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Forgotten children: child trafficking in the UK

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By Hollie Wilson

One of the biggest stories earlier this summer was the revelation by long-distance runner Sir Mo Farah that he was trafficked from his home in East Africa at the age of nine. In a BBC documentary, he revealed that he was taken from his family by an unknown woman and brought over to the UK.

Sir Mo’s story is sadly not a rare one. Every year, thousands of children and young people are trafficked to the UK, for a variety of reasons, including exploitation, forced marriage, domestic slavery, forced labour or crime. Earlier this year, a report from Every Child Protected Against Trafficking (ECPAT) noted that local authorities in England have a legal duty to safeguard and promote the welfare of children in their area, according to Section 17 and Section 22 of the Children Act 1989. Section 20 also imposes a duty on local authorities to provide accommodation for children in their area if the child is abandoned, lost or has no parental guardian.

Use of hotels by Home Office

A major issue facing children’s services with regard to child trafficking is finding adequate homes or places of care, particularly for the most vulnerable children. One of the main issues highlighted by the ECPAT report was the use of hotels by the Home Office to house unaccompanied children arriving to the UK. These hotels are outside of the English care system, and therefore increase the risk of these children suffering harm.

Immigration Minister Kevin Foster estimated that around 1606 children were being accommodated in hotels by the Home Office from July 2021 to June 2022. A response to the report found that 45 of those 1606 children went missing. This equals roughly four or five a month, and around one child going missing per week. Some of the children reported were as young as 11 years old.

The ECPAT report identified some of the main safeguarding details that have not been implemented by the Home Office. These include: getting details about the child’s background from before they came to the UK; information on why they have come to the UK; and evaluating the child’s vulnerability and risk of being trafficked. Addressing these could identify children in need, and prevent further exploitation or harm towards those at risk.

Support for survivors

For those who have survived child trafficking, the road to receiving sufficient and appropriate support is not easy. Some of the experiences reported include a young woman who was sexually exploited around the country as a child, yet was fined for being a “prostitute”. Even when she approached the police as an adult, the woman was not identified as a victim of trafficking. Another survivor was trafficked from the ages of 11 to 20, and despite being found by her youth worker numerous times in dangerous situations, was never identified as a victim of child trafficking and exploitation.

Even first responders have been found, in the instance of rescuing a child, to expect the child to declare themselves exploited, rather than using indicators and context clues to declare them so. A child will rarely have the understanding of what has happened to them at that moment, as many are groomed by their traffickers and don’t realise they were abused. This lack of understanding only increases when the child doesn’t understand English.

What has been done and what can be done?

Recommendations have been made for better collaboration and co-ordination between areas of Government. In addition, the NSPCC have argued for better support for children identified as trafficking victims, in order to tackle physical injuries (ill health, STIs or pregnancy from sexual violence), emotional issues (distress, feelings of shame and guilt) and potential lack of access to education or social and emotional development.

On 24 August 2022, the Home Office published news regarding the New Plan for Immigration. One of the changes highlighted is that “the transfer of unaccompanied asylum-seeking children (UASC) from temporary hotels to long-term care will be sped up.” Minister Kevin Foster stated that councils will have five working days – rather than ten – to transfer UASC from hotel accommodation to care once a referral is made under the National Transfer Scheme. Councils will also receive an additional £2,000 per child per month for the first three months if they make the transfer within five working days.

Cases such as Sir Mo Farah shedding light on their own experiences can also have a significant impact on raising awareness. Anti-trafficking charity Unseen UK has reported a 20% increase in calls to their helpline following his documentary.

With its recent push into the spotlight, it is crucial that this issue not be left to fade into the background before real progress is made and all vulnerable children are cared for.

Photo by Japheth Mast on Unsplash.

Further reading: more from The Knowledge Exchange Blog on children and young people

“I’m treated as an individual, not a problem:” The “No Wrong Door” policy

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The “No Wrong Door” (NWD) programme means exactly that – there is no wrong door to turn to for young people seeking support.

