectively to the needs of children and their families. This requires viewing families as a whole, doing more to address the transition between children and adult services, and ensuring the link is acknowledged and utilised by frontline staff.  More cross-organisational working is required between clinical commissioning groups, local authorities, public health, and parents and patients themselves to move prevention up the agenda and facilitate change across different parts of the system.

There is certainly evidence of shifting attitudes, particularly with the national emphasis on improving Child and Adolescent Mental Health Services (CAMHS), but this is just the first step in a long journey. Providing children, young people and their families with access to information, early intervention and preventative services will secure benefits in the long run, reducing the high costs associated with avoidable illness that pressure the health and social care system, and most importantly, supporting the healthy children of today to become the healthy adults of tomorrow.

 


[1] Royal College of Psychiatrists, No Health without Public Health (2010).

[2] Public Health England, National Child Measurement Programme (2013-14).

[3] RCS, Faculty of Dental Surgery, The State of Children’s Oral Health in England (2015).

[4] Diabetes UK, The Cost of Diabetes (2014).

[5] Department of Health, CMO’s Annual Report: Our children Deserve Better (2012).

[6] RCS, Faculty of Dental Surgery, The State of Children’s Oral Health in England (2015).