In its annual assessment of the state of health and social care in England, the regulator called for consistent funding targeted to areas of early intervention, better understanding by systems of the gaps in provision of care and treatment for their population to ensure that local areas can meet the needs of their children and improved management of demand and communication with children and their families. 

Ian Dilks, chair of CQC, said: ‘The health and wellbeing of a nation's children has been described as the best predictor of its future prosperity; failing to ensure good, safe care for our children today also risks failing their future.' 

Inequalities 

The CQC said problems in accessing care were heightened by inequalities. Attendance rates for urgent and emergency care for people living in the most deprived areas of England were nearly double those for people in the least deprived areas in 2023/24 with the difference rising to three times for people with mental health illness. 

Women and babies are still not receiving the high-quality maternity care they deserve with women from black and ethnic minority backgrounds continuing to be more at risk of experiencing poor maternity care and outcomes.

Average waiting times for autism assessment were far too long at 356 days for children and young people in April 2024 compared with 238 days for adults.

Mental health 

In mental health, lack of resources, ageing estates and poorly designed facilities affected the safety of inpatient wards. The report highlighted the CQC's special review of care provided by Nottinghamshire Healthcare NHS Foundation Trust that identified wider concerns around community mental health services, leading to recommendations to improve oversight and treatment of people with serious mental health issues.

Children and young people's mental health services remained a particular concern, where demand continued to rise amid problems with staffing and skills mix. One in five children and young people between the ages of 8 and 25 were estimated to have a mental health disorder in 2023. 

People with mental health issues between the age of 18 and 21 had the highest presentation rates at urgent and emergency care settings where the CQC found issues around triage and patient flow that affected care for all patients but identified specific issues around care for deteriorating children.

The CQC found low numbers of children's nurses and gaps in staff training in safeguarding and recognising sepsis meant that in some services, there was a risk that a deteriorating child might not be identified quickly, with patients at risk of sepsis not being assessed and treated promptly. 

Two-tier provision 

The report also warned of a shift towards two-tier provision in dental care where people relied more on private care where NHS activity was lowest with access issues having a clear impact on children and young people.

Tooth extraction rate related to decay was nearly three-and-a-half times higher for children and young people in the most deprived communities, compared with the most affluent.

Integrated Care Systems

Reviews of ICS before their pause found early positive signs with some having children and young people scrutiny boards to provide governance and monitor planned implementation.

However, the report highlighted long waiting times exacerbated by increases in demand as well as workforce shortages. It also noted a variation between some published ICS plans or a lack of clarity about their intended outcomes.