NWD works on several core principles, which include working with young people’s birth family or guardians, allowing care leavers to “stay close” to continue accessing support, and working closely with young people to identify ways to help their self-esteem and give them opportunities. NWD has been introduced in several areas of the UK.

England

The term “No Wrong Door” was coined in North Yorkshire, where two hubs were created in Scarborough and Harrogate. The North Yorkshire County Council website provides details on the work their teams do.  

Each hub has a dedicated team which includes a life coach, a speech therapist, two community foster families and community supported lodging places for 16- and 17-year-olds with trained staff. On top of this, every young person in the NWD programme has their own key worker who is supported by another team. Many young people struggle when they are moved around as they grow up; new teams or workers don’t know their history or personality well. Having one consistent key worker for each young person makes it easier to build trust and create a more positive relationship.

Wales

A report from the Children’s Commissioner for Wales has described the steps taken by the Welsh Government to implement a ‘no wrong door’ approach to supporting children and young people. Funding has been earmarked specifically for children with complex needs, and all regions of Wales now have specific multi-agency groups for young people.

Regions like Cardiff and Vale have been implementing some of the common core principles of NWD, such as continuity of staff, key workers and streamlined appointments, in addition to a “proactive not reactive early intervention response.”

Scotland and Northern Ireland

NWD was introduced in Scotland by the Children and Young People’s Mental Health and Wellbeing Board (CYPMHW). In addition to building the original programme, it gave young people the opportunity to identify wellbeing priorities. These included having a job, a safe and warm place to live, food and clothes, good relationships, safety, feeling happy and confident, good health and opportunities to learn.  

There seems to be less evidence of NWD being implemented in Northern Ireland, although it has been proposed as a way to support children of parents with mental illness.

Impact

There has been a great amount of evidence that NWD is effective in helping young people. The Department for Education (DfE) published a report in 2017 which looked at the initial success of the “No Wrong Door Innovation Programme.” They found that for young people who were supported under NWD, there had been a decrease in arrests and incidents of them going missing, which indicates that giving young people more stable support systems leads to an overall higher level of happiness.

The report also found that under NWD, 25% of those who were not previously in education, employment or training went on to become engaged in education, training or work. 87% of young people who were using substances when they entered the NWD programme had also stopped when they were interviewed as a follow-up.

What can be improved?

There are a number of aspects under NWD that can be improved. A lack of long-term funding has meant that staff were not given the security of knowing if their contract was being extended. This meant many workers found permanent jobs elsewhere to ensure their own job security, and those who stayed were anxious about their future which impacted them negatively. It also had a negative effect on the young people under NWD if staff leaving was not handled appropriately.

On top of this, some young people had mixed feelings around their transition out of the support network. While many felt they were being supported efficiently, others described the transition as “abrupt” and “too fast.” This is definitely something that can be improved on with more training for staff and more structure in place for those who need more time when moving forward into the next stage of life.

Final thoughts

While NWD is by no means perfect, it has significantly given young people support during the most transitional period of their life, from adolescence to adulthood. Having key workers develop consistent relationships has allowed them to more strongly advocate for young people as they see them as more than just a case number. As stated by one young person in one of the studies, with NWD, “I’m treated as an individual, not a problem.”

As the programme evolves and more structure is put into place, there is hope that many more young people can be encouraged and given the platform to achieve their full potential.

Photo by Priscilla Du Preez on Unsplash.

Further reading: more from The Knowledge Exchange Blog on children and young people

Reaching out: tackling loneliness in older people

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As we’ve previously reported, loneliness is a growing epidemic with significant consequences for many groups in society. One of these groups is the elderly – loneliness has been seen to affect around 10-13% of older people, and has been found to increase the risk of premature death by 30%.

