Time to get it right

Ensuring high quality healthcare services for children and young people is a key part of the coalition government's plans. Helen Burnell looks at recent developments.

The government set out a new vision for the health of children and young people on 16 September 2010 in an engagement document which can be found here. This was published alongside the much anticipated report of Professor Sir Ian Kennedy, Getting It Right for Children and Young People: Overcoming Cultural Barriers in the NHS so as to meet their needs. Readers will recall that that Sir Ian was commissioned to undertake the report, following the death of Baby P.

Achieving Equity and Excellence for Children

This document forms the opening part of an ongoing dialogue on how to ensure high quality services for children and young people. It is a detailed supplement to the ongoing consultation on the White Paper, Equity and Excellence: Liberating the NHS.

Andrew Lansley, Secretary of State for Health, states that the government (informed by Sir Ian’s report and in line with the new focus in the White Paper on patient-centred care) intends to ensure that it shapes the future of children and young people’s services to meet their needs more effectively by improving health outcomes to be amongst the best in the world, through more devolved, locally integrated service provision.

Achieving Equity and Excellence for Children outlines that it endeavours to:

• personalise services to individual needs which are appropriate for children, young people and their families;
• ensure that age specific information becomes routinely available and accessible;
• ensure that children, young people and their families are at the centre of the design and delivery of services, facilitated by local professionals; and
• ensure that improvements are measured in terms of outcomes for children and young people rather than just time-focussed targets.

The vision focuses on the objectives outlined in the White Paper.

Further important points from an NHS perspective include:

• NHS outcomes will be underpinned by quality standards formulated by NICE. Any specific considerations relating to children and young people should be an “automatic ingredient” of the standard, where appropriate.
• There will be an increased focus on the transition between children’s and adult services.
• Partnership working is again a focus of attention. The government states that it intends to lay down firm foundations for joint working and that the key responsibilities for organisations that will be responsible for child health are being set down following the reforms outlined in the White Paper.
• There will also be a focus on local commissioning.
• Children’s Trusts will be restructured in order to reduce bureaucracy. This includes a legislative timetable to abolish the need for a joint children and young people’s plan and to withdraw the statutory guidance relating to Children’s Trusts.
• Every organisation must also be clear about its own responsibilities in the field of safeguarding. PCTs and SHAs have responsibilities for safeguarding set out in statute. The government proposes that those duties should pass onto the GP consortia and the NHS Commissioning Board in due course. The government is also considering the links which would be necessary between Local Safeguarding Children’s Boards (LSCBs) and proposed Health and Well-Being Boards. This will be considered further in the report being undertaken for the Department of Education by Professor Munro. The government is considering a core accountability framework in relation to safeguarding via the Health Bill and we will keep readers updated in relation to this. As the vision outlines, this will be an important new role for GP consortia and one which will go beyond the experience of most existing GP commissioning groups. The NHS Commissioning Board will be responsible for overseeing the commissioning of NHS services for children and young people.
• Services should also consider the possibility that Gillick competent children and young people may not wish their parents to know that they are receiving healthcare or be involved in decisions about the healthcare they receive. This shows the increasing recognition of competent children’s autonomy in decision making.
• Health visitors warrant special mention as being well placed to help families to link to local communities and, where needed, to specialist care.

Professor Sir Ian Kennedy’s Report

Sir Ian’s report was published on the same day and key elements from his report have been incorporated into the Government’s vision for children and young people.

The report identifies a number of challenges concerning the quality of services alongside examples of areas of excellence. Overall, he has suggested in his report that child health services have received a “disproportionately low priority”.

It contains a detailed overview and analysis of the effectiveness of NHS services for children and young people. Sir Ian spoke to professionals in various roles and commented that he has seen enthusiasm, commitment and a real sense of caring and duty. The quality of services for children and young people varies across the country. Assessments have shown not only that a large number of services are in need of significant improvement but also, importantly, that there are some excellent services from which others might learn.

Sir Ian emphasises some important issues in promoting children’s health:

• Getting policy right.
• Considering change within the NHS including how services are configured in promoting positive health (e.g. addressing issues such as obesity, teenage pregnancy and substance abuse). Sir Ian also focuses on the need for the NHS to work in partnership.

