Dr Sheila ShribmanNational Clinical Director, Children, Young People and Maternity Services

NHS Employers Annual Conference

Child Health Strategy and Safeguarding

4th November 2009

The Children’s Plan: Building brighter futures

Children’s Plan sets out the vision for children & young people, and trailed development of a Child Health Strategy.

Government’s 2020 ambition for all children and young people is to:

• Secure the wellbeing and health of children and young people;

• Safeguard the young and vulnerable;• Achieve world class standards in education;

and • Close the gap in educational achievement for

children from disadvantaged families• Ensure young people are participating and

achieving their potential to 18 and beyond• Keep children an young people of the path to

success.

Every Child Matters – Change for Children

Be healthy Stay safe Enjoy and achieve Make a positive contribution Achieve economic well-being

Children’s NSF Standards

Core Standards (Standards 1-5):Promoting health Supporting parents/carersChild and family-centred servicesGrowing upSafeguarding

Standards 6-11Ill ChildHospital servicesDisabled childMental health and psychological well-beingMedicinesMaternity services

A healthy childhood is critically important

Improving children and young people’s physical and psychological health, by investing in children’s health from the early years, through childhood and adolescence, will benefit children, families, society and the NHS.

Children and young people are healthier than ever before

Supported by medical, technological, social and economic advances

Helped by more information and support for parents and more skilled professionals

To address inequalities, current trends and public concern

The past decade has seen continued improvements

But we need to do more to become world-class

The Strategy reflects the concerns people raiseChildren and young people:• Highlighted the importance they place upon their psychological

wellbeing as well as physical health• Want services that are easier to access in locations that are both

convenient and provide them with confidential support and advice

Parents and carers:• Want to know what health services are available in their local areas• Want more to be done to provide healthier environments for children • Parents of children with additional health needs want stronger

links between the multiple services that they may need to access

Practitioners: • Want central government to do more to support greater cooperation between Local Authorities

and Primary Care Trusts so that parents and children get the best possible support and advice

The Strategy is informed by

extensive engagement with children, young people, parents and practitioners through

a range of events across England.

Realising these ambitions will require partnership

Children and young people: As children grow up, so does the responsibility that children and young people have for their own health and wellbeing.

The Strategy will help young people to make healthy choices.

The Strategy will help parents and carers to support their children’s healthy development.

The Strategy sets out how those delivering health services to children and young people will be supported.

Parents and carers: Mothers, fathers and those caring for children and young people have the greatest influence on their emotional and physical health.

Practitioners: Those working on the frontline recognise the challenges of integrated delivery.

Four principles underpin how we will improve users’ experience of services from birth to 19

Public sector settings provide healthy environments and encourage children and young people to make healthy choices through their lives

Healthy opportunities

The right services are in place to meet the specific health needs and expectations of children and their families, informed by local assessments of what is required, intervening early where health needs arise

Responsive services

Extra support is provided for the most vulnerable and those from the most disadvantaged backgrounds

Targeted support

Mothers and fathers are provided with the information they need, with all local areas setting out what parents will be able to receive in their community, from pregnancy to services for young people to age 19

Informed users

The Strategy will realise our joint ambition for children’s health services

The Strategy cements our standards and ambitions…

• The National Service Framework for Children, Young People and Maternity Services

• Every Child Matters• The Children’s Plan

“… The Children’s Plan and the NHS Operating Framework signal a higher priority for children and young people in the operation of health services.”

Continued improvement to services to support families from pregnancy onwards

World-class health outcomes

Services of the highest quality

Excellent experiences in using services

Minimise health inequalities

Support to parents to give their children a healthy start and partners to deliver change in every area

Achieve long-term aims for children and young people’s health

Pregnancy and the early years

School-age children

Young people

Children with acute and additional needs

System Level Transformation

Support through pregnancy and the early years

A wide range of guidance and care is available for parents, babies and young children from before pregnancy through to the age of five delivered through Children’s Centres as well as GPs and other health settings. The core programme is the Healthy Child Programme:

