The government undertook to implement the principles of the convention and report progress after two years and subsequently every five years to the United Nations Committee on the Rights of the Child, the elected international body responsible for monitoring compliance with the convention. (The committee also encourages non-governmental organisations to produce alternative reports as a means of obtaining a fuller picture of the state of children's rights than that commonly presented by governments.)

The British government's first report setting out measures to achieve implementation was published in February 1994.(1) It lacked any critical appraisal of the state of children's rights in Britain, failing to identify aspects of children's lives in which there were difficulties or a need for change. An alternative report, the UK Agenda for Children, produced by a voluntary organisation, the Children's Rights Development Unit in collaboration with over 180 national organisations, provided a more detailed and critical analysis of the extent to which current law, policy, and practice complied with the principles and standards of the convention.(2) It too was sent to the United Nations Committee on the Rights of the Child, to whom the unit subsequently gave oral evidence in October 1994.

The committee questioned a government delegation on the contents of the British report in January 1995. After one and a half days' dialogue it produced a critique of the government's failure in implementing the convention and made recommendations for future action.(3) Its concerns, which reflected those contained in the UK Agenda for Children, included the lack of measures to tackle the growing problem of child poverty; evidence of a level of inequality in Britain between rich and poor greater than at any time since the 19th century; and the growing phenomena of homelessness amongst young people; the numbers of teenage pregnancies, higher in Britain than in most other European countries, and the inadequate provisions for sex education. It also noted as matters of particular disquiet the provisions of the Criminal Justice and Public Order Act 1994 limiting the rights of children in gypsy and traveller families and introducing secure training orders for 12 to 14 year olds.

The committee expressed grave concern that the law permitting "reasonable chastisement" as a means of disciplining children is incompatible with the right of children to be protected from all forms of violence. It commented that the principle of the best interests of the child was not reflected in education, health, or social security legislation and that article 12 of the convention--the right of children to express their views on all matters of concern to them--was not being addressed adequately in legislation or practice.(4)

Ultimately, the government is responsible for ensuring full implementation of the convention. However, everyone working with children has obligations to promote the rights it contains. Thus, all such health professionals should be aware of its principles and philosophy. Health authorities and trusts should ensure that children from minority ethnic communities, particularly those for whom English is not their first language, have effective access to all the services they need without discrimination.

Promoting positive change

Children and young people should have all the information they need to enable them to participate in their own health care. A new report by the Institute for Public Policy Research in London recommends an enforceable code of practice for health professionals to ensure that those children who want it are given information on proposed treatment and that their views are "genuinely taken into account."(5) Health promotion programmes should aim to enhance working relationships with young people. Confidentiality should be respected for teenagers as it is for adults. Staff should be familiar with the legislation governing the right of "competent" children to consent to their own treatment.

To promote positive changes in outlook and attitude, the Children's Rights Office, the British Association for Community Child Health, and the Royal College of Nursing produced a guide for practitioners on implementing the convention, Child Health Rights, which contains practical suggestions for action.(6) Professionals with a commitment to greater respect for children's rights must press the government to take the necessary action to achieve change and must lead by example, testing policy and practice against the principles and standards of the convention.

Perhaps the single most important step for a durable change in attitudes towards children in Britain would be the creation of a statutory children's rights commissioner with the explicit responsibility of representing or promoting the rights and interests of children in all areas of law, policy, and practice affecting them. The office might have powers to investigate breaches of the convention, monitor and promote compliance with the convention, scrutinise children's access to complaints procedures, develop models for the use of child impact statements on national and local government policy, and to report annually to parliament on the state of children's rights. Such work would need to be informed by the views and experiences of children and young people themselves.

We need an office of children's rights commissioner, together with a clear government strategy for children and a minister for children within the cabinet office.(7) These initiatives would mean that the next report to the United Nations committee, in 1999, could be approached confident in the knowledge that the principles and standards in the convention had been given serious consideration and that respect and care for children had been placed at the centre of the political agenda. Meanwhile, for those who work with children in the health service, there is no escaping the fact that the responsibility of ensuring the rights of children as established in the convention rests with us.

Gerison Lansdown
Director Children's Rights Office,
235 Shaftesbury Avenue,
London WC2H 8EL

Tony Waterston
Convener,
British Assocation for Community Child Health
Newcastle City Health NHS Trust,
Newcastle upon Tyne NE4 8NZ

David Baum
Professor Department of Child Health,
Royal Hospital for Sick Children,
Bristol BS2 8BJ

References

1 The UK's first report to the UN Committee on the Rights of the Child. London: HMSO, 1994.

2 Lansdown G, Newell P. UK agenda for children. London: CRDU, 1994.

3 Committee on the Rights of the Child. Concluding observations of the Committee on the Rights of the Child: United Kingdom of Great Britain and Northern Ireland. Geneva: United Nations, 1995. (CRC/C/15/Add.34.)

4 Making the convention work for children: explaining the history and structure of the UN Convention on the Rights of the Child and its application in the UK. London: Children's Rights Office, 1995.

5 Alderson P, Montgomery J. Health care choices: making decisions with children. London: Institute for Public Policy Research, 1996.

6 Child health rights: implementing the UN Convention on the Rights of the Child, a practitioner's guide. London: British Association for Community Child Health, 1995. (Obtainable from British Paediatric Association, London NW1 4LB.)

7 Newell P, Hodgkin R. Effective government structures for children: report of a Gulbenkian Foundation inquiry. London: Calouste Gulbenkian Foundation, 1996.