1. Thematic Discussion Paper
Young people and health
Introduction
The 1944 Education Act laid the basis for developing a broad range of educational
approaches including to meet the needs of children and young people. Since this time
there has been a range of legislative measures, Government documents as well as
academic research highlighting the need to ensure effective for young people’s health
and wellbeing through the often chaotic period of adolescence. Most recently the
Government has produced ‘Positive for Youth’: “the teenage years are a critical period of
growth and change. They are important for making significant life choices and decisions”.
Background
A new public health system is being established ‘Public Health England’. Each local
authority will employ a Director of Public Health to lead on the authority’s public health
responsibilities. Each authority will establish a Health and Wellbeing Board, a core aim of
which will be to join up commissioning across partnerships. Key to this will be the
development of the Joint Strategic Needs Assessment (JSNA) and the Joint Health and
Wellbeing Strategy. The strategy should provide the overarching framework within which
commissioning plans for the NHS, social care, public health and other services are
developed.
The Health and Wellbeing Board does not have any direct commissioning powers.
However GP Consortia will be required to have regard to both the JSNA and the strategy.
Local Authority funding for public health will be devolved through a non ring-fenced
grant. Commissioning will be expected to incentivise and reward the improvement in
health and wellbeing outcomes and tackling inequalities as well as to deliver best value.
The relationship between public health and children’s services will be critical. Local
authority arrangements will be expected to cover support for young people to prevent
unhealthy lifestyle choices such as risky sexual behaviour, smoking, drugs, alcohol and
lack of physical activity.
The Government is also proposing to develop a new Outcomes Framework for public
health alongside an NHS Outcomes Framework, this will cover a number of domains
including health protection and resilience, ill health, life expectancy and reducing
preventable mortality. Outcome indicators include: rate of hospital admissions for alcohol
related harm; under 18 conception rate; rate of hospital admissions as a result of self-
harm: and chlamydia diagnosis.
The Challenges
Meeting the needs of young people is a discrete area of work and must be seen in the
context of the physiological and emotional changes that young people experience during
puberty. Over the coming months the agenda of young people and health will become
incorporated into the new structures being set. Within new public sector arrangements it
is important to maintain the emphasis on the needs of adolescents and not allow this to
become subsumed into the aggregated needs of children and young people. Also,
following the principles of ‘Positive for Youth’ to confirm the need for young to have a
say in their health services and in health reforms.
The new public health system must encompass the need for services for young people
and the Children & Young People’s Health Outcomes Forum’s recommendation that
 ”all clinical commissioning groups and local authority commissioners of public health
services, commission services in a way that ensures that teenagers are managed in
age-appropriate services”.
“Inspiring Services, Improving Futures”
www.chyps.org.uk

2. Case for young people and health
The overwhelming evidence points to the importance of supporting young people’s needs
as a discrete group to best support young people and provide a safe and healthy
progression into adulthood. There are some counter arguments, where differentiation by
age seen as unhelpful. However, for young people there are associated issues of
physiological and emotional change during puberty; anytime when things go wrong
during adolescence for example, risky sexual behaviour, substance misuse and mental
health, outcomes can be devastating. The support must be to them as a ‘young person’
and their personal and social development not at a series of single issues. There are
three key points that support age differentiation of the needs of young people:
a) Firstly, the physiological and emotional changes that occur during adolescence
produce key health indicators that need to be carefully addressed by those skilled in
working with adolescents, particularly when relating to health needs. The Health
Outcomes Forum recommends “coherently addressing the different stages in life and
not tackling individual risk factors in isolation”. This means building personal
resilience to deal with these issues. It is crucial that informal learning needed during
adolescence is not replaced by crisis management.
b) Secondly, relationships with adults in positions of authority are not the most helpful
in steering a way through the ‘chaos’. In ‘Positive for Youth’ young people have
commented on the poor quality of PSHE at school, there is a weight of evidence
supporting the breakdown in relationships with parents/cares during adolescence and
many examples of young people wanting to exert their newfound status as an ‘adult’
through extreme political and social views, involvement in crime and behaviour
setting them ape art form their local community. It is important that young people
find supportive and appropriate adult role models outside the home, the school or
social care that demonstrate mutual respect.
c) Thirdly, issues for young people’s health have the potential to cause the most impact
in adult lives. If we ignore these issues for young people during adolescence or deal
with them in the wrong way we set up a generation of young people who are less
able or less resilient to cope with their adult lives. Issues such as sexual identity,
homophobic and sexual violence, mental health, self-harm, teenage conception and
substance misuse can also be linked to an inability to get and keep employment and
involvement in crime.
Conclusion
There is a large and growing body of evidence to support work with young people simply
because they are ‘young people’ and health is one of the key areas within the
curriculum. Within each local authority there should be clear links between public health
and young people’s health and wellbeing. Health and Wellbeing Boards should consider
soft outcomes for young people rather than concentrating solely on hard data. The Early
Intervention model is effective when local authorities clearly see the preventative and
developmental aspects for young people. Those working with young people should seek
to highlight the need for personal and social development that can have “longer- term
impact than those that focus on directly seeking to reduce the ‘symptoms’ of poor
outcomes for young people”. (A framework of outcomes for young people: Catalyst
Consortium/Young Foundation 2012)
Questions:
Do young people’s services engage with health reforms in your authority?
 If yes, how can young people influence the commissioning of services?
 If no, how can we best ensure that there is a specific focus on young people and
their personal and social development within the health service and its reforms?
Ruth Ashwell, CHYPS Executive; October 2012
“Inspiring Services, Improving Futures”
www.chyps.org.uk