Making connections

Creating relationships and connections is an important way of tackling loneliness, and the Rural Services Network has highlighted some good examples of bringing people together

These include “Village Agent” schemes, which link people in rural areas with advice and support services for independent living. Another initiative –  the “Rural Coffee Caravan Information Project” – specifically targets rural areas of the country, where there may be fewer opportunities to meet through shopping, meeting for food or simply seeing other people. This project allows older people to meet at a caravan where they are given coffee, tea and homemade cakes, as well as providing information on helpful services.

Along these lines is also the “Talk Eat and Drink” (TED) project launched in 2015, which was initially funded by the Big Lottery’s “Fulfilling lives: ageing better” programme. This allowed older people to become involved in activities such as ‘Sing For Your Supper’, ‘Fish and Chips Friday’ and a Sunday pub lunch, which not only enabled people to bond with others, but also ensured that they were being fed properly, especially if they were struggling with cooking at home or getting food for themselves.

Artistic endeavours

Another way to tackle loneliness in older people is through the arts. A report from the Baring Foundation has found that it is important for older people to have a range of activities and opportunities to connect them to others; the arts can be effective not only in keeping people in touch with others, but also in helping with health-related issues like dementia.

The arts exemplifies the principles behind ‘five ways to wellbeing’: connecting, being active, learning, taking notice and giving. Being able to create things allows older people to use their minds and skills to express themselves. They can also have enhanced self-confidence from the feeling of doing something for themselves.

Organisations such as Arts4Dementia and Artz (Artists for Alzheimer’s) have been able to help people living with dementia, including help with their co-ordination and wellbeing. Other companies like Spare Tyre use theatre to create multi-sensory productions, while the Library Theatre Company in Manchester delivers sensory workshops for people living with dementia which provide fun with props and music.

One of the biggest issues with this form of help is that the arts tend to be overlooked by local authorities and therefore don’t have enough funding. However, Manchester City Council, has been working to make their city more ‘age friendly’ and in particular to provide cultural activities for older people.

There have also been examples of “arts by prescription” where GPs have referred patients to arts projects to improve their mental health. This is part of the wider ‘social prescribing’ approach which our blog has previously covered.

Everyday skills

Other forms of tackling loneliness in older people include helping them develop skills through, for example, volunteering. Projects such as Touchstone in Yorkshire allowed people to self-refer themselves, or be referred through GPs and Age UK, where they could learn practical skills with other older people. 91% of those taking part felt they were more involved or connected with their community, and 86% felt they had more confidence to meet people.

Another programme by the charity Open Age, in London, created opportunities for older people to keep up with the performing arts, physical activity, digital skills, lunch groups, and trips. While these did cost money, they were only £1 an hour and were pay-by-session and drop in, which made it slightly more accessible. However, even these small amounts may be out of reach for those already struggling to make ends meet.

Final thoughts

Overall, there seems to be a range of activities and opportunities for older people to not only meet others and form connections, but learn new skills they can utilise for themselves.

However, it’s important to remember that older people are not a homogenous group, and no single approach will work for everyone. But as long as careful thought goes into ensuring that the needs of older people are at the heart of initiatives to tackle loneliness, the chances of success will be all the greater.

Photo by leah hetteberg on Unsplash 

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Digesting diet and health: the challenges of eating well

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Diet-related health problems are rarely out of the news. That’s because so many illnesses and diseases are the result of poor diet. There’s no shortage of suggestions for improving our diet, and for educating all of us on the benefits of eating well.

Policymakers are also concerned about this issue. Since the start of the COVID-19 pandemic, the NHS has been under greater pressure than ever, and government has been keen to address diet-related health problems.  

Examples of this include the most recent legislation to add calorie labelling to  restaurants and takeaways, which has been controversial. The new rules for England make it a legal requirement for large businesses with more than 250 employees, including cafes, restaurants and takeaways, to display calorie information of non-prepacked food and soft drinks.  The Scottish Government is consulting on similar proposals.

