The results showed that the lower the risk, the greater the numbers of patients requiring treatment, but the greater the reduction in death and disease. A 15 per cent risk threshold would cut cardiovascular disease by just over a third, boosting those needing treatment by an extra 10 per cent. Treatments to lower blood pressure would be much more effective if they were based on risk thresholds rather than current criteria, conclude the authors. As well as health needs which often stem from poverty, they may have undiagnosed health problems, be suffering the effects of physical or sexual abuse or neglect or may be in care because they are disabled and their parents need help to cope. Although the 1989 Children Act requires local authorities to ensure that each child has an annual medical report, uptake of health assessments can be as low as 25 per cent in some authorities.
Many young people refuse to attend and the reports are often of poor quality.
Children in care are often excluded from school and therefore from the input of school health services and unstable fostering means that children in care spend long periods as temporary residents of general practices. In an editorial, Leon Polnay, professor of child health at Queen's Medical Centre, Nottingham and Harriet Ward, senior research fellow at Loughborough University, say that a complete culture change, with designated and specially trained doctors and nurses will be needed to achieve better continuity of care for these children.