We’re raising the unhealthiest children and young people in decades, according to the latest findings, yet boosting the CP workforce could be key to a better future. Journalist Kaye McIntosh investigates.
The UK is on track to raise the unhealthiest generation of children for decades, warns the Royal College of Paediatrics and Child Health (RCPCH). In fact, young people across the UK face some of the worst health outcomes in Europe, reveals the latest RCPCH State of Child Health report (2026a). Some indicators of child health and wellbeing have even gone backwards since the last RCPCH publication monitoring outcomes in 2020.
Across the 12 indicators studied, from early childhood development to mortality, ‘most measures of child health and wellbeing show a worsening picture, and where progress was once being made, it has stalled’, the report finds.
Vaccination coverage remains a significant concern. Fewer than 90% of children in all four UK nations are now receiving both doses of the MMR vaccine by age five and in England this has fallen as low as 84%. Asthma admissions and mental health disorders are increasing.
In England, more than one in three (36%) children aged 10 to 11 is overweight or obese, while one in five children
aged eight to 16 has a probable mental health disorder.
Dr Helen Stewart, RCPCH officer for health improvement, says: ‘Children are about 25% of the patients that the NHS sees, but they are 100% of the future patient population. If we don’t deal with a lot of these problems, such as mental health, obesity, asthma and more, we are setting ourselves up for problems in the future, when most of those children grow up still carrying those problems.’
Underinvestment in the workforce is also a major area of concern. The report authors state: ‘Inequitable funding in the child health workforce has resulted in their limited capacity to deliver timely support and provide joined up working across child health services (RCPCH, 2026b).’
THE POOR DATA PROBLEM
There are serious gaps in the data around child health, making it difficult to develop evidence-based policy recommendations and targets for improvement – and to compare the four UK nations (RCPCH, 2026b). Poor quality and inconsistent data recording and sharing to measure
and monitor child health and wellbeing outcomes are major factors.
Dr Stewart says: ‘When we looked at the various indicators, we didn’t have the data for them in all four nations. They’re coded
differently and recording is inconsistent.
Without having data available on each of the metrics, it’s very difficult to measure progress to see where we really need to
make changes.’
She adds that while ‘most things are getting worse or stalling on our main indicators, having good data to be able to really assess progress is vital’.
The RCPCH report was developed in partnership with the Born in Bradford (BiB) research programme, members of which have previously spoken at the Unite-CPHVA Annual Professional Conference. Talking about the RCPCH report’s ‘meaningful recommendations around data, national targets and investment in children’s health’, BiB programme manager Sarah Ahern says: ‘We know that high-quality data can save lives and allows us not just to describe the problem but to test solutions and find out what works.’
Key RCPCH recommendations
Make child health a priority
Improving child health should be a key aim of government, not an afterthought
Invest in the workforce
Introduce a funded, long-term child health workforce strategy. Increase health visitor workforce capacity and contacts
Strengthen early years support
Boost primary care, maternal care and early years support in the first 1,000 days with adequate funding
Targets
Commit to meaningful, explicit national targets to improve children’s health and reduce inequalities
Improved data
Strengthen the quality, collection and sharing of child health data to track progress.
HOW DID WE GET HERE?
Cross-party health and social select committee chair Layla Moran pins the blame partly on the decline in health visitor numbers in England.
‘Responsibility for health visiting services was transferred from the NHS to local authorities in 2015 – the time that the workforce started to decline,’ says Layla.
‘Local authorities were particularly badly affected by cuts to their central government funding in the years after 2010. So it’s unsurprising that, in turn, there were cuts to the number of HVs. According to a study [Conti et al, 2026], local authority spending on universal
health visiting fell by almost 20% in real terms between 2016-17 and 2023-24.’
Dr Stewart says: ‘The picture around why progress on children’s health has stalled, and in some cases declined, is complex.’
The RCPCH (2026b) report, however, identifies three areas that cut across all 12 indicators. Alongside gaps in the data: ‘Continued underinvestment in the child health workforce, compounded by the legacy of austerity and recent economic challenges, makes it difficult to respond to an increased demand on services,’ says Dr Stewart.
‘We will never get ahead of the curve without equitable and meaningful investment in children’s health services and the workforce who care for them, which is why we continue to call for a funded, long-term child health workforce strategy.’
Plus, widening child health inequalities continue to have a profound impact. The report found that children growing up in more deprived areas are more likely to have worse health outcomes than their peers in less deprived areas. ‘Strong evidence shows how social determinants influence health outcomes,’ says Dr Stewart. She highlights that in England, children in the most deprived areas are four times more likely to die from asthma, while infant mortality in the most deprived communities is more than double that seen in the least deprived areas (see our cover feature for more analysis on childhood poverty).
‘The scale of challenge is significant, but it’s clear that investment in early intervention can improve outcomes for life’
CAN WE DO BETTER?
The challenges facing child health are not inevitable, says Rukshana Kapasi, Director of Health at Barnardo’s. ‘Many of the social determinants of health that the RCPCH report highlights are avoidable – such as poverty, poor housing, food insecurity, access to support, and opportunities in childhood.
‘We know that better outcomes for childhood health are possible. Through our services, we see every day how the right support at the right time can change childhoods, change lives, and improve outcomes that last a lifetime.’
Family support services, young carers services, mental health support, family hubs and early help programmes show children can thrive ‘when barriers are removed and families are given the support they need’, Rukshana adds.
‘The scale of challenge is significant, but it’s clear that investment in early intervention can improve outcomes for life. The real question is not whether these challenges can be addressed; it is whether we are prepared to make the long-term investment and transformational change needed to do so.’