Commitments to strengthen support in pregnancy and the early years

Expand Family Nurse Partnership to 70 areas by 2011

Help for vulnerable first- time mothers

Access to a named health visitorRole of Sure Start Children’s Centres

Development of the health visitor work force and the Healthy Child Programme for 0-5sHealth visitor workforce

Development of new Antenatal and Preparation for Parenthood programme

Antenatal and postnatal support

A wide range of support and healthy opportunities are available for children of school-age – both in and out of school:

Support for school-age children

Further piloting of free school mealsUptake of healthy school meals

An improved Healthy Child Programme for school-aged children

Developing a core health programme 5-19

Promoting pupils’ healthSchools supporting children’s health

Commitments to strengthen support for school-age children

Support for young people

There is a range of health-related services for young people, delivered in a way that is appropriate to their needs:

‘You’re Welcome’ standards across EnglandYoung people-friendly health services

New awareness campaign backed by fundingContraception

Three hours high quality sports a week for 16-19 year oldsSports

Commitments to strengthen support for young people

You’re WelcomeThe Quality Criteria covers:

• Accessibility

• Publicity

• Confidentiality and consent

• Environment

• Staff training, Skills, Attitudes, Vales

• Join-up working

• Monitoring and evaluation, involvement of young people

• Health and adolescents

• Sexual and reproductive health services

• Child and Adolescents Mental Health Services (CAMHS)

Children with acute or additional health needs

We are working to ensure high quality, timely and accessible support is available for children and young people with acute or additional health needs and their families

The right help to cope with sudden, short-term physical or mental illness; long-term or complex medical conditions; disabilities; and with palliative and/or end-of-life care.

Commitments to strengthen support for children with acute or additional health needs

Test and expand new approaches to the provision of services including urgent and emergency care

and wheelchair provision

New approaches to service provision

All children with complex health needs have an individual care plan by 2010Individual care plan

Confirms £340 million in NHS allocations 2009-2011

Funding for services for disabled children

Long term conditions

• Diabetes 84% under 16s poorly controlled

• Asthma 75% hospital admissions avoidable

• Epilepsy Up to 24% misdiagnosed

• Individual care plans – by 2010

Supporting local partners jointly to set out and deliver a local offer that reflects local needs

The Strategy will realise our joint ambition for children’s health services

… and links to wider health policy & Programmes, including

• High Quality Care for All (NHS Next Stage Review)

• World-Class Commissioning

• Transforming Community Services

Sets out the vision for a 21st century NHS

High Quality Care for All

• Has ambitions for an NHS that:– helps people to stay healthy– gives patients more rights and control over their own health and

care– gives patients even greater influence over the services they use– is pioneering, embracing the best new ideas and treatments– values its staff and empowers them to lead local change

• The Child Health Strategy details how NHS organisations will work in partnership with others to achieve these ambitions for children and young people, building on SHA Next Stage Review work on child health

Quality, Innovation, Productivity, Prevention

What can we do on child health and well-being?

• Marshall the evidence base – for focus on the early years, and on early intervention

• Roll-out evidence-based programmes e.g. Health Child Programme 0-5, 5-19

• Pursue higher quality, better value e.g. wheelchairs, community equipment for disabled children

• High quality, cost-effective workforce – Action on Health Visiting, Transforming Community Services

• Innovation in partnership working, third-sector contribution• Stronger commissioning for child health

Commissioning to Improve Health Outcomes

• World class commissioning is a programme of development and assurance to achieve a step-change in commissioning for health outcomes, supported by commissioning competences and an assurance system to drive up performance and development.

