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Improving the care of children and young people in the UK: 20 years on
  1. Albert Aynsley-Green
  1. Correspondence to Professor Albert Aynsley-Green, Emeritus of Child Health, University College London, Aynsley-Green Consulting, Salisbury SP28LE, UK; al{at}

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In 2000, practitioners in child health asked a simple question—who speaks for children and their health at the policy level?1 It documented the invisibility of children in the National Health Service (NHS) and made recommendations for the future. As we experience unprecedented political turbulence, austerity, increasing poverty and ideological reforms of health and education, is all well in the UK for children, childhood and child health now?

The context

Children are our nation's most precious resource because of the change in the old age dependency ratio—the number of active working age adults per pensioner. In 1971, the ratio was 3.6; it fell to 3.2 in 2008, and despite a recent increase in birth rate largely in mothers born outside the UK, it could fall to 2.0 within 35 years.2

We need healthy, educated, creative and resilient children to become the productive adults supporting an ageing population, so investing in them should be a top national priority. As well as being our future, they are citizens today deserving all the entitlements that follow, including the 42 Articles of the United Nations Convention on the Rights of the Child (UNCRC).

There is much to celebrate. There are outstanding children and young people exemplified by the award to exceptional young people by the Diana Princess of Wales Memorial Award, the success of young able bodied and disabled British Olympians, the authority of Young Parliamentarians, and turning the challenges of teenage cancer into effective fund-raising. These all reflect the positive attitudes and behaviours of countless children and young people.

The majority are loved in their families. They are hardworking, strive to be successful, are law abiding and when given an opportunity, contribute to the society.

Children, generally, are healthy and fewer die than 20 years ago. Scientific advances have transformed knowledge of the pathogenesis of diseases, …

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  • Contributors This invited review was performed solely by me with no conflicts of interest.

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.