I am here as the Northern Ireland Commissioner for Children and Young People and would like to begin by speaking to you about my role in promoting and protecting children’s rights and about the United Nations Convention on the Rights of the Child.
I will also share with you some of my reflections about how the work of healthcare professionals relates to children’s rights and how, I believe that all of you who provide services and practical support to meet the health and wellbeing needs of children are uniquely placed to champion their rights.
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 health services. Nursing and health care professionals working with children and young people have an extremely important role in helping them with the challenges that they face.
All of you have a real opportunity to reach out to children and young people in your specialist capacities.
But what about my role in reaching out to children and young people, what is the job of the Children and Young People’s Commissioner for Northern Ireland?
My role is set out in legislation and, with the support of my office, my aim is to improve the lives of children and young people in Northern Ireland. I am a watchdog for children, trying to make sure that all government departments and public bodies really are taking account of children’s needs.
It is my job to work with children and young people to help them challenge and change the world around them. And most importantly – to give them a voice in doing this.
My fundamental vision is that children’s rights and best interests must be placed at the heart of every law, policy, practice or service that affects them.
The legislation that established my role in Northern Ireland 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 my work 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 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 being met.
The rights can be categorised into a number of groups – there are civil rights and freedoms; rights around family life and alternative care arrangements; rights to education, play and leisure. There are also special protection rights for children such as refugees, asylum seekers or those in the youth justice system.
And there are, of course, rights about children’s health and welfare. These include:
· rights to access the highest attainable standard of health
· rights to access services for treatment and rehabilitation when required, and,
· rights to regular reviews of their care and treatment when children are receiving ongoing in-patient or residential care.
There are also 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 – in fact this implies 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.
The second general principle is that all decisions that affect children’s lives should be taken in their best interests. This will 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 – is perhaps the most fundamental factor in my work as children’s commissioner.
I would like to emphasise the value of ‘listening’ to children and young people in your roles as nursing professionals and health specialists. Listening to children, respecting their right to express their views and wishes and taking these into account 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 children with the health issues that they tell you 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 situation, 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 and you can support parents and carers in recognising and responding to their needs.
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 the Children’s Commissioner it is also my 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, nor favours to be given or taken away at the whim of a 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, I am aware that not all children and young people are able to enjoy their rights under the Convention.
In 2008 my office published a wide ranging review of children’s rights in Northern Ireland. In relation to health and welfare, the report highlighted concerns where particular groups of children and young people were likely to be marginalised and disadvantaged.
For example, the report called for more being done to tackle the physical health inequalities experienced by children living in poverty and for the development of a comprehensive, child-centred strategy for children with disabilities. The review also voiced concerns that while under 18s make up 25% of our population less than 5% of the mental health budget is allocated to children and young people.
While completing the review we talked to children and young people and I’d like to share with you how some of them had difficult experiences of health services:
One child told us:
“Doctor’s don’t explain about the tablets that they give you, they just give you them”
Another said that:
“Sometimes they talk to me, but often talk to my mum or dad, cause they think I’m too young too understand”
One young person reflected on their experiences saying:
“As I become stressed in hospitals or doctors’ surgeries my needs tend to be second guessed. This could be seen as trying to minimise my distress – or it could be seen as overlooking my needs as I don’t really count”
We are also very aware of the many ways that health professionals, particularly nurses, make the world of difference to children going through scary and/or painful illnesses or treatments. When you find the time to listen, to support, to laugh with or comfort a sick child, you not only lift their spirits for that moment, but you can also help to speed their recovery.
And NICCY, while often far from the individual child, also has a role to play. Whether it is in relation to budget allocation and service commissioning, to joined-up working across government or to individual practice and interactions with children – Northern Ireland needs independent institutions, like NICCY, to monitor, safeguard and promote the fulfilment of children’s rights.
My office in Northern Ireland, or as we call ourselves, NICCY, came into being in 2003 and part of our work is to see that government complies 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 Northern Ireland. 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 Commissioner 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 Commissioner I am here to hold our government to account as to whether they action them.
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 2008 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 to health, the Concluding Observations stated concern over the ever-widening gap in terms of access to health services and urged government to ensure greater co-ordination between health policies and strategies to reduce poverty and inequality.
One example of this was the Committee’s concern that there was a widening gap in infant mortality between the most well-off 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.
When it came to mental health, the Committee made a particular recommendation that mental health and counselling services had to be strengthened – again with a particular focus on those who face risk of disadvantage or inequality. This includes care experienced children, children in contact with the juvenile justice system, and children affected by the legacy of the conflict.
In raising specific concerns about the health of adolescents, the Committee made recommendations about government strengthening sexual health education and services and ensuring teenagers have access to information and counselling services in relation to substance use.
So in all of these areas the message from the Committee was: while there have been some achievements, not enough has been done.
So these are the Concluding Observations around health ….. and what next? What is my role in holding government to account on these recommendations?
In November we marked the 20th anniversary of the Convention on the Rights of the Child. This was a time for celebration – but also a time for reflecting on what government has done or, as the case may be, not done, in the twelve months following the publication of the Concluding Observations.
The four Children’s Commissioners who work in each of the jurisdictions of the UK collectively made a joint statement on the governments’ response to the Concluding Observations. We asked the Westminster and devolved governments to deliver on all the recommendations of the Committee.
At NICCY we are also marking the anniversary through our year long “Make It Right” campaign which highlights key areas of children’s lives where we believe more action most be taken by government to ensure children are able to fully realise their rights.
Each month we are focusing on one issue, for example, poverty, or family support, or education, and are asking politicians, professional, parents and, most importantly children and young people, to join with us locally in holding our government to account on these issues.
And our message will be this – as Janusz Korczak said:
“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.”
Making this a reality for children and young people in Northern Ireland is a fundamental step towards ensuring their rights are realised. And this is a shared responsibility for us all – as professionals, as parents, as members of families and communities.
If you listen to children, if you support them in understanding their health and in making decisions about their care, this will have wider impact on their confidence, autonomy and developmental chances. Moreover, if you take children seriously and treat them with tenderness and respect you allow them to participate more fully in all aspects of society.
The importance of your role – as health professionals devoted to working with children and young people – in helping to realise their rights to life, health and development is vital to this.