• The joint planning and commissioning framework for children, young people and maternity services was developed with children’s services commissioners across health, local government, schools and youth justice

Children’s Trusts• Subject to the passage of legislation, from April 2010

Children’s Trust arrangements will be stronger. New legislation will:

– Put Children’s Trust Boards on a statutory basis for the first time– Transfer ownership for the CYPP from LAs to the CT Board– Add in new ‘relevant partners’ including schools

• These new arrangements provide an opportunity for ever- closer joint working

Transforming Community Services• Transforming community services is a 2 yr programme to

deliver high quality community health services through– Improving services – developing a Quality Framework and six

Transformational Guides (one on Children and Families)– Developing people – securing clinical leadership and ownership

through the Innovation and Leadership in Community Services Fund launched Jan 09

– Improving systems – developing the business infrastructure to support world class commissioning and provision of community services

Eight cross-cutting work strands

3a. Better Information for effective needs assessment to

improve commissioning

1. Effective local Leadership and Accountability on child health through Children’s Trusts, to be fully reflected in

statutory Children & Young People’s Plans

2. Joint Commissioning arrangements that build on World Class Commissioning competencies, with help for

CT partners from the Commissioning Support Programme

3. Service delivery through a high quality Workforce with the right skills and capacity, delivered through multi- agency teams who are better able to work together

5. Improve Service Quality

through inspection and

assurance systems, better informed by the

views of children, young people and parents

6. Better co-ordinated regional support & challenge, with Government Offices, Strategic Health Authorities and delivery partners working more effectively at local, regional & national level

7. Better national communication to ensure coherent messages on the importance of child health are communicated across DCSF & DH, building on positive response to the strategy among stakeholders

3b. Better Information

sharing to provide more personalised

support to users

8. Enable delivery partners to prepare for tighter fiscal context by ensuring better value for money is achieved through stronger partnership working locally, regionally and nationally.

3a. Better Information for effective needs assessment to

improve commissioning

SafeguardingThe Challenge

Lord Laming: “Whilst the improvements in the services for children and families, in general,

are welcome it is clear that the need to protect children & young people from significant harm & neglect is ever more challenging”

“Challenge to effectively translate policy, legislation & guidance into day to day practice on the frontline in every service”

“now needs to be a step change in the arrangements”

“some agencies still think they are helping out children’s social care rather than thinking safeguarding is everybody’s responsibility”

“ultimately the safety of a child depends on staff having the time, knowledge & skill to understand the child & young person & their family circumstances”

Landscape

Higher focus on children

The opportunity of safeguarding children – high profile

Care Quality Commission – core standard 2 declarations, new registration process

5 areas to focus – Laming’s areas

Strong effective leadership

Early intervention

Adequate resources

Quality, performance management

Inspection & support

Strong effective leadership

Board safeguarding lead – looking at competencies for this role now.

Named safeguarding professionals – clarity, resource, support

Membership of LSCB – at a senior level

Culture of openess and support

Early intervention

Don’t lose the focus on this

Common assessment framework & lead professional

Tracking systems – A/E, GPs etc., Out patient DNAs – Information sharing

Think child, think parents, think family – SCIE guidance – Mental Health Trusts (NPSA)

Information Sharing

• Safeguarding highlighted in SHA assurance framework

• Developing sentinel indicators for the NHS

• NHS Operating Framework for 2010/11

• David Nicholson’s second letter to NHS 16 July 2009 asks chief executives to assess their own position against the findings of the CQC report Safeguarding children and take urgent action where necessary

• Meetings with individual SHAs to ensure that appropriate action has been taken

• Assess information from SHA meetings and set out next steps

Information sharing

• Appropriate information sharing is essential to:

– Support effective integrated working– Enable early intervention– Safeguard and promote welfare– Ensure wider public protection

• Information sharing needs to be necessary, proportionate, relevant, accurate, timely and secure

• Poor decision-making, based on incomplete information, can lead to poor outcomes and can mean that children and young people slip through the net

• There is a leadership role for Children’s Trust partners in developing information sharing governance frameworks

Support and guidance

Products available at: www.dcsf.gov.uk/ecm/informationsharing

Action on Health VisitingCollaboration between DH & Unite / CPHVA to address fall in health visitor numbers, clarify specialist contribution, improve

image and update education and training

Involved large number of stakeholders – health visitors, managers, academics, parents, DCSF and commissioners

1st phase produced guidance, based on consensus view of the role of health visitors:

• Leading and delivering the Healthy Child Programme• Being the named health visitor in Sure Start Children’s Centres• Supporting vulnerable families• Defining the specialist skills in protecting children• Creating and developing effective teams

Also reiterates the public health role of the health visitor

Next phase focuses on building health visitor workforce, education, career pathways and leadership

Guide- Getting it Right for Children & Families: Maximising the contribution of the health visiting team. www.dh.gov.uk /publications

Adequate resources

Designated and Named professionals

Training – my review and Intercollegiate competencies

Supervision and support

Clinical networks project

Action on HV

Quality & performance management

Safeguarding part of NHS performance management systems – David Nicholson’s letter, SHA assurance.