Sugar and salt taxes

Another example of regulations directed towards diet-related health problems would be taxes on sugar and salt in foods. There have been suggestions to either tax all foods based on their salt content, or specific foods which are classed as “high” in salt.

A sugar tax – the Soft Drinks Industry Levy – was introduced in April 2018 by the UK Government. It was later reported that consumers had bought 10% less sugar through soft drinks, which will also have lowered risks of obesity, type 2 diabetes and high blood pressure.

A report from the Institute of Fiscal Studies in 2021, looked at the impacts a tax on added sugar and salt could have on purchases of food both at home and out of the home in the UK. The report found that a salt tax could potentially see a decrease in risks of coronary heart disease and strokes.

In addition, the study suggested a salt tax could reduce the number of NHS treatments for obesity-related conditions, resulting in  lower NHS costs. The report also indicated an increase in overall economic output due to a healthier workforce.

However, there may also be less welcome consequences. A ‘snack tax’ has been estimated to potentially add as much as £3.4billion a year to families’ shopping bills. Introducing such a tax during the current cost of living crisis would add greatly to the financial stresses being experienced by households across the country.

Counting the calories

Displaying the number of calories in meals on menus has long been proposed as a way to tackle obesity and health issues, as so many people are unaware of just what is in the food they order. Public opinion is extremely divided on this subject, with some being in favour of this extra measure to help them when eating out if they wish to make healthier choices.

However, adding calorie information to menus may have undesirable effects. 1.25 million people in the United Kingdom have an eating disorder, and the COVID-19 pandemic is likely to have increased this number as more people struggle with mental illness and increased stress.

Beat, a UK-based eating disorder charity, has highlighted  that calorie labelling exacerbates eating disorders of all kinds. In addition, pushing a “diet culture” could send the wrong messages about eating rather than embracing a more positive approach towards food.

A further  study by the British Medical Journal reported only a small decrease in calories purchased when trialling calorie labelling in three chain restaurants in the United States. The researchers also found that after one year, that reduction diminished.

Meeting in the middle?

Another suggestion that has been discussed is tackling health-related inequalities, and understanding why certain groups are more vulnerable to these issues than others. For example, the House of Commons library has reported that in England people living in the most deprived areas were 9% more likely to be overweight or obese than those in the least deprived areas. The briefing also reported that  children in the most deprived areas of England were twice as likely to be obese.. More education focusing on not only what is healthy food, but how to be healthy with fewer resources could help reduce such inequalities.

Final thoughts

From tooth decay and high blood pressure to cancer, eating disorders and mental ill health, there are significant health and wellbeing impacts resulting from unhealthy eating habits. These issues also have serious consequences for healthcare services.

As we’ve seen, legislation has already been introduced to tackle diet-related health problems. But it’s likely that government will have to consider further measures to ensure that the food that we eat is both good for individuals and for wider society.

Further reading: more on food and nutrition from The Knowledge Exchange blog

Young carers: sacrifice and support

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While there has been a lot of conversation about the vulnerable over the last two years of the COVID-19 pandemic, and rightly so, there has not much attention given to the people who care for them, particularly the young people who do so. Young carers carry a lot on their shoulders, and this has only been increased with the impact of the pandemic affecting those they love. However, we also need to look out for these young people and give them the support they deserve.

Issues faced by young carers

Young carers are faced with many challenges due to their position and this can depend on the carers, their age, the level of care they give and who they care for. A report on siblings of disabled children from the UK charity Sibs found that the particular young carers they engaged with tended to not get as much attention and support from their parents because of their sibling needing more urgent care. Even something as simple as going out to play centres or restaurants must be adapted to fit the disabled sibling, with the carer sibling rarely getting their own choice.

Young carers have also been found to be at more risk of mental health problems than others, particularly if the person they are caring for is a parent with a mental illness or a history of substance misuse.  A study from Scotland found that young carers, much like adult unpaid carers, were more likely to have physical health issues such as tiredness, backache and bad diets in addition to reporting worry, stress, anxiety, depression and resentment. They were also found to have significantly lower self-esteem and feelings of happiness than non-carers.

