Making It Work For Scotland's Children
A summary
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The report Making It Work for Scotland's Children reviews the achievements of the Child Health Support Group during its first three years. The report also looks forward, revealing the Group's plans for driving forward its ambitious agenda.
This is a summary of the report's main points.
Vulnerable children and the NHS - the background
In spite of many examples of high quality care by dedicated staff, national audits of services have painted a bleak picture of support for the most vulnerable children.
For Scotland's Children (Scottish Executive, 2001) found that:
services are fragmented;
support is poorly targeted;
support often comes too late to make significant improvement; and
services for the most vulnerable children are stigmatised.
It's Everyone's Job to Make Sure I'm Alright (Scottish Executive, 2002) found that:
some children and families are not getting the help they need when they need it;
some children are not being adequately protected; and
the needs of children lose out to the needs of the system.
Since devolution, child health has risen rapidly up the Scottish Executive's agenda. It has become the fourth national priority for the NHS, alongside cancer, coronary heart disease and mental health. Two of the four pillars of the Scottish health improvement plan focus on children's health in the early years and at vulnerable points of transition in the teenage years.
For the NHS as a whole, the White Paper Partnership for Care (February 2003) heralds a simpler structure, leading to more efficient communication and learning. Fifteen unified boards will take in planning, commissioning and operational functions. These boards will have close links to GP practices, local authorities and other partners in new, locality-based Community Health Partnerships. The new structure will also include the three regional service planning groups for West, North and South-East Scotland.
The Child Health Support Group
The Health Minister set up the Child Health Support Group in July 2000 to work with the Scottish Executive, NHS, local authorities and the voluntary sector to improve child health and children's health services. Frontline clinicians and professionals make up its 16-strong membership, from medicine, nursing, social work, allied health professions, public health and the voluntary sector. They work closely with a large network of stakeholders.
The Group provides support and direction for NHS Boards and Trusts in Scotland, as well as giving expert advice to Ministers and the Health Department on child health and child health services. Through its members' expertise, experience and independence, the Group aims to influence and shape national policy and local practice.
Achievements in the first three years
Drawing on existing guidance and best practice, the Group has produced a national template, providing a clear framework to help NHS organisations in planning, providing and monitoring child health services. This highlights the importance of good communication and effective working between primary care and community-based and hospital services ('a combined service'). It also emphasises the need for joint work with other partner agencies in local authorities and the voluntary and independent sectors ('an integrated service').
During its first two years, the Group visited all NHS Board areas in Scotland, gathering information about local health care systems and advising on local improvements. Before each two-day visit, the Board concerned would complete a specially-designed template for self-assessment, to gauge how it complies with guidance and good standards of clinical practice. The visits have found examples of innovation and excellence in practice and management, as well as areas of difficulty. They have also prompted local development and new investment in children's services.
The Group provided expert advice in the Scottish Executive's response to the public inquiry into child deaths following cardiac surgery at Bristol Royal Infirmary. Although the response acknowledged that there has been no suggestion of similar problems in a Scottish hospital, it reinforced the need to avoid complacency. Following a recommendation from the Group, the Health Department is to review emergency care for acutely ill and injured children.
Child health has become part of the national Performance Assessment Framework (PAF) for NHSScotland. In December 2001, the Scottish Executive issued the first self- assessment tool to help NHS boards assess progress. The Group was also involved in revising the PAF tool for 2002-2003. The tool should enable more effective comparison of individual Boards' performance and of progress between Boards.
The Group's visits to local health care systems took place alongside a national review of progress in developing better integrated services for children. An external action team of professionals had been seconded to the Scottish Executive for the review, and there was close collaboration between the two teams. Group members contributed to the Action Team's review and were consulted on the development of the final report, For Scotland's Children.
The Group organised Scotland's first national conference on child health in February 2002. Attracting 300 delegates, the conference emphasised that children and young people, and support for their healthy development, are a key priority for the Scottish Executive. It highlighted innovative practice across the country. The second annual conference, held in February 2003, focused on the conclusions of the national review of child health screening and surveillance by the Royal College of Paediatrics and Child Health, set out in the fourth edition of Health for all Children.
* Giving a profile to child and adolescent mental health
Along with NHS Health Scotland, the Group jointly sponsored the launch of the Scottish Needs Assessment Programme (SNAP) report on child and adolescent mental health. A number of young people had been consulted in the development of the report, and they took part in the launch. The SNAP report provides a comprehensive and authoritative account of the issues affecting the mental health and wellbeing of children and young people in Scotland.
