11 September 2009
Good morning ladies and gentlemen. Can I just begin my saying how delighted Al and I are to be here with you today to celebrate 25 years of children’s nursing within the Royal College.
We are here as two of the four Commissioners for Children and Young People holding office across the four jurisdictions of the UK – myself as the Children’s Commissioner for Northern Ireland – and Sir Al as your Children’s Commissioner here in England. Unfortunately the Welsh and Scottish Commissioners have been unable to join us today, however, Al and I are here to present a common voice to you across the UK.
I would like to give you a bit of an introduction through speaking to you about our joint roles as commissioners in promoting children’s rights, and also share some reflection around how this relates to the role of children’s nursing, and to all of you who work in a capacity to provide services and practical support for the health and wellbeing needs of children across the UK.
I think that we all recognise the particular vulnerabilities of children and young people. I also think that we would all agree that children and young people need to be especially “looked-out-for” within the health service. Nursing professionals working with children and young people have an extremely important role in helping them with the challenges that face them. All of you have a real opportunity to reach out to children and young people in your specialist capacities – and the huge number of you here today to celebrate children’s nursing is a testament to this.
But what about the children’s commissioners, what are we all about?
Each of our roles are set out in legislation, but put broadly, we work, together with the support of our offices, with the aim of improving the lives of children and young people in our respective countries. It is our job to work with children and young people to help them challenge and change the world around them. And most importantly – to give children and young people a voice in doing this.
In simple language, we are watchdogs for children in each of the UK jurisdictions, trying to make sure that all government departments and public bodies really are taking account of children’s needs.
Whilst the strength of our mandate, the level of our independence, and our arrangements for funding can vary considerably, the fundamental vision which each of us shares is one in which children’s rights and best interests are at the heart of every law, policy, practice or service that affects them.
The legislation that set up my role in Northern Ireland, for example, requires me to “safeguard and promote the rights and best interests of children and young people” as a general principle of my work.
And indeed, all the work that each of us does as Children’s Commissioners is guided by the provisions of the United Nations Convention on the Rights of the Child – or the UNCRC, as it is often called. The UK signed up to this international Convention nearly 20 years ago, and in doing so it made a binding promise to make the UNCRC rights a reality for all our children.
Let me talk to you a little bit about what some of those rights are, and perhaps show their relevance to your practical roles in supporting children’s health and welfare needs.
The rights can be categorised into a number of types – there are civil rights and freedoms; rights around family life and alternative care arrangements; rights to education, play and leisure. There are special protection rights for children such as refugees, asylum seekers or those in the youth justice system; and, of course, rights around health and welfare.
Let me first run you through the four ‘general principles’ to the UNCRC – these dictate how each and every right should be protected and promoted.
The first general principle is that children shall not be discriminated against in the exercise of any Convention right. So, for example, the fact that a child has a disability should not dilute their rights to health – and in this case, this does in fact imply that the government must take special measures to pre-emptively remove the obstacles that could prevent a disabled child from effectively enjoying their rights around health care. Similarly, children living in poverty should not be denied access to health care due to costs – which can often be ‘hidden costs’.
The second general principle is that all decisions that affect children’s lives should be taken in their best interests. This in fact may be a principle that many health practitioners here today will be well used to applying. And it is often not an enviable matter to assess. This is particularly the case when it is viewed in light of the third general principle that I will mention: that is – all children have the right to have their voices heard in every matter concerning them.
The child’s right to have a say – and not just to have a say, but to actually be listened to and have their opinions taken on board – as I have already mentioned – is perhaps the most fundamental factor in our work as children’s commissioners.
I will not dwell on this now as I know that Al would like talk to you later on about the commissioners’ work in participation. But I would like to emphasise the value of ‘listening’ to children and young people in your roles as nursing professionals and health specialists. And this is very much related to the final general principle of the UNCRC that I have yet to mention: the child’s right to life and to the fullest level of development.
In your roles, whatever your speciality, such an important part of what you do is about listening to and supporting the health issues that children tell you that they are facing – be they physical, sexual or mental health issues.
The famous Polish paediatrician and children’s rights advocate Janusz Korczak memorably said, long before the Convention on the Rights of the Child came to exist, that “a child has the inalienable right to grow into the person he was meant to be.”
Look out for children and support them in exercising this right. If you work with adolescents, you can be the crucial adult in their life who will listen to them, making all the difference to their experience of the health care system. Your conversations with them about the health problems that they face will help them take some control of their health, and perhaps even speed their recovery.
If you work to support babies or young children and their parents, you will know that even those in their early years can tell you how they feel about things. As Janusz Korczak remarked:
"When is the proper time for a child to start walking and talking? When they do. When should their teeth start cutting? When they do. How many hours should a baby sleep? As long as they need to."
