THE HEALTH SERVICES
The Children's Safeguards Review
6.1 The main issues raised by the Review related to the health needs of looked after children and to the protection of children whilst in a health care setting. It included:
meeting the health needs of looked after children
- looked after children were not receiving the health care they needed, in particular from mental health services. The Health Departments should facilitate appropriate action by local and health authorities to identify and meet the health needs of looked after children
- many looked after children had been abused, but were not receiving the treatment they needed. Local and health authorities should assess and meet the need for treatment of children who have been abused
protecting children in health care settings
- it appeared that Section 85 of the Children Act, which requires health authorities to notify local authorities about a child who has been or is intended to be in hospital for more than 3 months, was not being consistently followed. An SSI inspection should assess the matter
- there should be an inspection of the arrangements for safeguarding and promoting the welfare of children in all nursing homes and hospices in which children were accommodated
- units providing in-patient mental health services for children needed to be fully aware of child protection issues.
The Government Response
6.2 The NHS is continually striving to improve the services it provides to all patients. The Government is determined that action must be taken to ensure that the health care needs of looked after children are met, and that children living in health settings are safeguarded and their welfare promoted.
Meeting the health needs of looked after children
6.3 Meeting the basic
health needs of looked
after children is a priority
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6.3 The Government recognises that looked after children have particular health needs, with a high prevalence of both physical and mental illness. Meeting the basic health needs of looked after children was identified as a priority in the National Priorities Guidance (NPG) for 1999/2000 which was issued jointly to the NHS and social services authorities on 30 September 1998, and targets have been set for making improvements.
6.4 Entry to care is a key opportunity to identify the health needs of the child or young person being taken into care and to plan, with them, any necessary action. The NPG sets targets to ensure that all children entering care are offered a comprehensive health assessment, and have an appropriate treatment plan drawn up. The Government will issue further guidance on this in 1999.
6.5 Improvement to child
and adolescent mental
health services to be given
priority
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6.5 The NPG also specifically addresses child and adolescent mental health services within the joint priority for Mental Health Services. Priority will be given to building up core services, increasing staffing levels and developing multi-disciplinary teams within local child and adolescent mental health services. Building closer and more effective links with Social Services Departments will be an integral part of this process.
6.6 From 1999 a new annual reporting mechanism will monitor improvements at a national level. For the first time funding for child and adolescent mental health will be made available for further developments through the Mental Illness Specific Grant. In Wales, this grant has been subsumed into general allocations.
6.7 Identifying the needs
of children who have been
abused
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6.7 To allow more effective commissioning of services, better information on the prevalence and nature of mental health problems in children and young people is needed:
- a survey of the mental health of children and young people throughout England, Wales and Scotland, commissioned by the Health Departments is now being piloted. The results of the main survey will be available at the end of 1999
- a project specifically to assess the needs of looked after children is being developed, and this will report in 2000
- the Welsh Office has commissioned a survey of child and adolescent mental health services in Wales to pinpoint deficiencies in the system
- the Welsh Office has commissioned a project to develop an information pack for primary school teachers on the sources of help available when a child shows signs of mental illness or emotional disturbance.
6.8 The needs of children who have been abused will vary according to the nature of the abuse and the individual circumstances of the child. A variety of agencies may be involved eg the NSPCC, as well as the NHS in providing services for these children. The Department of Health funds a number of research projects which aim to increase understanding of the causes of abuse, its prevention and the effectiveness of interventions for those children who have developed problems.
6.9 Looked after children may move frequently. This can disrupt treatment that they are undergoing. It has led to disagreements over which NHS agency should pay for their treatment. Revised guidelines on district of residency which will put an end to this will be issued in Spring 1999.
Protecting children in health care settings
6.10 The Government agrees that the operation of Section 85 of the Children Act should be assessed. Social Services Inspectorate (SSI) working in partnership with a NHS Executive Regional Office will undertake a thematic review as soon as possible, and the Government will consider the need for any further action once the results of the review are available.
6.11 Child protection
and welfare issues in
non-NHS health care
settings
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6.11 Residential care homes are currently regulated and inspected by local authorities and nursing homes, hospices and independent hospitals are currently registered and inspected by health authorities. In the regulations governing such homes, child protection and child welfare issues are not prominent and the Government will announce how best to ensure that child protection and child welfare issues are dealt with in 1999.
6.12 The Government agrees that special attention needs to be given to ensuring that children in in-patient mental health units are safeguarded. It will consider this further, when the forthcoming report by the Health Advisory Service 2000 on in-patient mental health units in Wales is available. The procedures for employing staff are covered in Chapter 8.
6.13 The Children Act and the Mental Health Act both apply in certain circumstances to children with mental health problems. Better guidance is needed to assist health professionals and social workers to determine how to work most effectively within the legislative framework. The Code of Practice for the Mental Health Act is currently undergoing a major revision, and the new version will specifically address the interface issue. Subject to Parliamentary approval the new Code will be published early in 1999.
6.14 In the longer term a review of the Mental Health Act has recently been announced. This will cover aspects relating to children and young people, such as the interface between the Mental Health Act and the Children Act.
6.15 Rules for the welfare and protection of children visiting high security hospitals are being developed.
Implementation, Monitoring and Enforcement
6.16 The Government is taking action in the areas recommended by the Children's Safeguards Review by:
- requiring all children entering care to be offered a health care assessment and treatment plan. Guidance will be issued in 1999
- a programme of targeted investment in child and adolescent mental health services. The NPG for 1999/2000 sets targets for building up core child and adolescent mental health services
- continuing to build the evidence base for mental health problems in children and young people, including the specific needs of children who have been abused, to enable the NHS to best target its resources to meet identified needs
- assessing the use of Section 85 of the Children Act, to inform action as required
- including the protection of children in residential care homes, nursing homes, hospices and independent hospitals as part of its work on the regulation of children's services, and considering appropriate action to protect children in in-patient mental health units
- issuing a revised Code of Practice for the Mental Health Act which will specifically address the interface with the Children Act and, in the longer term, reviewing the Mental Health Act.
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6.17 Monitoring and
performance assessment
through NHS Executive
Regional Offices
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6.17 The Government can and will ensure that the response to the Review's recommendations is implemented by the NHS. Progress towards the targets set in the National Priorities Guidance will be monitored through the regional performance management arrangements.
6.18 The Regional Offices of the NHS Executive manage the performance of NHS organisations within their Region working, as appropriate, with their counterparts in the Social Care Regions. Proposals to strengthen performance assessment were included in the White Paper The new NHS. In Wales these proposals were set out in the White Paper Putting Patients First. Regional Offices will have new powers to intervene on the Secretary of State's behalf on grounds of quality or if problems arise in partnership working with other agencies. The Government does not intend to change the principle that levels of service provision are best determined at local level. But health authorities and NHS Trusts must always take full account of national priorities and national guidance when considering the need for improved or additional services.
Outcomes
6.19 The Government expects these policies to deliver:
- improved identification and delivery of services to meet the health care needs of looked after children with all children and young people being offered a comprehensive health assessment on their entry into care
- improved child and adolescent mental health services
- better understanding of mental health problems of children and young people in general, and looked after children in particular
- improved understanding of the workings of Section 85 of the Children Act 1989 to inform future action
- improved protection for children in registered care homes, nursing homes, private hospitals, hospices and in-patient mental health units
- a better understanding of the legislative framework for children with mental health problems and improved working within this.
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