Audit Commission: 'Health of under-fives has not significantly improved'

The health of under-fives has not significantly improved despite more than £10 billion of investment, a report said today.

Government policies and programmes over the last decade have failed to bridge the gap between the poor and well off, according to the Audit Commission study.

While some aspects have got better, including a fall in the number of babies dying, other results are "disappointing".

The report - Giving Children a Healthy Start - says an estimated £10.9 billion has been spent, directly or indirectly, on improving the health of under-fives in England since 1998.

Of this, £7.2 billion has been spent on Sure Start, a programme to improve services for young children.

It includes children's centres, maternity grants to cover essentials and family lessons on areas such as health and nutrition.

Today's report said such investments have "not produced widespread improvements in health outcomes".

It goes on: "Some health indicators have indeed worsened - for example, obesity and dental health - and the health inequalities gap between rich and poor has barely changed.

"Children under five years living in deprived areas are 8% more likely to be obese; 9% more likely to be of a low birth weight; and 12% more likely to have an accident than those living in the rest of England."

Childhood obesity rose from 10.1% to 13.9% between 1995 and 2008, although the rate of growth may now be slowing, the report goes on.

Infant death rates have fallen from 5.6 to 4.8 deaths per 1,000 live births but the figure is "still relatively high" compared with other European countries.

Following the MMR scare on a possible link with autism, immunisation rates for mumps, measles and rubella among five-year-olds have decreased from 93% to 89% between 1999 and 2009, the report went on.

Meanwhile, the average five-year-old in 2005/06 had 1.47 decayed, missing and filled teeth, compared with 1.43 in 1999/00.

A youngster in a deprived area is 19% more likely to have bad teeth than the average child.

Summing up, the study said that between 1999 and 2008 "health outcomes for the under-fives, on the whole, have only marginally changed".

Steve Bundred, chief executive of the Audit Commission, added: "It's encouraging to see some improvement in the health of babies and young children, but the under-fives rarely seem a priority locally.

"Overall, the findings are disappointing. Children need a healthier start in life and policies are not delivering commensurate improvement and value for money."

He said that, despite progress, the infant mortality rate remains higher than countries such as the Netherlands, France, the Republic of Ireland and Spain.

"Even before they are born, for many, place and parents' income determine their quality of life and their lifespan."

While it is obvious something needs to be done to tackle falling immunisation rates, the number of health visitors in England has dropped by 10%, the report said.

Some parents from vulnerable groups are not using Sure Start children's centres because they are unaware of the service, or they say they dislike the "judgmental nature of health professionals".

The Audit Commission calls for councils and the NHS to be clear about how much they are spending on the under-fives.

The cash should be targeted at improving the lives of the most vulnerable and progress must be monitored.

Health Minister Gillian Merron said: "This Government is committed to giving children and young people an equal chance of good health and there is much to celebrate already, such as the success of our Sure Start centres which provide health and advice services to millions of families in the most deprived areas.

"We have also seen increases in breast-feeding rates, a recent decrease in child obesity after a long upward trend and the new immunisation schedules which ensured that in 2008 no child died of meningitis C.

"We know there is still more to do and we're determined to keep up the momentum, which is why we introduced the Healthy Child Programme, the first universal, evidence-based programme to ensure that all children get the best possible start in life."

Rosie Dodds, public policy officer at the National Childbirth Trust, said: "The NCT welcomes the report Giving Children a Healthy Start as it provides a much needed impetus to make children's services more effective in reducing health inequalities.

"NCT workers are involved in providing services through children's centres in some local areas. Our feeling is that much more could be done to reach out and include vulnerable and marginalised families who are not keen to 'attend' and access these services for themselves.

"We support the Audit Commission's recommendation that local bodies should co-ordinate policies and targets so that there is a more coherent approach to funding and improving health for young children."

Liberal Democrat health spokesman Norman Lamb said: "This report paints a picture of patchy improvements and missed opportunities despite significant investment.

"Effective action now will not only save the NHS money in the future, it will change people's lives.

"Efforts to build a fairer society are doomed if health inequalities continue to grow."