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Download the full conference report here An innovative conference on children's health rights was held by the Royal College of Paediatrics and Child Health this week to mark the 20th anniversary of the UN Convention on the Rights of the Child. Opening the event, Professor Terence Stephenson, president of the Royal College, pointed out that this year is also the 50th anniversary of the 1959 “Platt report on child welfare in hospitals” – a pioneering document of its time which set out for the first time standards for the treatment of children in hospitals. Explaining what rights meant to her personally, Alex Willsher, a member of the Royal College's Youth Advisory Panel, said: “Most importantly, it means the right to be heard. On too many occasions our opinions are dismissed because we are thought too immature. But we want to be listened to, or at least considered... We may sometimes be listened to, but people only hear what they want to hear.” It is easy to make assumptions about what we want, she said, “But you need to ask us - you might be surprised.” Speaking of the achievements made since the CRC came into force, Geraldine Van Bueren, professor of international human rights law, said we now have children's parliaments around the world; children in South Africa and Brazil were consulted in the drafting of their national constitution; and international political and diplomatic spaces are no longer closed to children and their advocates, for example former child soldiers have spoken at the UN Security Council. There are many lessons that we have to learn from countries in the south, she said, particularly to be more positive about our successes and to think differently about the potential of law for alleviating child poverty. The potential of the law Child poverty in this country is seen as a political, economic, and social issue rather than as a challenge for the law. Other regions, such as Latin America, Asia and Africa, are thinking very differently about socio-economic rights, for example in Argentina and South Africa, children have a constitutional right to the highest standard of healthcare and to adequate housing. Why is the UK failing on this? The government is failing on its child poverty targets, and the economic crisis is exacerbating the situation. A complaints mechanism would do much to protect children, she said, highlighting the international campaign underway to establish such a procedure under the CRC. Whilst important cases have been won at the European Court of Human Rights in Strasbourg on child rights, a case from the UK has yet to be taken on the allocation of resources. Yet it is possible under the Human Rights Act and European Convention on Human Rights to argue that some children in the UK face poverty so extreme that it becomes degrading. Another way to protect children is to incorporate the CRC so that the Convention can be used in British courts. Indeed, the UN Committee on the Rights of the Child has recommended this twice to the UK. Read the full speech here. "Only a minority of children feel respected by adults" Highlighting why children's right to be heard should be taken seriously, Al Aynsley Green, Children's Commissioner for England, said “We live in a very, very peculiar country, with a peculiar view of children today,” he said. “In the face of this there is an urgent need for children and young people's voices to be heard. But only a minority of the children I meet tell me they feel respected by adults.” More needs to be done to promote children's participation in election processes, he said. He was selected by children and noted that children's involvement in the appointment of teachers is increasing. He recommended that children should also have a say in the appointment of paediatricians. With technical competence taken as a given, children should be allowed to choose those candidates who they feel are more empathetic. He emphasised that listening is not enough: we must develop a more scientific approach to advocacy. Why children need paediatricians to be strong advocates Urging paediatricians to become more active advocates, Peter Newell, Coordinator of the Global Initiative to End All Corporal Punishment of Children and Children are unbeatable! Alliance, stressed that we have not been consistent in turning legal obligations into action. “We should collectively admit to ourselves and to children that children’s rights advocacy is still in its infancy; it is not in the same league as advocacy for women’s rights or environmental issues. He said he found it “astonishing” that so-called child rights advocates shy away from the language of rights because of its unpopularity, saying it did little to serve children's best interests. “This is as true of children’s health rights as other rights, and particularly true for babies and young children whose rights to life and survival as well as to health and to health services without discrimination are frequently breached – in the UK as in other countries.” He emphasised that NGOs, national human rights institutions and other professionals to ensure the recognition of the Convention as a legal instrument. “Children need paediatricians who see their role, alongside other professionals, as strong and informed advocates of children’s rights, understanding that the Convention is a legal instrument; understanding that when the government fails to meet its obligations, it must be challenged, including if necessary in the courts,” he said. He outlined a set of suggestions for the Royal College The purpose would be to:
Read the full speech here. Camila Batmanghelidjh, Chief Executive Kids Company, spoke of challenges to ensuring child protection, participation, and securing adequate provisions for children. “The abuse and neglect experienced by children is repeated in the organisations that we run. It is a competition between the drug dealer and the social worker, and at the moment, the drug dealer is doing the better job, by ensuring they have food in their belly, money for public transport...” Social workers have a case load of 24 children and they are lucky to see four in a week. In terms of mental health, some 30,000 children are on the waiting list for support in the UK, she said. Managers are now encouraging clinicians not to diagnose children as having mental health issues so that they remain the budgetary responsibility of social services. We need to be serious about giving children access to protest, object and complain about the lack of care they are exposed to. It is not just children who are affected; care workers go in to the profession with ideas about the aspirational quality of care they would like to deliver. If carers keep going to work knowing that they are delivering poor service, it is only a matter of time before that “space of humiliation shuts down your ability to feel.” We all feel too small to effect change - she said – that the institutions and they system are too big. This leads us to betray our own sense of quality as well as the children who turn to us for help and support. We are not doing a good enough job. “If children have to carry a knife to protect themselves, they are hardly going to be impressed by a t-shirt that says “no knife, life”. We have to gain the moral courage to say it how it is and do something more brave than we are currently doing.” Workshops explore Child Rights in the health care context In the afternoon session, four parallel workshops convened to discuss the major themes and key issues around the rights of the child in relation to paediatric care and the national health care system. Most notably, youth facilitators from the Expert Patients Programme – Staying Positive led a conversation on the Child's Right to Be Heard. The facilitators explained that Staying Positive provides young people with long-term disabilities the means both to encourage adults to recognise their rights and to teach other children to express themselves freely and with confidence. After breaking the ice, participants acted in several role play scenarios to better understand the dynamics between doctors and young patients. In their report back to the general assembly, the youth facilitators emphasised that participants had learned the importance of body language, the advantages of open, two-way communication in all doctor-patient interactions, and the continued need for Staying Positive and other youth-led groups to stay involved in linking young patients with health care professionals. Meanwhile, the working group on the Child's Right to Adequate Health Care redefined its mission from discussing adequate health care for children to looking for ways to provide the best possible care. Participants felt that ensuring equality in access to health care, building professional education and training programs, and establishing links between health care and education were the most pressing issues ahead. A conversation across the hall on the Child's Right to Non-Discrimination centred on similar themes, highlighting in particular the inadequate health care provided to asylum-seeking children. The group worried about young carers, avoidant social service agencies, and the substandard care provided to certain classes or groups of typically disadvantaged children. Finally, the working group on Child's Rights and Advocacy underscored the value of taking a legal approach to child's rights in medicine and focused on ways to involve members of the College more in advocacy initiatives. The group suggested that the College appoint a child rights officer, conduct a survey to determine the existence of the child rights approach in local health care settings, and develop a training plan to include child rights teaching. Child rights and medicine: the way forward In closing the session, Professor Stephenson reminded paediatricians, as professionals who work with children, that they must always keep the child at the centre of their thinking in their day-to-day work. He encouraged the participants to become actively involved in promoting children's rights, emphasising that “if everybody does their bit, it can be a huge achievement.” Before officially adjourning the conference, Richard Serunjogi, a member of the RCPCH Youth Advisory Panel, led the assembly in observing a minute of silence for the rights of young people around the world. During this time of reflection, it became clear that the conference had already begun to expand children's participation in the health care context and would mark an important step towards the medical profession's full recognition of children's rights.