1. Allocate a greater and more equitable share of health service funding to children in the multi-year Comprehensive Spending Review, ensuring that ICSs increase their spending on specific children’s services by a greater proportion than their overall spending. 

2. Work with NHS Online and Healthier Together to improve the quality and accessibility of online health and nutrition information available to families, parents and carers. Launch a national campaign aimed at parents, caregivers and children about the importance of nutrition, how to make healthier choices, and the dangers of excess sugar, salt and ultra-processed foods. This should focus on improving children’s nutrition through clear national dietary guidelines that include examples, recipes and tips, and be relevant to all families regardless of budget, time constraints, dietary and cultural requirements. 

3. Place a stronger focus on addressing the shortages in the child health workforce (including in school nurses, health visitors, midwives and consultant paediatricians), and improve staff retention across the medical, nursing and allied health professional specialist children’s workforce when reviewing the NHS Long Term Workforce Plan.

4. Set clear expectations that providers improve performance for children’s community and mental health services to ensure that no child has to wait longer than the 18-week target to receive care and treatment. 

5. Implement a strategy to drive progress in reaching World Health Organization targets for childhood vaccination uptake rates, reversing the decision to remove this as a key target for 2025/26. 

6. Set an expectation that every ICS strategy includes specific focus on children and young people’s health, wellbeing, and health and care services, including clear pathways to ensure that local systems are sufficiently prioritising children. 

The Department for Education should: 

7. Accept the recommendation of the Education Committee to use the Children’s Health and Wellbeing Bill to auto-enrol all eligible children for free school meals.  

8. Improve monitoring of compliance to the School Food Standards, ensuring that all school breakfast clubs and school lunches meet the standards.

Cross-government departments should:  

9. Develop a whole-government approach across all departments to involve and listen to children and young people in policy-making to support national prioritisation and focus on prevention. 

10. Place explicit metrics for improving child health into the health mission, including improvements to health outcomes such as obesity, vaccination rates and breastfeeding rates, with explicit and adequate representation for children and a focus on listening to their voices on the Health Mission Delivery Board. 

A questionnaire was developed to assess patients’ views on the leaflet. The questionnaire used an emoji scale to determine what emotions the leaflet elicited, open-ended questions to gain more detailed responses, and a section for parents or carers to provide comments.

There were 3,000 copies of the leaflet printed and distributed, and 72 children were involved in the evaluation.

Parents and carers were positive about the leaflet, and particularly about the writing, illustrations and explanations. Many said they wished they had seen it before they attended hospital.

Overall, the leaflet was positively received by children and parents, and was not reported to provoke anxiety or significant numbers of new questions. In response to suggestions, the word ‘patient’ was changed to personal pronouns throughout the leaflet and other helpful sections on subjects such as visiting times and parking were added.

Wider availability of the leaflet to paediatric inpatient populations could make children feel calmer on admission to hospital. Further research on the effects of this leaflet in more diverse populations would be welcome, along with whether disease-specific leaflets would be beneficial.

Download the leaflet

1. Raise awareness of juvenile idiopathic arthritis and its symptoms with the healthcare professionals who will see this group of patients.
2. Streamline and publicise local referral pathways with clear measurable timelines for patients with suspected juvenile idiopathic arthritis.
3. Provide timely access to appropriately trained physiotherapy, occupational therapy, pain and psychology services at the diagnosis of juvenile idiopathic arthritis, and then as needed through adolescence and adulthood.
4. Offer age-appropriate information about juvenile idiopathic arthritis and medication risks and benefits to patients and their parents/carers at diagnosis and on an ongoing basis.
5. Provide training to the patient, if age-appropriate, and/or their parents/carers on how to administer subcutaneous injections for juvenile idiopathic arthritis at the point treatment is initiated.
6. Ensure timely access to intra-articular steroid injections by staff who have been trained to deliver age-appropriate care in units where local or general anaesthesia can be delivered.
7. Provide a holistic, developmentally appropriate rheumatology service for patients with juvenile idiopathic arthritis.
8. Develop NICE guidance for the management of juvenile idiopathic arthritis.

Four national foundations to recover children’s health services and improve child health outcomes:

• Ensure fair funding for children.
• Prioritise children in Integrated Care Systems.
• Support a sustainable child health workforce.
• Improve data and digital innovation.