These are the kinds of things that health care professionals such as yourselves, can do, and are doing in your work with children on a daily basis. And in doing so, you are making their rights a reality for them.
As children’s commissioners it is our role to promote these rights among all professionals, parents, and of course, children.
It is important to remember that, for Governments, delivery of the rights contained in the UNCRC is by no means optional. These rights are not a matter of charity, or favours to be given or taken away at the whim of a government minister, department or policy. They are legal rights, signed up to by the UK government, and to which they must be held to account.
However, we as children’s commissioners, are aware that not all children and young people are able to enjoy their rights under the Convention.
And it is for this very reason that the UK needs such independent institutions to monitor, safeguard and promote the fulfilment of children’s rights. This is why our roles originally came into being across each country in the UK. Wales came first, with their first Commissioner being appointed in 2001. My office in Northern Ireland, or as we call ourselves, NICCY, came into being in 2003. The first Scottish Children’s Commissioner was appointed the following year, and Al as Commissioner in England the year after that.
Part of our work is to see that our governments comply with the minimum standards for children’s rights within the UNCRC. We do this by reporting to the UN Committee on the Rights of the Child in Geneva every five years on the current state of children’s rights in the UK. This Committee is the official, international United Nations treaty body which monitors countries’ compliance with children’s rights.
Each State that has signed up to the UNCRC can expect to undergo scrutiny from Geneva around every five years. At the end of the process – and that includes hearing the evidence from the Children’s Commissioners and from NGOs – the Committee on the Rights of the Child will issue what it calls ‘Concluding Observations’. In the UK, these are recommendations made to both Westminster and to our devolved Governments to improve service provision and the fulfillment of rights through better compliance with the provisions in the UNCRC. These recommendations are a serious matter, and as children’s commissioners we are here to hold our governments to account as to whether they action them.
Given the relatively new establishment of the four children’s commissioners here in the UK, it was only last year that the four of us had the first opportunity to go to Geneva together to submit our evidence to the Committee on the Rights of the Child. While much of our day-to-day work is focused on our own country, this was a very important and very large piece of UK-wide joint work for us.
This was also the first time that the Committee in Geneva was able to make its Concluding Observations on the UK in the knowledge that we, as independent institutions, had been monitoring the rights of children and young people on an ongoing basis.
So what came out of this process? What did the Committee on the Rights of the Child have to say about the Westminster and the devolved governments’ compliance with the UNCRC in terms of rights around health and welfare?
The UN Committee published its Concluding Observations in October last year and one of the most striking findings across each of the categories of rights was inequality. Inequalities are faced by children and young people on a number of levels.
With regards health, the Concluding Observations stated concern over the ever-widening gap in terms of access to health services and infant mortality between the most and the least well-off groups in the UK. This has been found to be the case despite the Government having invested substantial amounts to address access to health services. The message from the Committee: not enough has been done.
When it came to mental health, the Committee made a particular recommendation that more resources and improved capacities be employed to meet the needs of children with mental health problems – with a particular focus on those who face risk of disadvantage or inequality. This includes children deprived of parental care, children living in poverty, children in the juvenile justice system, and children in Northern Ireland affected by the legacy of the conflict.
For those of you who work in schools, you may be interested to hear that the Committee made a specific recommendation around reinforced efforts needing to be put in place by government to provide adolescents with appropriate sexual health education, and also reinforced sexual health services.
A further recommendation was made around the need to continue to address substance use by teenagers across the UK, and also to strengthen mental health and counselling services, with a big issue around ensuring that these services are sensitive to adolescents in all parts of the UK.
So these are the Concluding Observations around health….. and what next? What is the role of the children’s commissioners? We will be there to hold the governments to account on these recommendations.
This November we will mark the 20th anniversary of the Convention on the Rights of the Child – this will be a time for celebration – but it will also be a time for reflecting over what our Governments have, or, as the case may be, have not done, in the twelve months following the publication of the Concluding Observations. The four Commissioners will make this anniversary by making a joint statement on the governments’ response to the Concluding Observations. And my office in Northern Ireland will be mobilising children and young people to join with us locally in holding our government to account – and our message will be this:
"Children are not the people of tomorrow, but people today. They are entitled to be taken seriously. They have a right to be treated by adults with tenderness and respect, as equals."
And we recognise the importance of your role – as health professionals devoted to working with children and young people – to help to realise their rights to life, health and development. Moreover, if you support children in making decisions about their health care, this will have wider impact on their confidence, autonomy and developmental chances, allowing them to participate more fully in society.
Hand over to Al…