Driving forward the child health agenda - the Child Health Support Group workplan
The Group has successfully raised the profile of child health services, both locally and nationally. It has played a crucial part in making sure that expertise and advice about best practice are shared across the country. The Group now has comprehensive information about child health services in Scotland, and where there are strengths and areas for development.
A revised remit and workplan are continuing the Group's work to drive forward improvements, alongside the national network of Lead Child Health Commissioners in NHS Boards.
During the programme of visits to local health care systems, a number of issues came up again and again. These now provide the basis for this second stage of the Group's work, with the workplan focusing on five specific areas. A lead member of the Group is overseeing each area, in partnership with other stakeholders, to ensure progress in tackling the challenges. Sub-groups are working on the issues, widening the network of people shaping and influencing policy and service development in these critical areas.
Promoting social justice through better integrated services for children
During its visits to local health care systems, the Group found excellent examples of joint planning and delivery of services. It also found that there were challenges and problems in developing integrated working in many organisations and in most areas. There was a need for focused leadership and support for the NHS in joining up with their local authority and voluntary sector colleagues.
The Group aims to support:
the development of joint assessment;
the delivery of the three-year national programme of child protection reform;
the effective integration of planning, managing and delivering children's services; and
bringing in the recommendations of Improving Health in Scotland: The Challenge (Scottish Executive, 2003), focusing on early years and teenage transitions.
Reviewing and planning specialist paediatric services
It is increasingly difficult for specialist doctors and nurses to get the experience they need to keep up their skills, especially when they are dealing with complex or rare conditions. A planned approach is needed to develop the workforce and reshape services.
The Group will review key medical specialties in paediatrics. Working with existing networks, it will gather the information that will help to develop these into Managed Clinical Networks. Starting with a pilot study in child oncology and haematology, the review will go on to look at four other specialties:
A second phase of the work will look at the impact that redesigning paediatric specialties is making on training and education.
Strengthening community-based child health services
The Scottish Executive is targeting extra support for the most vulnerable children to 'close the opportunity gap' and to make sure that agencies deliver seamless services for children. Community-based child health services are essential in this.
The fourth edition of Health for all Children (Royal College of Paediatrics and Child Health, 2003) is the most recent UK-wide review of child health surveillance and screening. There is widespread recognition that screening and health promotion could be more effective, and that families in difficulty could get support more quickly. Following the Child Health Support Group conference on the implications of the review, the Scottish Executive is to produce national guidance on this.
The Group is helping to develop the guidance, which will set out the elements of a national programme of screening and health surveillance for all children. It will also point the way to the NHS, local authorities and others working together to make sure that vulnerable children get the help that they need, early enough to support their healthy development.
Championing and developing child and adolescent mental health
The Group is aiming to promote development in child and adolescent mental health. It is also aiming to support a planned approach to developing specialist services of this sort in Scotland. The main objectives are:
to inform the Scottish Executive response to the SNAP report on child and adolescent mental health services;
to support NHS Boards and partners to implement the recommendations from the SNAP report;
to tackle workforce pressures in specialist child and adolescent mental health services, in partnership with NHS Education Scotland;
to work closely with the National Programme for Improving Mental Health and Wellbeing to promote mental health and emotional wellbeing for children and young people; and
to encourage health services to engage children and young people in their own care planning, peer support and service planning and design.
The SNAP report emphasises that the concept of mental health and emotional wellbeing should have equal priority with ill health and mental disorder, to pre-empt mental health problems before they become entrenched. The Group will work with the National Programme to support national mental health promotion initiatives.
Promoting the involvement of children and young people in NHSScotland
Patient Focus, Public Involvement (Scottish Executive, December 2001) sets an ambitious agenda for the NHS to develop a responsive, person-centred service. Children and young people are traditionally a hard group to reach for the NHS, and the Child Health Support Group is committed to helping break down this barrier.
The Group is planning to:
consult on principles for the NHS in involving young people and provide information through web-based development of the National Template (this will signpost existing resources to help boards to engage with children and young people);
discuss with the new Scottish Health Council how their work will involve children and young people and be helped by them; and
work with the Health Department to collate information from the Performance Assessment Framework 2002-2003 and issue information about positive developments taking place in the NHS.
The Child Health Support Group's vision is for children's services that are:
seamless, with families receiving all the help they need without being aware of (and often struggling with) the boundaries between services and organisations;
effective, based on the best available evidence about what works; and
responsive, informing and involving children and their families in planning their care, and consulting families about the kinds of services they need.
The full report Making It Work For Scotland's children is available from:
The Stationery Office Bookshop
71 Lothian Road
Edinburgh EH3 9AZ
Tel: 0870 606 55 66
Visit the Child Health Support Group website at www.show.scot.nhs.uk/chsg.