Throughout the COVID-19 pandemic, growing evidence has shown the effects of the disease, and measures to contain it, have not been felt equally across the UK, with the North of England one of the hardest hit regions. Even before the pandemic, the North suffered from higher levels of poverty, poor health, and inequality compared to other parts of the UK. In a major new report, researchers from The University of Manchester examine how COVID-19 has interacted with existing inequalities in health, education, and productivity among the children of the North.

• The lifetime economic impact of COVID-19 on the North’s children is estimated at around £25 billion.
• Children living in the North of England face higher levels of poverty, poor health, and infant mortality than their peers in the south.
• Tackling the UK’s productivity gap means tackling inequalities, through a child-first, place-based recovery plan.

A new report from 40 leading Northern academics, including nine from The University of Manchester, produced by the NHSA and the N8, outlines the inequalities that were already facing children in the North, and how COVID-19 has exacerbated them. Child of the North: Building a fairer future after COVID-19 makes clear recommendations to policymakers to (1) tackle the effects of the pandemic in the North, and (2) address the underlying problems that already existed.

The report highlights that during the COVID-19 pandemic, children living in the North of England:

• faced worse health and education outcomes than those in the rest of the country;
• missed more school, with estimated negative impacts on lifetime earnings;
• reported higher levels of loneliness and poor mental health; and
• faced higher levels of both relative and absolute poverty due to illness, long-COVID, and job loss as the economic shock sinks in.

Even before the pandemic, children in the North experienced worse outcomes than the rest of the country, with higher levels of poverty and poor health, and there were fewer resources available to support young children and their parents and carers.

What have we found?

The report, with colleagues from across the North of England, looks at a wide range of factors, from child poverty to children in care, to build up a picture of ‘The Child of the North’. It paints the portrait of a child facing worse economic and health outcomes compared to the English average, with impacts that will be felt across their lifetime. While we have split the health and economic impacts below, it is important to remember that poor health will affect economic productivity, and vice versa.

Health impacts

During the pandemic, children in the North were lonelier than children in the rest of England. 23% of parents in the North reported that their child was ‘often’ lonely compared to 15% in the rest of the country. Their parents and carers were also more likely to have often been lonely during the first lockdown: 23% in the North compared to 13% in the rest of England. The mental health conditions that children in the North developed during the pandemic could cost an estimated £13.2 billion in lost wages over their working lives.

And before COVID-19, Northern children were more likely to be in care. Of the 26 local authorities with more than 100 children per 10,000 in care, 21 are in the North. The region also saw much larger cuts to Sure Start children’s centres; an average of £412 per eligible child in the North, compared to £283 in the rest of England.

Most shockingly, children in the North face higher levels of infant mortality – dying before the age of one – than the English average.

Economic impact

Children in the North face a lifetime loss of earnings of around £24.6 billion, due to loss of learning experienced during the pandemic – only 14% of Northern children received four or more pieces of offline schoolwork per day, compared to the English average of 20%. In particular, pupils in the North East and Yorkshire and Humber lost 4-5 times more learning in primary maths compared to areas in the South of England (4.0 and 5.3 months’ learning loss respectively, compared to less than a month in the South West and London).

Before the pandemic, the North had child poverty rates of 27%, compared to 20% in the rest of England. Children in the North have a 58% chance of living in a local authority with above average levels of low-income families, compared to 19% in the rest of England. Children from an ethnic minority, who represent 1 in every 5 children in the North, are more likely to live in a deprived area than children from an ethnic minority in the rest of England.

What can we do?

Alongside the other report authors, we have set out recommendations to tackle the inequalities suffered by children during the pandemic and beyond. Broadly, these can be split across two themes: (re)investing in welfare and health services; and improving and learning from best practice to identify and support the most vulnerable. Crucially, all interventions have to be at place-level, to account for the sharp disparities found between and within cities and towns.

Funding and (re)investment

Government investment in welfare, health, and social care systems that support children’s health must increase, particularly in the areas most affected by COVID-19. This will involve rapid, focussed investment in early years services, such as the Health Improvement Fund, including health visiting, family hubs and children’s centres – as supported in the Leadsom review – but with investment proportional to need and area-level deprivation adequately accounted for.

• Prioritise support to deprived areas by increasing the spending available to schools serving the most disadvantaged pupils. This requires a reversal of the current approach which will deliver 3–4 percentage points less funding to schools in poorer areas relative to those in more affluent areas.

State welfare should be expanded to tackle child poverty. Child benefits, child tax credits, and the child element in Universal Credit must all increase. Alongside this, introduce universal free school meals, make the Holiday Activities and Food Programme scheme permanent, and extend it to support all low-income families. Promote the provision of Healthy Start vouchers to all children under five years, and make current government food standards mandatory in all early years settings.

The government should also invest in and develop a place-based monitoring system for understanding the longer-term health impacts of the COVID-19 pandemic on children and parents. Achieving this will involve changes in the way data are collected, aggregated, and published, with a greater focus on routinely evaluating the impact of COVID-19 on children across different localities. Area-level measures of children’s physical and mental health should be developed to better understand place-based inequalities.

Targeted support should then flow to families where needed, including outreach services more closely tailored to the needs of vulnerable parents. Embedding Equity Impact Assessments in all policy processes will greatly aid in this.

Improving and learning from best practice

Commissioners of maternity and early years services must consider the impact of pandemic-related service changes on inequalities in families and children’s experiences and outcomes, and factor this into service delivery during the recovery. NHS England and the Office for Health Improvement and Disparities should adopt a public mental health approach that includes a focus on mental ill health prevention early in the life-course, recognising the importance of early detection and prompt access to professional treatment.

• More research should be undertaken into the relationship between child health and economic performance, so that we understand the causal pathways between those in order to identify entry points for policy.

Meanwhile, there must be support for educational settings to initiate earlier interventions. Teachers and early years professionals see many of the first indicators of children’s risk and vulnerabilities. Prioritising strong pupil and staff relationships and collaboration with parents/carers will ensure a firm foundation for meeting children’s needs, and for a return to learning.

Address the uneven geographic distribution of children’s residential care, including secure provision, in order to reduce the disproportionate burden on the North. An impact assessment of the disproportionate costs to a range of services in the North due to the number of children with complex care and support needs, is needed and long overdue.

Promoting and expanding the Race Disparity Audit, sharpening the focus on children and drawing on disaggregated data by region. Ethnicity should be included in all national public health data collection systems, including child and maternal health datasets.

In public services and decision-making roles – particularly leadership positions – there must be specific recruitment targets and campaigns to improve the representation of ethnic minority staff, as well as greater transparency on the diversity of workforces. 1 in 5 children in the North are from an ethnic minority, and this must be reflected in the services that support them.

Summary

The problems faced by the Child of the North are not necessarily unique to the region – but they are far more starkly demonstrated there than anywhere else. This report, its findings, and its recommendations are not intended to disparage efforts to reduce inequalities across the UK, but to provide an evidence-based approach to tackling the problems where they present themselves most harshly. The UK Government has committed to ‘levelling up’ the country’s most deprived areas – the North is the place to start.