Impact of pandemic

The COVID-19 pandemic impacted young carers greatly. Sibs reported that a lot of parents felt their carer children were extremely worried about contracting the virus and giving it to their sibling, or bringing it into the household if their family were shielding or vulnerable. Others also reported their child withdrawing from friends, either because of shielding or simply because they were uncomfortable socialising outside of their household. Sibs also noted cases where siblings would become the object of their disabled sibling’s anger or frustration.

In addition, a lot of activities and support groups normally put into place for these specific carers, in order to give them attention and opportunities to enjoy life outside of their role as a young carer, were cancelled due to COVID-19, and left many young carers at home, where they were often ignored if their sibling or parent needed additional support.

Other young carers have had to take on a range of duties, including shopping for their families or taking care of their home or other siblings. A lot of these young people have had to balance this with continuing their education from home and dealing with having their lives outside of the home cut off due to social distancing and isolation. This is on top of the general struggles of growing up as a child and adolescent. Izzy, a 12-year-old interviewed by a study from the Centre for Research on Children and Families, said she felt her entire life was “being a mini adult, but it’s not a pick and choose the time sort of thing.” 

Support

There have been a range of support services for young carers across the United Kingdom. Young carers groups have been found to be a great resource to help find other young carers and share some of the issues that affect them with people who understand. These groups  are also important as an outlet outside of their role in the family home, providing support  solely for  young carers. Even during the pandemic, some groups were able to schedule calls for young carers which provided them with interaction just for them, and something to look forward to each week at home.

However, many young carers remain “hidden” from services, either out of choice or because they have been ignored. Some simply don’t know about support groups or services, or have been found to not consider themselves ‘carers’. Instead, they  view their lives as “normal” or doing something that’s “expected” of them. Others may be afraid of the stigma their particular situation may bring them, and therefore want to be perceived as the same as their fellow students.

Final thoughts

The pandemic has pushed conversation and debate towards how we care for the most vulnerable in our society, and hopefully will lead to improvements in our attitudes towards care. However, this also has to extend towards unpaid carers, and particularly the young people who often shoulder invisible labour at the expense of their childhood.

Further reading: more from The Knowledge Exchange blog on carers

Health inequalities and ethnic minority communities: breaking down the barriers

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Almost from the start of the coronavirus (COVID-19) pandemic, its unequal impact on ethnic minorities has been clear. But the health inequalities experienced by Black, Asian and Minority Ethnic (BAME) communities predate the pandemic. As the Local Government Association has observed:

“…the truth is these inequalities were already having an impact on the health and wellbeing of ethnic minority communities before COVID-19 hit – it is just that the pandemic has shone a light on them like nothing before.”

Recently, the Centre for Ageing Better hosted a webinar titled “Ethnic health inequalities in later life,” based on the report of the same name, published in November 2021.

The report mainly looked at the period from 1993 to 2017, although the webinar was able to offer more recent information regarding the COVID-19 pandemic, which of course greatly affected health inequalities.

Widening inequalities

Dr. Sarah Stopforth, one of the researchers for this study, explained that  ethnic inequalities have been found to widen more after the age of 30, and by the age of 40 have established themselves. One of the study’s main findings was that poor health for White British women in their 80s was the equivalent to the poor health of African and Caribbean women in their 70s, and the equivalent to Pakistani and Bangladeshi women in their 50s.

While there were similar results for men from these same ethnic groups, it is clear that women across all ethnicities have poorer health than their male counterparts. Why is this happening?

The reasons are complex, but Sara suggested that  health inequalities are usually tied to the socio-economic inequalities present in our society. However, she also said that this tends to ignore the underlying causes of these health outcomes.