The Born in Bradford research programme has tracked the lives of more than 30,000 children and young people since 2007. Sarah from BiB says that the RCPCH report is ‘not a story about failure on the part of families’.
‘It is about challenges driven by inequalities and circumstances that policy has the power to change.’
She points to the example of Bradford’s clean air zone. After one year, GP visits for respiratory illness in the city fell by 25% and for heart problems by 24%, an average of 732 fewer visits a month compared with pre-Covid levels. This saves the NHS an estimated £30,700 a month (Mebrahtu et al, 2025).
A UK government spokesperson said: ‘Following a decade of neglect, too many children – particularly those growing up in the most deprived communities – continue to experience poorer health outcomes than they should. That’s why this government is taking decisive action to lift children out of poverty, tackle health inequalities and raise the healthiest generation of children ever.’
The spokesperson listed expanding mental health support in schools, free school meals to more children, and opening family hubs and local health centres among its actions.
‘Children are about 25% of the patients that the NHS sees, but they are 100% of the future patient population’
VITAL SIGNS: A SNAPSHOT
The updated RCPCH State of Child Health 2026 report looked at 12 indicators of child health and wellbeing: infant mortality, child mortality, immunisations, early childhood development, oral health, obesity, mental health, emotional health and wellbeing, vaping and smoking, asthma, substance misuse and injuries.
Early years development in England remains below pre-pandemic levels and the 75% target. In 2024, just 51% of children eligible for free school meals achieved a good level of development.
Infant mortality rates remain high in England (3.9 per 1,000 in 2018 and 2024) and Wales (3.5 in 2018 and 3.6 per 1,000 in 2023). Northern Ireland saw a slight increase from 2018 to 2024 (4.2 to 4.5 per 1,000), as did Scotland: rates rose from 3.2 in 2018 to 3.3 per 1,000 in 2024.
Child mortality – Scotland has the highest rate across the nations at 8.9 per 100,000 (2024), though it has reduced from 11 in 2018. England is not far behind: 8.5 per 100,000 in 2024, down from 9 in 2018. Wales has seen the most significant reduction since, with the lowest rates of 6.4 per 100,000 in 2024, down from 13 in 2018. Northern Ireland has significantly reduced from 10 per 100,000 (2018) to 7.1 in 2024.
Overweight and obesity – in 2024-25, around a quarter of four to five-year-olds were overweight or living with obesity in England and Scotland, with similar rates in Wales (27.3%) and Northern Ireland (25%) in 2023-24.
Emergency admissions for childhood asthma rose to 148 and 157 per 100,000 (England and Scotland) in 2023/24. Progress in reducing these has reversed in recent years, after earlier declines. Many deaths are preventable and persistent inequalities affect outcomes.
HVs ARE KEY
The RCPCH report is clear that HVs are key to improving child health. It states: ‘HVs have a vital role in health promotion for families and are often the frontline for identifying issues in young children to provide early intervention and prevent ill health escalating.
‘However, the health visiting workforce is currently unable to meet the demand in their services due to their reduced capacity, coupled with the current long waiting lists for children’s community health services, such as in speech and language therapy. This can result in delays in diagnosing and mitigating any developmental delays (RCPCH, 2026c).’
CPHVA president Yvonne Coghill says of the findings: ‘The report paints a picture of failure that will be familiar to community practitioners. But it also offers opportunities for change. Investing in the child health workforce is a key recommendation. HVs and school nurses spot opportunities to work with families and intervene early. The RCPCH rightly identifies that the workforce is key to reversing this picture of decline.’
The health and social care committee agreed earlier this year in their updated report on the first 1000 days (UK Parliament, 2026), that ‘HVs are the backbone of early years care’ and spoke of the need for government to rebuild the HV workforce (see Resources).
Rukshana concludes: ‘The government needs to go further and faster, with a clear action plan for child health, meaningful measures of progress, long-term investment in services and the workforce, a commitment to prevention, and a focus on tackling child poverty and inequalities.
‘This will require listening to children, families and frontline professionals about what is happening on the ground. ‘We know what works; the challenge now is delivering it at scale and sustaining it over time.’
RESOURCES
- The RCPCH State of Child Health 2026 report
- More information about the Born in Bradford research programme
- First 1000 Days: a renewed focus, report by the health and social care select committee, 2026
Image: ISTOCK
REFERENCES
Conti et al. (2026) The state of health visiting in England. See: https://www.dropbox.com/scl/fi/pin8ecz703fl264aumbu0/Health_visiting_FOI_brief_March_2026_FINAL.pdf?rlkey=fo7411s0gtwb3y6eedz39ha47&e=3&st=fa6oewbw&dl=0 (accessed 2 September 2026).
RCPCH. (2026a) The UK is raising one of the unhealthiest generations in decades, paediatricians warn See: https://www.rcpch.ac.uk/news-events/news/2026-07/uk-raising-one-unhealthiest-generations-decades-paediatricians-warn (accessed 2 September 2026).
RCPCH. (2026b) State of child health. See: bit.ly/rcpch_child_health_2026 (accessed 2 September 2026).
RCPCH. (2026c) State of Child Health: Early childhood development indicator. See: https://www.rcpch.ac.uk/work-we-do/state-of-child-health/early-childhood-development (accessed 2 September 2026).
Mebrahtu TF, Santorelli G, Yang TC, Tate JE, Jones S et al. (2025) Impact of an urban city-wide Bradford clean air plan on health service use and nitrogen dioxide 24 months after implementation: An interrupted time series analysis. See: https://www.sciencedirect.com/science/article/pii/S0013935125002397?via%3Dihub (accessed 2 September 2026).
UK parliament. (2026) First 1000 Days: a renewed focus. See: bit.ly/hsc_1000_days (accessed 2 September 2026).