Sir Ian outlines that the NHS must invest to save and invest because it is right to do so. His approach contemplates the integration of services, working collaboratively within the NHS and across other agencies. Savings will be made through greater efficiency, through co-location (and the benefits it brings) and through the joint planning and commissioning of services. His report endorses the need to empower professionals within the safeguarding arena.

Sir Ian outlined that his review has uncovered cultural barriers standing in the way of improving the services of the NHS for Children and Young People. These barriers were created and operate, at a number of levels, from Whitehall through regional and local organisations, to contacts between individual professionals and with children, young people and those looking after them.

Recommendations

Sir Ian’s recommendations include:

• Recommendation 1: Responsibility for policy relating to health and wellbeing of children and young people should be brought together in a single Government department. In addition to health and healthcare, this responsibility should extend to include as many other aspects of public services used by children and young people as possible.
• Recommendation 3: Funding for the health and healthcare of children and young people and ‘transition’ to adult hood must be identified, separated from the funding dedicated to the care of adults and transferred to the responsible Government department for further distribution to organisations at local levels.
• Recommendation 4: There should be dedicated local partnership in every local authority or similar area which is responsible for the planning and delivery of children and young people’s health and healthcare at the local level and for integrating these services into all of the services provided.
• Recommendation 9: The Local Partnership must create structures whereby the views of children and young people can be sought and taken account of in the planning and delivery of health and healthcare services.
• Recommendation 12: The Local Partnership should have a dedicated team drawn from NHS Commissioning organisations, local authorities and elsewhere, which is responsible for commissioning all services, including health and healthcare services, for children and young people.
• Recommendation 14: There should be a single point of access to the NHS’s services for children and young people through general practices or the hub of some form of poly-system.
• Recommendation 16: Information about the care of children and young people must be collected and consolidated at the central point of access, the general practice or the hub of some form of poly-system. It should be available to all who provide services for children and young people. Readers may recall previous concepts of a similar hue, for example, the now defunct ContactPoint.
• Recommendation 17: There should be a dedicated information officer in general practices or at the hub of poly-systems responsible for the collection, coordination and dissemination of information about the care and welfare of children and young people in the relevant area to those providing services/need to know.
• Recommendation 18: All GPs, practice nurses and other professionals attached to general practice or who form part of a poly-system should, as a matter of urgency, receive training in the comprehensive care of children and young people.
• Recommendation 19: The initial training for GPs, the Quality and Outcomes Framework and the system of revalidation should all incorporate the need for training and the comprehensive care of children and young people.
• Recommendation 20: General practices and those at the hub of poly-systems should seek to ensure that there is at least one professional who has specialised knowledge in the comprehensive care of children and young people.
• Recommendation 21: Urgent action is called for to respond to the mental health needs of children and young people. Mental health services must be available and accessible, including through self-referral, and be integrated with other services, particularly through schools.
• Recommendation 29: There should be a single criterion for measuring the quality of the NHS services for children and young people – satisfaction. There should be two elements to satisfaction: where the children and young people are satisfied with the outcome achieved, by reference to what they are able to judge; and whether the professionals should be satisfied, by reference to the current appropriate benchmarks of performance. The internal performance management and external regulation of the NHS must reflect this approach.
• Recommendation 32: Arrangements must be agreed, regarding funding and other matters, to address the changing needs of children and young people as they mature, including greater continuity of care into adulthood. Ensuring a smooth transition between children’s and adults’ services should be a priority for local commissioners.
• Recommendation 33: NHS services for children and young people should be designed, organised and delivered from the perspective of the child, young person and parent or carer. Relevant NHS services should regularly assess the expectations and views of children and young people using the services, and should take action in light of the findings, which should be made public.

Conclusion

Many of the recommendations/aspirations are not new, such as listening to children and young people. There has been an increase in recent years in feedback being made publicly available in relation to the NHS’ interface with children, e.g. the anonymised publication of executive summaries following serious case reviews. Formalising that process however is new. There is clearly a change of focus in some areas, including the impending responsibility of GP consortia and a single responsible department for children and young people.

We will watch with interest to see how clinical governance around child protection and commissioning decisions will continue to develop in line with the White Paper and the new vision.

Helen Burnell is an associate at Mills & Reeve. She can be contacted on 020 7648 9237 or via This email address is being protected from spambots. You need JavaScript enabled to view it..