The role of the NHS

Dr. Habib Naqvi from NHS England talked about the role of the NHS in tackling health inequalities. He asserted that our healthcare system should be well equipped to respond to these inequalities, given the UK’s long history of migration by people from Afro-Caribbean communities. So why has it not been able to?

A lot of this, he explained, was due to the fragmentation of the NHS. The many areas of the sector are not working co-operatively to reach a collective and consistent goal, which then affects the ability to tackle issues such as inequalities in the sector.

In addition, Dr Naqvi pointed to mortality rates for ethnic minority groups – living longer does not always mean living in a healthy way. One of the features of “long Covid,” is its tendency to exacerbate long-standing health complications or to weaken COVID-19 patients’ health even after the illness. Again, ethnic minority communities have been disproportionately affected by this condition.

Another impact of  the COVID-19 pandemic has been a heightened feeling of isolation and fear for many ethnic minority groups, something highlighted in a report from the University of Manchester. Many were unable to communicate with healthcare staff due to language barriers or health conditions affecting their communication skills, and were often having to be admitted alone due to Covid restrictions. The inability of patients from ethnic minority backgrounds  speak for themselves raises concerns about their healthcare. Research has found evidence that ethnic minority patients – especially women – are not having their illnesses taken seriously.  

Vaccine hesitancy

Linked to this is the controversial issue of vaccine hesitancy, which has become a particular concern among ethnic minority groups. One of the reasons that many members of ethnic minorities may feel hesitant or scared to take the vaccination is because of the lack of communication and information, linked with their previous healthcare experiences.

It was suggested during the webinar that even throughout the pandemic, the healthcare sector has not effectively protected ethnic minorities, despite these health inequalities long being known.  Health professionals have attempted to reach out to communities and help them with any fears regarding COVID-19 or the vaccination process, but this can be difficult with social distancing restrictions. As a result, people within BAME communities may have to rely on family and friends to get information regarding vaccination, which may not calm their fears.

Data, care and trust

One of the key points driven home by Dr. Naqvi was the need for better data in order to better understand health inequalities among ethnic minority communities. Birth to end-of-life care was also mentioned, including tackling racial bias that can be found even in antenatal care. Finally, the concept of earning trust was highlighted. Dr. Naqvi said that the NHS must work to earn trust from BAME communities, particularly among the elderly, given the long-standing disparities in treatment and discrimination many have faced over the years.

Final thoughts

The webinar offered useful insights into how deeply healthcare inequalities lie. Our previous blog post on the future of public health offered a reminder that access to efficient, well-supported and high quality healthcare is vital for everyone. This webinar underlined that message, but highlighted its special significance for those experiencing longstanding health inequalities.

Photo by Hush Naidoo Jade Photography on Unsplash

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More than growing pains: young people and mental health

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The last few decades have seen increasing rates of mental health disorders among children and young people. But while children and young people’s mental health is currently high on the public agenda, many of these mental health conditions remain unrecognised and untreated.

The NHS conducted a Mental Health Survey for Children and Young People in 2017, interviewing 3,667 children and young people, which was followed up in 2021. The follow-up survey found that 39.2% of 6 to 16 year olds had experienced a decrease in their mental health since 2017, while approximately 52% of 17 to 23 year olds also reported a decrease. Within these last four years, a number of factors appear to have impacted these figures, including the continued rise and prominence of social media platforms, family life, and, of course, the Coronavirus (COVID-19) pandemic.

Impact of the pandemic

The beginning of the pandemic marked the closure of all schools, colleges and universities. Not only were young people faced with the anxiety and stress associated with living through a global pandemic, particularly for those who are immunocompromised or have family members who are, but these closures also cut off access to resources for mental health problems. A survey by YoungMinds in January 2021 found that among over 2000 participants who were under the age of 25 in the UK with a history of mental illness, 75% agreed that they were finding the current lockdown harder to cope with than the previous ones, and 67% believed that the pandemic will have a long-term negative effect on their mental health.

