Moving Away from the ‘Illth’ Model
In 2010, Sir Michael Marmot published ‘Fair Society Healthy Lives’ calling on society to ensure that every child has the best start in life, and to strengthen the role and impact of ill-health prevention.
Six years on from the Marmot Review, despite advocates campaigning for child health to be further up the agenda, a large health gap remains, with the varying quality of care and health services across the country exacerbating the inequalities. Children and young people (CYP) in the UK have poorer health outcomes than in other developed countries. Child poverty is one of the most important indicators of health and well-being; rates of child poverty in the UK are high, between 10-15%, meaning we are performing poorly when compared to other countries with advanced economies. When you review current national policies – including the NHS Five Year Forward View – it is clear that CYP are not the focus. Moreover, there are few care strategies that explicitly state the importance for CYP against competing priorities, especially the health and wellbeing of the UK’s aging population.
I recently attended a Children’s Health workshop hosted by the Children’s Hospital Alliance and NHS England. A discussion around the concept of ‘Illth’ in relation to children’s health services was of particular interest to me. Illth – the reverse of wealth - is a concept coined by John Ruskin, which refers to accumulation that results in illness rather than well-being. In children’s health, it is manifest in the common failure to prevent chronic illnesses such as diabetes, which are becoming more prevalent at a younger age. This made me reflect on the urgent need of the NHS to become a comprehensive ‘health’ service, and move away from just acting as a reactive ‘ill-health’ service. That is to say, should we continue to treat illness reactively and fail to bolster public health efforts, the NHS will become increasingly unsustainable. Although there have been significant improvements in child health over the last decade, the ‘illth model’ still prevails today and health services remain heavily hospital (rather than community) based.
A movement to preventive care is essential, and in the case of children, perhaps a more achievable feat due to the greater engagement opportunities in the development years. We can play an important role in enhancing prevention, by embedding it within care provision at different touch points in a child’s life. Manageable solutions to achieve this would be to make better use of the country’s existing educational structure to embed health education and preventative care messages in the early formative years, for example through investment in school nursing, education at nursery schools, and for greater care opportunities in the community via health visitors for babies and parents.
New models of care for children are currently being adopted around the UK. Whilst these services need to be different from those for adults, key learnings from successful adult care models could be easily implemented to improve outcomes for CYP. Many of these models share a common focus on the movement to treat patients out of hospitals and bring more care into the community.
The workshop called key stakeholders together to design and share best practice models of care. The attendees of the meeting were all in agreement that a better understanding and evaluation of these approaches are needed in the future in order to understand their impact in improving quality care.
Working with clients across the country to transform children’s services, at PPL we have learned that to design successful new models of care, we must:
- Understand the needs of children and young people and their families/ carers
- Allow easy access to care – and move away from a hospital based model
- Ensure that services are preventative, not reactive
- Increase communication between care providers
- Join up health records to allow a seamless patient experience
Children have the right to the best care possible. To a far greater extent than adults, due to their daily interaction with the education and healthcare system during their early formative years, they provide us with the opportunity to shape the care service experience. This enables us to give them a healthy start in life, helping to prevent physical and mental ill health in adulthood.
 UNICEF Report (2012) Measuring Child Poverty. Accessed from http://www.unicef-irc.org/publications/pdf/rc10_eng.pdf on 10.03.2016