Renuka Jeyarajah-Dent 15 May 2018

Children Today: Securing health that lasts a lifetime

I am Coram’s deputy CEO. Thomas Coram, our founder, wanted to ‘save’ children dying on the streets because of destitution and illegitimacy. In 1739, through Royal Charter, he set up the Foundling Hospital and at that time stigma and a belief in the possibility of a fresh beginning meant anonymity with a focus on physical health and education.

It seemed a simple solution, but we now know that working with children enduring separation, loss and trauma is far more complex.

An event at the Foundling Museum last week sought to address the situation today and actions to optimise children’s resilience. Dr Max Davies (Royal College of Paediatrics and Child Health) compared child obesity and conduct disorder, both associated with poverty and deprivation and with significantly different rates in ‘priviledged’ Dulwich Village and Camberwell Green close by.

I have worked with Camberwell’s children, so often stigmatized by the dominant narrative which tends to blame the sufferers. We have come a long way in 350 years in realising that disadvantage at birth cannot be compensated for child by child through removal from birth family. However, our combined service provision remains poor (no specialist service for conduct disorder in Camberwell) and I agree with Dr Davies in that these conditions have no simple cause and associated cure. Seeing them as ‘disorders of disempowerment/inequality’ so with empowerment at the heart of services, should be the focus.

We need to bring understanding and respect to the people we work with – and enable pride and choice in those who have little to start with. No longer can a Thomas Coram depend on people knowing and accepting their place when social media tells you in an instant what others have.

The worsening inequality gap (and related social mobility and health consequences) with a return to pre-1997 levels can not be tolerated. However, there is another truth - whether because of better identification or otherwise – the numbers of children and young people (even in Dulwich Village) suffering mental/emotional ill-health are much higher than before.

So, what of solutions? Sir David Behan reflected on a career of 40 years spanning social work to CEO of CQC. His grandfather was a ‘foundling’ (a Coram child) – a ‘lowly’ start – but whose grandson, benefited from the warmth of a family and simple hard work. Warmth and acceptance allow people the courage to fail and continue.

I was reminded again of this when Sir David spoke of Serious Case Reviews, their repeated finding of poor inter-agency communication, but their increased emphasis on holding leaders responsible rather than accountable, when rarely is a tragedy one professional’s fault. It is perhaps because of this ‘blame’ culture that confidence in politicians has plummeted and yet leaders will need our confidence to operate with agility in modern service landscapes characterised by Volatility, Uncertainty, Complexity and Ambiguity – what Sir David called VUCA – the same context that our children must navigate.

I believe the solutions though not easy are to be found in what both Dr Davies and Sir David said. What is required is a radical re-think of what we offer children in their journey to adulthood – not just at key points - remembering the most vulnerable but learning from the successful – a more radical shift than the current Green Paper addressing children’s mental health allows us to make.

We must learn from what Sir David has found to be important: our passion and motivators as leaders; our shared values and related behaviours; the data we share and importantly our ability to listen and trust (not just observe) those we work with and most importantly seek to serve. We are none of us voiceless, powerless or choiceless but some of us can, together, enable positive choices for those more vulnerable.

Most moving was the voice of a young person. She had experienced state care. She thanked professionals for what they did well, but she had endured moving from placement to placement with no swift access to mental health support and nobody to help her understand it was not her fault. She concluded ‘I have experienced separation and loss, but I also have hope: for myself and for others.’ As she spoke I was reminded that it was simple things done well that make us who we are. Thomas Coram was right: every child must be ‘protected’ and the warmth and stability this young person needed was no different to Sir David’s grandfather years before. She and my co-chair (just 17) represent the future and with them in it, there is hope.

Renuka Jeyarajah-Dent is Coram’s deputy CEO

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