Peer support groups and face to face services such as counselling that could be accessed through school were closed, or made accessible through the internet or over the phone. While this does offer some kind of continued support, it is not a form of support that works for everyone and many young people were left feeling unsupported. The YoungMinds report emphasised that any future provision must recognise the value of face to face interaction alongside virtual and digital forms of support.

Alongside issues with access to support, school closures  also disrupted routines, which for many people of all ages with mental health problems can be particularly important as a coping mechanism. It has been suggested that being unable to attend school or university in person, or part-time jobs, can lead to a relapse in symptoms where young people relied on these routines. Refusing to undertake typical daily activities such as showering, getting out of bed and eating sufficient meals are some of the effects seen amongst these young people – all which can exacerbate feelings of depression or loneliness.

Role of families

Families have been found to play a vital part in helping young people who are suffering from mental health issues. This has only become more apparent with the impact of COVID-19 lockdowns, where young people would most likely be living with their family – whether that be parents, siblings or other relatives or caregivers. Lockdown guidelines that mandated staying at home would leave these young people spending more time with their families, and the closure of other services outwith the home, meant these young people’s households often became their main support system. The NHS follow-up survey found that both family connectedness and family functioning were associated with mental disorder, highlighting the importance of supporting families to enable them to support young people’s mental health.

The Local Government Association has recently published a guide on a “whole household approach” to young people’s mental health, stressing the importance of educating families on how to support their young people. This is highlighted as particularly important when they transition from child services to adult services as many teenagers and young people struggle with the lack of support offered when they are legally considered adults.

Social media

Another big issue affecting young people’s mental health is the use of social media. While there are many reported benefits of social media, particularly in relation to connecting with others, there are also growing concerns about its effects on wellbeing and the pandemic has undoubtedly exacerbated this. The NHS survey found that, in 2021, half (50.7%) of 11-16 year olds agreed that they spent more time on social media than they meant to and 16.7% using social media agreed that the number of likes, comments and shares they received had an impact on their mood. Those with a probable mental disorder were particularly likely to spend more time on social media than they intended, and girls seem to be more affected that boys.

The survey found that 21.1% of girls reported that likes, comments and shares from social media affected their mood, compared to 12.1% of boys. It also found that double the number of girls than boys spent more time on social media than they meant to. Other research has also highlighted the disproportionate impact on young girls. One study found that constant social media use predicted lower wellbeing in girls only and that these mental health harms may be due to a combination of cyberbullying, and a lack of sleep or exercise. This was not found in the teenage boys interviewed.

Solutions

When addressing mental health problems, it is clear that a ‘one size fits all’ approach does not work. As highlighted in the research, mental health problems can present themselves in a range of ways, and depend on a number of variables.  People from different socio-economic and cultural backgrounds, or those with additional needs, often face more stigma and can find it more difficult to express their problems or access the correct support for their specific needs.

There have been suggestions for more targeted support for young people and the issues they may be facing, including more investment in schools and social services. Particularly for adolescents who are transitioning to adulthood, it is important to provide continuous support. As highlighted in the NHS Mental Health Survey, more adolescents and young adults (17 to 23 year olds) mentioned a decrease in their mental health than younger people (6 to 16 year olds). Children and Young People’s Mental Health Services (CYPMHS) notes that the transition from child to adult mental health services tends to begin around three to six months before the individual turns 18, although there can be flexibility.  Perhaps even greater flexibility is required, particularly as we assess the damage left by the pandemic. It is argued that engaging adolescents in the provision of mental health services and a shift towards early intervention and prevention will also be important as we look to build new solutions.

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The future of public health: lessons from the pandemic

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The Coronavirus pandemic (COVID-19) has impacted all sectors of our society, but none more-so than public health services.

Last month, The Health Foundation hosted a webinar discussing the lessons from the pandemic and the future role of public health. The webinar drew on the findings from The Kings Fund report “Directors of public health and the COVID-19 pandemic”.  It considered the issues facing public health as a result of COVID-19, and proposed steps to rebuild the healthcare sector and begin tackling the problems left as we slowly move out of the pandemic.

