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Place-based opportunities to reduce inequalities for children and young people

Pooven Maduramuthu

Yesterday I was delighted to participate in a panel discussion at The King’s Fund’s Integrated Care Systems and place-based partnerships conference. We discussed how Integrated Care Systems can enable local government, NHS and third sector organisations to work together to design solutions which reduce inequalities and improve outcomes for children and young people.

Being born into apartheid-era South Africa, this is a topic very close to my heart. As a child, I experienced segregation in the education system first-hand. Since moving to the UK about 20 years ago, most of my career has had a strong focus on public sector improvement and improving outcomes for people. Whilst I have worked across all public services, I have always gravitated towards people-centred services, including health and local government. And now more than ever in this country, the social justice agenda demands action.

With an impressive 300 delegates attending our session, it is clear that reducing inequalities for children and young people is high on the agenda. Of those who participated in the session polls, 95% believe that children and young people need to be given a greater emphasis – yet only 34% say their ICS has a dedicated workstream which focuses on this cohort. Only 36% agree that ICSs will fundamentally change the way we support the health and wellbeing needs of children and young people. The big question then is this – how can we get that percentage up and build confidence in this aspect of an ICS’s role?

The pandemic has only exacerbated underlying challenges, which means that it is critical that an integrated approach is taken to improve outcomes for our children and young people. The figures speak for themselves:

  • There has been an 11% increase in the number of children with Speech, Language and Communications as their primary need in 2018-2020
  • 93,000 children across the country turning five are not fully MMR vaccinated. There is a large disparity across the country – ranging from 93% vaccinated in Dorset to 73% in North London – with no STP/ICS reaching the WHO threshold for herd immunity
  • 35% of children aged 10-11 years are overweight or obese

Leaders in the system may not know the exact data, but they are aware of the challenges. The question is – if they choose to act, what can they do about it?

Without a doubt, the health and care systems are complex. There is no one size fits all approach –local solutions must be designed to deliver better outcomes that cost less. But ICSs do provide opportunities to co-ordinate and deliver place-based solutions to help address these inequalities and improve outcomes for children and young people:

  • System partners must work together to establish common goals and set an inclusive ambition – a quick and coordinated response now prevents escalation and costs for all partners later.
  • New structures offer real opportunities for prevention and early intervention cooperation – the behaviours we need to influence are those of the parents, not the child.
  • Targeted interventions will drive measurable impact on the ground, and build confidence amongst the workforce – we must utilise learnings from Covid to really innovate at scale.

There are already good organisations, individuals and partnerships supporting children and their families – ICSs must springboard from this foundation and take it to the next level. Some places are already doing this well, and we need to learn from them. ICSs provide a real opportunity to improve the lives of our children and young people, and we owe it to them to grasp this.

Written by

Pooven Maduramuthu



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