How Barnardo’s is helping GPs to improve the health of children and young people

The British charity Barnardo’s was founded by Thomas John Barnardo in 1866 to care for vulnerable children. The charity runs nearly 200 physical and mental health services for children, young people and families throughout the UK.

This is across a wide range of areas including mental health, child and family health – including family hubs, the 0-19 Healthy Child Programme (which covers school nurses and health visitors), social prescribing, and therapeutic programmes.

In this interview, we speak to Rukshana Kapasi, Director of Health for Barnardo’s (who has over 30 years of experience as a healthcare professional), about how GPs and other healthcare professionals can utilise the services Barnardo’s has to offer.

What are Barnardo’s key aims and values?

Our aim is to ensure that the mental and physical health needs of children, young people and families are consistently met in a place, time and way which suits them.

Our work often complements existing services from local authorities or the NHS or helps to plug gaps in current provision. For example, we offer mental health support for those who are on waiting lists for the Children and Adolescent Mental Health Services (CAMHS).

Barnardo’s also provides specialist services including parenting programmes for children with specific needs, such as neurodivergence or developmental delays.

How does Barnardo’s work in partnership with the NHS and its primary care teams?

Barnardo’s works with the NHS in a range of innovative ways to ensure the right help and support is available at the most appropriate time and place. Many of our services run alongside NHS community teams.

Our family hubs (such as SOLAR, which provides mental health support) work closely with primary care services to ensure they are fully integrated into NHS pathways. So, GPs and other NHS staff will make referrals, signpost to us, or ask us to provide further assistance through our services, family hubs, helplines and website.

Sometimes, the families we help need further medical support for certain conditions, such as asthma, so we help them to arrange follow-up appointments with their GP.

We also work closely with the NHS on issues such as safeguarding, for example if we have a concern about a child or young person who has used one of our services and we need involvement from a safeguarding agency.

We are keen to build on our working relationships with the NHS, particularly to develop and expand the services we run to complement healthcare, as well as deliver services which extend the current remit, such as nurses and mental health support in schools.

What kind of social prescribing services does Barnardo’s have to offer?

At a time when NHS services are stretched to capacity, yet a huge number of children and young people are struggling with both their mental and physical health, social prescribing provides vital early intervention by referring people to community-based support, where appropriate.

LINK in Cumbria is Barnardo’s flagship social prescribing service. It provides one-to-one and group support for children and young people who are struggling with low mood, anxiety, social isolation and confidence issues.

Each child or young person is assigned a designated social prescribing LINK worker who helps them to develop a bespoke support plan. LINK run their own events including summer schools, craft days and cinema nights to bring children and young people together. The service also identifies local groups and activities which may be beneficial for them within their communities and then makes the necessary introductions or connections so they can use those services going forward.

Since its inception in March 2020, LINK has helped more than 500 children and young people aged 5-19 across four rural Primary Care Networks (PCNs), with more PCNs keen to get involved. The team is co-located in GP practices as well as running community and school drop-ins. Their aim is to provide non-clinical solutions to improving wellbeing, physical and mental health, particularly through connecting with friends, family and peers.

Data from LINK shows that, through the service, 88% of children and young people say it helps them feel less isolated, 78% have more self-awareness to deal with their emotions and challenges, and 66% have improved their relationships with family and friends.

Social prescribing is an excellent example of how organisations and charities, such as Barnardo’s, can work alongside primary care to better support children, young people and families. We have learnt and benefitted from strengthening relationships with GPs when setting up non-medical services.

We know that the key to this type of success is building a shared purpose, establishing a healthy appetite for risk to try new things, building trust, and delegation so everyone can play a key role in the partnership. These are universal principles which can be applied to partnerships across the NHS, which are designed to change how things are done and better support children, young people and families.

Can you tell us about the trial for family support workers in A&E? Do you have plans to roll it out further?

We ran a six-month pilot scheme last year where three Barnardo’s Family Support Workers spent time working at a paediatric A&E ward in Hertfordshire. They provided ‘in the moment’ care for families who could benefit from both immediate, as well as ongoing, support away from an acute healthcare setting. Many visits to this paediatric A&E were avoidable, yet the numbers were rising, with many families attending more than once.

This was – and still is – a reflection of what is happening on a national scale. A Red Cross report found that some people attend A&E up to 300 times a year.¹ This is largely due to a lack of awareness of other possible sources of support or a range of complex needs requiring help and support outside of the healthcare system, such as parental confidence or poor housing.

At a time when the needs of families are often multi-faceted, yet acute healthcare services are stretched, the service aimed to provide early help and support and signpost people to the most appropriate ways and places to receive care and advice.

The pilot was a great success and it helped nearly 200 families find a way forward for their health conditions as well as the situations which they were arising from, such as poor-quality housing. In total, 75% of those followed up on the recommendations which had been set out by the Family Support Workers. Many families also said that it boosted their confidence in their parenting abilities, supported wellbeing, reduced social isolation and improved quality of family life.

We’re keen to roll out the scheme further with a focus on specific conditions including asthma and oral health. This is to align with the NHS Core20Plus5 approach which identified these as key clinical areas which need addressing to reduce health inequalities.

Why is it so crucial that children and young people receive physical and mental health support?

Barnardo’s has recently been working with Sir Michael Marmot at the Institute of Health Equity and three Integrated Care Systems throughout the country to look at the health of children and young people. So much from the hugely influential Marmot Review in 2010 is still evidently accurate – it is crucial to give children the best start in life if healthy routines and principles are going to be embedded throughout their lifetimes.