Need robust audit processes at all levels to ensure compliance – policies and procedures alone are not enough.

Inspection & support

CQC review of safeguarding – some serious concerns

Need robust audit of systems to ensure compliance

Inspection and support (culture)

Recognise the neglect of children by being aware of the whole history and the significance of it ie maternal deprivation such as severe early trauma, parental death, abuse, mental illness

Recognise mounting stress in families Awareness of the danger of professionals mirroring the chaos of families they

are working with Ensure they do not deal with overwhelming information and the feeling of

helplessness by the “start again” syndrome ie putting aside knowledge of the past and focusing on the present

Awareness of the debilitating impact neglectful families have on how professionals think, feel, and behave

Need clear mechanisms to report and discuss concerns and to build up a clear picture of risks and protective factors

Awareness of the effects on workers of parental hostility such as becoming frozen, hampered in reflecting, making judgements, acting clearly and following through

Contd.

Practitioners need to work in safe “containing” organisations that allow them to be curious and encourage them to puzzle over what is happening in families. Organisations need to deal helpfully and supportively, not defensively, with the complexity of practice and decision making.

A system of good line management that is creative, empowering and sensitive to the individual needs of frontline staff (Laming)

Effective, regular supervision that concentrates on the dynamics of practice and the worker’s emotional responses is crucial

The supervision needs of those in health …. Require a degree of priority Importance of ongoing training – the tendency towards “silo practice” where

professionals preferred to work within the comfort zone of their specialism, underlines the importance of joint child protection training

Taken from the 2005-07 Review of Serious Case Reviews

Sir Ian Kennedy’s review of NHS children’s services (1)

• David Nicholson asked Sir Ian to undertake a thorough review of NHS children’s services, to report back to him in March 2010. The review will consider:

– the cultural obstacles that can stand in the way of sustained improvement in the provision of care for children

– what can be done to develop the NHS’ contribution to safeguarding children.

• Sir Ian intends to visit widely in the NHS, and is keen to hear from key stakeholders, partners and anyone working in or using services. He can be contacted at childrensservicesreview@dh.gsi.gov.uk

Sir Ian Kennedy’s review of NHS children’s services (2)

• The areas Sir Ian has already designated priorities include:– the care of children outside specifically paediatric settings; – health visiting and community services; – the pathways of care; – primary care including A&E; and – arrangements to safeguard children;– the management of the transition to adult care; – how the NHS works with its partners to support children; and – how the NHS responds to the needs of families as well as individuals.

Vetting and Barring Scheme

From 12th October 2009 the following changes came into effect that will further enhance protection of children and vulnerable adults:

it is now a criminal offence for barred individuals to apply to work with children or vulnerable adults in a wider range of posts than previously. Employers also face criminal sanctions for knowingly employing a barred individual across a wider range of work;

the three barring lists (POVA, POCA and List 99) have been replaced by the creation of two new barred lists administered by the ISA rather than several Government departments. From now on checks of these two lists can be made as part of an Enhanced CRB check;

additional jobs and voluntary positions will be covered by the barring arrangements, including moderators of children’s internet chat rooms, and large number of NHS staff;

employers, social services and professional regulators have a duty to refer to the ISA any information such as why they stopped or considered stopping an individual working with vulnerable groups where they consider them to have caused harm or pose a risk, ensuring threats to vulnerable groups can be identified and dealt with.

More information: www.isa-gov.org

DH commitment to staff support – what else will help

Finally:

“When I approach a child, he inspires in me two sentiments: tenderness for what he is, and respect for what he may become”

Louis Pasteur