Health of socially excluded groups: lessons must be applied

Editor—The editorial by Watt points out that projects targeting socially excluded groups tend to address consequences rather than addressing the causative issues.¹ It is often the provision of evidence of shocking health figures, such as those for children looked after and accommodated by the local authority (in care), that underpins the release of funding.² These initiatives will have a beneficial effect on the health of the nation only if lessons learnt from them are applied to mainstream services.

In Lothian, funding has been obtained from the Scottish Executive for the residential care health project, targeting children and young people in residential units provided by the local authority. By the time a young person enters a residential unit, he or she will have moved around the care system several times. Only 46% of children looked after continuously for four or more years have spent at least the preceding two years in the same placement, and 18% of looked after children experience three or more placements in the course of one year.³ Lynch and Gough acknowledge that the healthcare system breaks down when people move away from their general practitioners.⁴

We found that 54% of young people in our units currently have no health information in their files for the information of those who care for them. The health care of these young people starts off at a disadvantage because of the chaotic homes they come from, but this figure reflects largely the effect of inadequate basic health supports to a disadvantaged group. The health information that is required for anyone to care safely for a child is held in many different places, and rectifying this has been a particular challenge for us. We believe that it is the place of the health system to support social services in collating this information for the benefit of children and young people.

Lynch and Gough make the further point that it can be difficult to find general practitioners sympathetic to the lifestyle of socially excluded groups of children. These children do not choose their lifestyles: they are imposed on them by the lottery of their birth. If this type of work with a small group of looked after children can be put into mainstream child health services, both paediatric and primary care, then we can move effectively away from the concept of providing a “special” service.