“Inspiring Services, Improving Futures”

www.chyps.org.uk

Thematic Discussion Paper

Young people and health

Introduction

The 1944 Education Act laid the basis for developing a broad range of educational

approaches including to meet the needs of children and young people. Since this time

there has been a range of legislative measures, Government documents as well as

academic research highlighting the need to ensure effective for young people’s health

and wellbeing through the often chaotic period of adolescence. Most recently the

Government has produced ‘Positive for Youth’: “the teenage years are a critical period of

growth and change. They are important for making significant life choices and decisions”.

Background

A new public health system is being established ‘Public Health England’. Each local

authority will employ a Director of Public Health to lead on the authority’s public health

responsibilities. Each authority will establish a Health and Wellbeing Board, a core aim of

which will be to join up commissioning across partnerships. Key to this will be the

development of the Joint Strategic Needs Assessment (JSNA) and the Joint Health and

Wellbeing Strategy. The strategy should provide the overarching framework within which

commissioning plans for the NHS, social care, public health and other services are

developed.

The Health and Wellbeing Board does not have any direct commissioning powers.

However GP Consortia will be required to have regard to both the JSNA and the strategy.

Local Authority funding for public health will be devolved through a non ring-fenced

grant. Commissioning will be expected to incentivise and reward the improvement in

health and wellbeing outcomes and tackling inequalities as well as to deliver best value.

The relationship between public health and children’s services will be critical. Local

authority arrangements will be expected to cover support for young people to prevent

unhealthy lifestyle choices such as risky sexual behaviour, smoking, drugs, alcohol and

lack of physical activity.

The Government is also proposing to develop a new Outcomes Framework for public

health alongside an NHS Outcomes Framework, this will cover a number of domains

including health protection and resilience, ill health, life expectancy and reducing

preventable mortality. Outcome indicators include: rate of hospital admissions for alcohol

related harm; under 18 conception rate; rate of hospital admissions as a result of self-

harm: and chlamydia diagnosis.

The Challenges

Meeting the needs of young people is a discrete area of work and must be seen in the

context of the physiological and emotional changes that young people experience during

puberty. Over the coming months the agenda of young people and health will become

incorporated into the new structures being set. Within new public sector arrangements it

is important to maintain the emphasis on the needs of adolescents and not allow this to

become subsumed into the aggregated needs of children and young people. Also,

following the principles of ‘Positive for Youth’ to confirm the need for young to have a

say in their health services and in health reforms.

The new public health system must encompass the need for services for young people

and the Children & Young People’s Health Outcomes Forum’s recommendation that

”all clinical commissioning groups and local authority commissioners of public health

services, commission services in a way that ensures that teenagers are managed in

age-appropriate services”.

“Inspiring Services, Improving Futures”

www.chyps.org.uk

Case for young people and health

The overwhelming evidence points to the importance of supporting young people’s needs

as a discrete group to best support young people and provide a safe and healthy

progression into adulthood. There are some counter arguments, where differentiation by

age seen as unhelpful. However, for young people there are associated issues of

physiological and emotional change during puberty; anytime when things go wrong

during adolescence for example, risky sexual behaviour, substance misuse and mental

health, outcomes can be devastating. The support must be to them as a ‘young person’

and their personal and social development not at a series of single issues. There are

three key points that support age differentiation of the needs of young people:

a) Firstly, the physiological and emotional changes that occur during adolescence

produce key health indicators that need to be carefully addressed by those skilled in

working with adolescents, particularly when relating to health needs. The Health

Outcomes Forum recommends “coherently addressing the different stages in life and

not tackling individual risk factors in isolation”. This means building personal

resilience to deal with these issues. It is crucial that informal learning needed during

adolescence is not replaced by crisis management.

b) Secondly, relationships with adults in positions of authority are not the most helpful

in steering a way through the ‘chaos’. In ‘Positive for Youth’ young people have

commented on the poor quality of PSHE at school, there is a weight of evidence

supporting the breakdown in relationships with parents/cares during adolescence and

many examples of young people wanting to exert their newfound status as an ‘adult’

through extreme political and social views, involvement in crime and behaviour

setting them ape art form their local community. It is important that young people

find supportive and appropriate adult role models outside the home, the school or

social care that demonstrate mutual respect.

c) Thirdly, issues for young people’s health have the potential to cause the most impact

in adult lives. If we ignore these issues for young people during adolescence or deal

with them in the wrong way we set up a generation of young people who are less

able or less resilient to cope with their adult lives. Issues such as sexual identity,

homophobic and sexual violence, mental health, self-harm, teenage conception and

substance misuse can also be linked to an inability to get and keep employment and

involvement in crime.

Conclusion

There is a large and growing body of evidence to support work with young people simply

because they are ‘young people’ and health is one of the key areas within the

curriculum. Within each local authority there should be clear links between public health

and young people’s health and wellbeing. Health and Wellbeing Boards should consider

soft outcomes for young people rather than concentrating solely on hard data. The Early

Intervention model is effective when local authorities clearly see the preventative and

developmental aspects for young people. Those working with young people should seek

to highlight the need for personal and social development that can have “longer- term

impact than those that focus on directly seeking to reduce the ‘symptoms’ of poor

outcomes for young people”. (A framework of outcomes for young people: Catalyst

Consortium/Young Foundation 2012)

Questions:

Do young people’s services engage with health reforms in your authority?

If yes, how can young people influence the commissioning of services?

If no, how can we best ensure that there is a specific focus on young people and

their personal and social development within the health service and its reforms?

Ruth Ashwell, CHYPS Executive; October 2012