When the children’s national service framework, weighing in at a
hefty 2kg of paper, was launched last week, ministers hailed it as
the best thing for children since sliced bread – or at least for 50
Many social care professionals agree, saying it includes nearly
everything they could have wished for.
The reservations begin, however, on how the 10-year plan will be
implemented at local level throughout England: there are many
concerns about whether the money will get through and how the
framework will be monitored.
There has been a particular welcome for the standards on mental
health and disabled children.
The NSF includes a commitment for children and young people to
receive urgent mental health care when required. This should lead
to “a specialist mental health assessment where necessary within 24
hours or the next working day”.
Child and adolescent mental health services (Camhs) are also to be
available to everyone until they are 18 and admission to a young
people’s unit will become the “appropriate and preferred option”
for most 16 and 17 year olds who require this course of
Although nearly all of the NSF is couched in broad terms, it is
specific about how many staff are needed for Camhs teams.
A generic, specialist, multidisciplinary team for more severe,
complex or persistent disorders will need at least 20 whole-time
equivalents per 100,000 population for a teaching service and 15
per 100,000 for a non-teaching service.
The Royal College of Psychiatrists welcomes the NSF commitments,
but cautions about resources. Professor Sue Bailey, chair of the
college’s child and adolescent psychiatry facility, says: “It is
essential that emergency services are developed fully so that
urgent mental health assessments will be available within 24 hours
or the next working day.”
She says funding has to be found to train people to be flexible in
meeting urgent assessment requirements and welcomes the guidance on
the number of staff needed for specialist Camhs.
The NSF is explicit about the problems with resources and makes
clear service redesign and new ways of working are crucial. For
24-hour cover, it says, in the short term this will have to include
arrangements with adult services, specialist registrars working
across several providers and multidisciplinary on-call arrangements
with psychiatric back-up.
In general, it calls for “a range of new and amended roles” with
staff working across agencies.
Dinah Morley, acting director of mental health charity Young Minds,
is optimistic but realistic. She says: “Reading between the lines
on 24-hour access and emergencies, it doesn’t mean that if your
child needs to get an assessment there will be a child mental
health practitioner available. The staff are not there. In some
places, there is a lot of service redesign that needs to be done.
However, Camhs over the past four to five years have made great
strides. We are on the way.”
The disabled child standard is highly praised, although is deemed
the most expensive area to fund.
Jo Williams, chief executive of learning difficulty charity Mencap,
says the recognition of the need to provide short breaks for
children and families is crucial.
She says: “One thing that leaped out at me was that primary care
trusts and local authorities have to offer short breaks. The people
who I meet say some sort of break is vital.I hope primary care
trusts and local authorities will find ways to make that happen.
The real challenge will be to see that children’s trusts make this
Williams says early intervention is a theme running through the
standard that is absolutely crucial, and that another key element
that has “a resonance with the people we talk to” is the bit about
transition into adult life. The NSF says a multi-agency transition
group should be in place to co-ordinate this.
National Children’s Bureau chief executive Paul Ennals says of the
disability standard: “The thing that really strikes me is the gap
between the standards and the reality. It is difficult to envisage
that, within 10 years, it will need to be met. The challenges are
enormous. I really want them to get there, but there is a long road
Ennals says there is a particular challenge on the “strong focus on
inclusion, where the standard expects that disabled children will
have the same access to facilities”.
National clinical director for children professor Al Aynsley-Green
says the key is services being based on more accurate information
about where children live and what services they need – a mapping
approach based on that used in Vancouver, Canada, and something
that could be done through children’s trusts.
He says: “Somebody needs to have a step back and an overview. I
would like the local authority to be responsible for the lives of
the children in its territory. The main thing I want to see is a
better understanding in professional staff as to what we are doing
– the question of joint assessment, joint inspection.”
However, Aynsley-Green makes clear that service redesign is
crucial, as is recruiting more staff.
He says: “In speech and language therapy, a two-year-old child in
some parts of London needing services could wait two and a half
years for them. Yet in the outer London borough of Hillingdon the
waiting time is zero, not because they have more staff, but because
of redesign of services.”
Setting the standards
The national service framework for children, young people and
maternity services is the biggest and the most complex of the
frameworks, with 11 standards in three parts.
- Part 1: Sets out the five core standards that will
apply to all children and young people.
- Standard 1: Promoting health and well-being, identifying needs
and intervening early. This includes screening, immunisation,
prevention and early identification and treatment of mental health
- Standard 2: Supporting parents or carers. Information, services
and support must be available, including early support and
intervention for children with learning difficulties.
- Standard 3: Child, young person and family-centred services.
Services must be integrated to provide co-ordinated care packages
through, increasingly, children’s trusts.
- Standard 4: Growing up into adulthood. All young people must
have access to age-appropriate services, including services
relating to nutrition, sexual and reproductive health, mental
health, injury and substance misuse.
- Standard 5: Safeguarding and promoting the welfare of children
and young people. The government’s intention to require local
authorities to have a children and young people’s plan is important
- Part 2: Sets out standards in services for particular
groups of children and young people.
- Standard 6: Children and young people who are ill. The health,
social, educational and emotional needs of children must be met
throughout their illness.
- Standard 7: Children in hospital. High quality, evidence-based
hospital care must be delivered in appropriate settings. This
standard was published previously.
- Standard 8: Disabled children and young people and those with
complex health needs. Co-ordinated, child and family-centred
services should be based around helping families to live ordinary
- Standard 9: The mental health and psychological well-being of
children and young people. Multidisciplinary mental health services
must be available from birth until age 18.
- Standard 10: Medicines management for children. Children, young
people, their parents or carers and health care professionals must
be able to make decisions about medicines based on risk and
- Part 3: Sets out standard on maternity
- Standard 11: Maternity services. These must be supportive and
designed around the individual needs of women and their