Lack of resources

One of the main themes of the webinar was raised by Shilpa Ross of The Kings Fund, who explained that a lack of resources and shortages in public health existed long before the COVID-19 pandemic. The impact of longer term reductions to the public health grant meant that health services were not ready for the pandemic, nor for how long it has lasted. This has had a knock-on effect elsewhere in the NHS. A Care Quality Commission report noted that in July 2021, almost 300,000 people were waiting more than 52 weeks to begin hospital treatment.

On top of this, public health has faced staff shortages. Because so many healthcare services are “fishing in the same pond for recruits,” Shilpa explained that it has been especially hard to fill vacancies. In addition, many healthcare workers have experienced short and long-term effects of the virus, and the additional workloads have left many stressed and burnt out. The disruption to education could further delay the training and employment of potential new healthcare workers.

While the NHS has in some cases set up drop-in sessions for support and made efforts to provide even basic support, such as bottled water to aid hydration, these cannot fill the hole created by healthcare staff shortages.

Widening inequalities

Professor Kevin Fenton of Public Health England argued that “inequalities have defined the pandemic,” and would be the legacy of the last year and a half. A 2020 report by the Institute of Health Equity, commissioned by The Health Foundation, found that in England members of Black, Asian and minority ethnic groups (BAME) were more likely to be affected by COVID-19. The report attributed this partly to people in these groups living in more deprived areas, working in occupations with a higher exposure risk to the virus (such as healthcare or customer service roles), and in some cases living with multiple generations in their home (complicating self-isolation). The authors contended that while inequalities in social and economic conditions were present before the pandemic, they contributed to the unequal death toll resulting from COVID-19.

These inequalities have widened, partly due to the shortage of resources and staff. It has only grown more difficult to address the ever increasing numbers of people needing treatment, both urgent and non-urgent. As a result, the most vulnerable in society have fallen by the wayside.

Changing how public health works

The webinar also discussed how public health can move forward as the country slowly returns to a new form of normal. In addition to the restructuring of Public Health England, a new tax – the Health and Social Care Levy – will put an additional £12 billion into health and social care over the next three years. However, money alone is not enough – the webinar participants agreed that the infrastructures and inner workings of public health must evolve as we move towards a more efficient system of working.

Professor Fenton stressed the importance of engaging with local communities, and that the response towards the pandemic going forward must be grounded in their experiences, and what they need from both the public health system and also local authorities. He noted that while there may be pressure to go back to the way things operated before the pandemic, we must move forward: by understanding what worked and what didn’t, progress and better services can be achieved. Shilpa Ross added that a more targeted and tailored approach to health inequalities has provided more significant results in terms of vaccination and testing rates. This has in turn raised levels of trust within communities that public health teams may not have engaged with before the pandemic. All of this, however, takes up precious time.

Professor Jim McManus, Director of Public Health for Hertfordshire County Council, highlighted the importance of prevention not only for COVID-19 moving forward but other health conditions.  He stated that they must be tackled at a place where they can stop others continuing to be affected, in addition to treating those who are currently being affected.  Robin Tuddenham, Accountable Officer for NHS Calderdale Clinical Commissioning Group, agreed, and stressed that problems like homelessness and poverty should not be seen as separate from health but rather as important factors in the prevention of ill health.

Concluding thoughts

Highlighting the underlying issues and difficulties affecting public health before the pandemic is one step towards addressing them.

The webinar demonstrated that the pandemic has shifted how public health is perceived and valued. It has reminded all of us how important access to efficient, well-supported and high quality healthcare really is. Those working in decision-making roles in the healthcare sector are clearly looking towards the next steps for public health and how to give people the highest quality and most efficient care possible. With this in mind, the pandemic may have created a stepping stone towards a better healthcare system.

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