Young people in the frame

Al Aynsley-Green, tells Children’s Express interviewers
Akousa Bonsu and Jimmy Tam how the National Service Framework for
Children will affect young people’s lives.

Al Aynsley-Green is the national clinical director for children.
He’s also a paediatrician at Great Ormond Street
Hospital.

What are national service frameworks and how will the
children’s NSF be implemented?

NSFs are documents that come out of the government. They give
guidance to people on how to provide services for different sets of
people. There are NSFs for cancer services, for people with heart
disease, for older people for example, and now we have one for
children’s services, which is very good news. By the way, the
word “children” includes young people, mothers and families. And
there’s a lot that’s very good about services for
children, whether it’s in hospitals or it’s children
who need to be looked after.

But you also know that there’s a lot that isn’t so
good. We recently had the report on the murder of Victoria
Climbié, which shows that there are big problems in the social
care of children. And two years ago, we had another report on
children who’d had heart surgery in Bristol which showed that
the health services weren’t as good as they could be.

So my job is to lead the development of services for children
and think about how we are going to shape them for the future.

When do you think that the NSF will take effect and
change services for children?

I don’t expect it to change suddenly over night because we
have a lot of difficulties and problems not least finding enough
doctors and nurses and social workers and teachers and so on to
support the services. But I hope it will make a big difference.

Have you consulted young people to find out what their
views are?

Yes, we carried out a lot of consultation. We have had 15 events
across the country in the last few weeks where we have been talking
to children and young people about what they think about our
services.

We involve all six of the big children’s hospitals, and
they have surveys in their hospitals about what children and young
people think about their services. And we sent postcards to schools
asking people to feed in.

We have got to make sure that we listen seriously and not just
in a token way to what you and younger children want from the
services and us.

I think that it will have an important impact, because it will
set a series of standards that have to be implemented which is very
new for children’s services. They are trying to pull out from
all the information we have where there are good things being done
already, and there are some good things that are being done.

We can learn from that, and how we can get people to think more
seriously about the needs of the child and young person rather than
the needs of the doctors and nurses.

How are you going to monitor this process to make sure
that standards are met right across the board?

It is quite a big process. Primary care trusts are local
organisations that are responsible for local delivery of services
and they will be monitored very carefully. For example, one of the
problems we have is getting good enough services for young people
with emotional and mental health problems. They are very important
and relevant to young people as they struggle to go through
adolescence. And we know that the service hasn’t been very
good. So the government has made child and adolescent mental health
services a serious issue. New money is going into them and every
local trust has to deliver a year-on-year improvement over the next
few years and that will be very heavily monitored.

Would it not have been better to have given the money to
the different departments so that they could improve their
services, rather than setting up the national service framework
which must have been costly and time-consuming?

That’s a good question. I think the whole thrust of
government policy at the minute is to make local communities more
responsible for what is done. Now our job is to make sure children
taken seriously. In Russia under Stalin, the government said: “you
do” and everybody did. But that is not the way we operate in a
democracy.

So the government has put a big injection of “new money” into
the health service. One of the things that we are anxious to make
sure happens is the primary care trusts have to make sure that they
are listening to the views of the people who live locally. And we
are going to make sure that young people, like yourselves, are
actually working with the trusts to define services in the area you
live, whether it be schools, hospitals or whatever.

Are you involving teachers in the national service
framework?

Yes. One of the big changes that we are trying to focus on is
the life of the child and young person and not just the “disease”.
For example, we are trying to get people to think about the
child’s journey, and the milestones within it. Let me give an
example. Supposing one of your friends gets knocked down in the
street. He or she is then taken to hospital to an emergency room
and assessed, then admitted to a local hospital. If your friend has
a head injury they might be referred to a regional centre – a large
hospital that can do an operation on the brain. They then come back
to a local hospital to recover from that and then eventually go
back to the family and hopefully everything is OK after the
accident. But sadly many young people are damaged.

So what we are trying to get people to say is: “what does the
child need at each of those milestones?” and what does the family
need at each of the milestones. And then if the child comes from a
poor family you can see how you get some support for the parents to
visit.

We need to make sure the social needs of the family have been
thought about. And then if the child is not able to go back to
“normal school” then you have to think seriously about their
educational provision. So that tells us how we can bring in health,
social care and education. This is meant to be about the life of
the child not just the disease of the child.

Akousa Bonsu is aged 16 and Jimmy Tam, 18. Children’s
Express is a programme of learning through journalism for people
aged 8-18. PLease visit the website at
www.childrens-express.org