All kinds of early experiences shape who we become, and health is no different. The experiences children have whilst they are young and developing have an impact. Alongside contributing factors such as housing, air pollution, poverty and access to services, adverse childhood experiences (including poor mental health), which all shape a person’s health throughout their lifetime. Addressing them requires the provision of community-based solutions, such as family hubs, which provide support without stigma for families in challenging circumstances. Family hubs also provide the space and time for children and parents or carers to bond through play and form strong connections and stable relationships.

Not only is good health from a young age beneficial for each individual but it is also better for the NHS and society overall as a healthier population will reduce the pressure on stretched health services.

How has the cost of living crisis impacted the children, young people and families you support? And what can GPs do at a time when many families are struggling financially?

Barnardo’s published a report, A Crisis On Our Doorstep, earlier this year which looked at how the cost of living crisis has impacted the mental and physical health of children, young people and families.

It was informed by a YouGov poll of over 1,000 British parents of children aged 18 or under. It found that one in three (30%) parents said their child’s mental health had worsened throughout winter 2022/23, up from one in four (26%) in October.

It also found that poor sleep, lack of access to fresh air and poor nutrition were impacting on physical health. The poll found that 23% have recently struggled to provide sufficient food for their children, 50% of parents have cut back on leisure or social activities to save money, and 49% of parents worry that their children are missing out on a ‘normal’ childhood due to cutbacks.

These findings touch on the Marmot Review’s social determinants of health and how the way people live, grow and develop can lead to health inequalities. It found that people who live in the poorest neighbourhoods will have worse health outcomes, including a reduced life expectancy, and that they are also more at risk of substance misuse and smoking.

Over the last six months, Barnardo’s has been providing immediate help and support for families already in receipt of its services. This includes providing food vouchers, warm clothing and essential items such as washing machines or beds. This is all to minimise the impact of the cost of living crisis on the health of children, young people and families.

Many people are also going to see their GP due to the mental and physical impact of the cost of living crisis, such as stress or poor nutrition. Social prescribing signposts people to community-based support which could help with this, such as food banks, warm places to spend time (such as community centres), mental health services or financial advice.

How do we reduce health inequalities for children? And what could the government do?

Barnardo’s has long been calling on the government to do more to support the health and wellbeing of children and young people. This includes providing free school meals for all primary school aged children, rolling out Mental Health Support Teams across all schools and colleges and setting up more family hubs across England to provide universal support for children, parents and carers from pregnancy through to adulthood.

Yet the focus should be on prevention rather than treatment, as it is universally recognised that that the first 1,000 days and beyond of a child’s life are crucial for their development and build foundations for lifelong health and wellbeing. For many families, good health and wellbeing are increasingly hard to achieve. Healthy local environments can help with this such as clean air, access to open space, warm homes and nutritious food. Universal services, such as family hubs and youth centres, can also complement primary care provision from pharmacies, GPs and dentistry to support good long-term health.

Barnardo’s largely welcomed The Hewitt Review into Integrated Care Systems (ICSs), and much of what it outlined has the potential to improve the lives of children and young people if the government implements the recommendations and the required funding is allocated.

ICSs are heading in the right direction, but children and young people mustn’t be forgotten. A robust workforce plan is crucial to ensure that the health service can manage day-to-day demands as well as tackle urgent challenges, such as children and young people’s mental health, and begin to shift towards tackling inequalities and expanding prevention services. We look forward to seeing how newly announced proposals will bring about change.

Health for all should mean just that. A child’s circumstances at birth shouldn’t put them on a trajectory towards poor health as they progress into adulthood. Modern medicine pioneer Hippocrates famously said it’s about “what sort of person has a disease, rather than what sort of disease a person has.” That message must be remembered.

Children’s social care also needs to be adequately funded to help reduce the number of children taken into care. We have seen this work effectively through a service Barnardo’s runs in partnership with Newport City Council. Baby and Me supports parents-to-be who have previously had a child taken into care. Since the scheme’s launch in 2019, there has been a 48% reduction in social services being involved in a baby’s care from birth. This is a great success, and we want to see more of this positive change.

How can ICSs champion children, young people and the voluntary, community and social enterprises who support them?

At Barnardo’s, we see working with ICSs throughout England as presenting a unique opportunity to reset the physical and mental health agenda. There is a need to develop the right systems and services for both now and in the future to support the wellbeing of children, young people, and families.

As Barnardo’s is a children’s charity, embedding the voices of young people into everything we do is a matter of routine. You can’t make decisions about people without proper consideration and involvement of the people who will be affected by them. It makes perfect sense that, if we want to improve the health of the population and future-proof the system, then we need to start with the younger demographic.

Incorporating the voices of children and young people brings a host of benefits to both improvement of the service and ensuring that the policy stands the test of time. It also goes some way to help close the gap between health inequalities too, which is a key issue in our post-pandemic world.

We helped Frimley ICS in Surrey put together a model for embedding the voices of children and young people across their systems. With the ICS still in its formative stages, Frimley’s leaders sought to build a strong case for making children and young people a specific and separate portfolio. These early days for the ICS were rightly identified as the ideal time to shake up how services have traditionally been designed and delivered. We hope their positive example will encourage others to follow suit.

We are also working with three ICSs across England and the Institute of Health Equity to ensure children and young people are part of the decision-making processes which inform healthcare in their regions. Their views will be sought and then fed directly into plans for policy and services to help address the inequalities they are coming up against.