Three targeted areas of focus address parts of the health system under exceptional pressure:

• Reduce pressure on urgent and emergency care.
• Reinvest in community health services.
• Improve the interface between primary and secondary care.

• Nearly all (97%) trusts responding said demand for CYP services has increased since the Covid-19 pandemic. 
• 86% said waiting times for initial assessments had increased compared to pre-pandemic.
• 90% said that the health and wellbeing of children is not considered enough in national policy.
• 82% said they cannot meet current demand and 75% would be unable to meet anticipated demand in next 12-18 months.
• 86% were concerned about the impact on staff morale of challenges providing care.

The recommendations set out a different approach to healthcare, more closely aligned with usual NHS clinical practice that considers the young person holistically and not solely in terms of their gender-related distress. The central aim of assessment should be to help young people to thrive and achieve their life goals.

• Services must operate to the same standards as other services seeing children and young people with complex presentations and/or additional risk factors.
• Expand capacity through a distributed service model, based in paediatric services and with stronger links between secondary and specialist services.
• Children/ young people referred to NHS gender services must receive a holistic assessment of their needs to inform an individualised care plan. This should include screening for neurodevelopmental conditions, including autism spectrum disorder, and a mental health assessment.
• Standard evidence based psychological and psychopharmacological treatment approaches should be used to support the management of the associated distress from gender incongruence and cooccurring conditions, including support for parents/carers and siblings as appropriate.
• Services should establish a separate pathway for pre-pubertal children and their families. ensuring that they are prioritised for early discussion about how parents can best support their child in a balanced and non-judgemental way. When families/carers are making decisions about social transition of pre-pubertal children, services should ensure that they can be seen as early as possible by a clinical professional with relevant experience.
• NHS England should ensure that each Regional Centre has a follow-through service for 17–25-year-olds; either by extending the range of the regional children and young people’s service or through linked services, to ensure continuity of care and support at a potentially vulnerable stage in their journey. This will also allow clinical, and research follow up data to be collected. 
• There needs to be provision for people considering detransition, recognising that they may not wish to re-engage with the services whose care they were previously under.
• A full programme of research should be established to look at the characteristics, interventions and outcomes of every young person presenting to the NHS gender services.
• The puberty blocker trial previously announced by NHS England should be part of a programme of research which also evaluates outcomes of psychosocial interventions and masculinising/ feminising hormones.
• The option to provide masculinising/feminising hormones from age 16 is available, but the Review recommends extreme caution. There should be a clear clinical rationale for providing hormones at this stage rather than waiting until an individual reaches 18. Every case considered for medical treatment should be discussed at a national Multi- Disciplinary Team (MDT).
• Implications of private healthcare on any future requests to the NHS for treatment, monitoring and/or involvement in research, and the dispensing responsibilities of pharmacists of private prescriptions needs to be clearly communicated.

• NHS boards
• local authorities
• Health and Social Care Partnerships (HSCPs)  
•  The report concludes with a summary of key learning points and five recommendations. 

Child health experts from across the UK produced the report, which includes perspectives from parents and carers with lived experience. Chaired by Professor Helen Minnis FMedSci and Professor Sir Andrew Pollard FMedSci, the group examined the positive impact of intervening in the early years on the health and future of the nation. 

Drawing on an extensive body of evidence, the authors make five recommendations for governments and policymakers to urgently start addressing the issues raised. These include:  

• Implementing effective early years interventions to improve child health and wellbeing and promote research to identify further approaches. 
• Establishing a unifying vision across Government for the early years to coordinate policies and resources. 
• Addressing the decline in child and family health workforce and fragmentation across sectors to deliver effective services.  
• Improving collection and access to data on the wider determinants of child health to enable research and policy implementation.  
• Ensuring diverse voices of children, parents and carers are represented in developing early years policies and interventions. 

While stressing that no single age period determines health outcomes, the report presents robust data showing that frontloading investment in the earliest years, including preconception and during pregnancy, delivers lifelong benefits by establishing healthy foundations to reduce the risk of complex health issues. Early childhood is a cost-effective time to intervene compared to opportunities later in life.