“Not in front of the children” is officially no longer an
acceptable attitude for health and social care professionals
delivering services to children and young people.
Instead, vulnerable children and their families will have to be
consulted, listened to and their opinions taken into account across
the spectrum of care. Efforts must be made to increase the ease
with which services can be obtained, and professionals will have to
consider the needs of each child as their main priority, rather
than the needs of the organisation delivering care.
Seems obvious? Possibly, but until the publication of the
long-awaited National Service Framework for Children, Young People
and Maternity Services, these principles had never been spelled out
as government policy.
Launched earlier this month by health secretary John Reid and
education secretary Charles Clarke, the NSF has been welcomed by
all sectors as a crucial opportunity for a wholesale change in
approach to the delivery of children’s services which everyone
agrees must not be missed. The 11 standards it contains are
acknowledged to be ambitious, and demand a commitment to
inter-organisational co-ordination the like of which has never yet
been experienced between the NHS, social services, the education
sector and voluntary bodies.
Speaking for the Royal College of Paediatrics and Child Health
(RCPCH), vice-president Simon Lenton is convinced that the NSF
could be the catalyst in transforming the way children and families
experience their contact with care services. He is equally clear
that achieving the framework’s full potential will require time and
an acceptance by everyone providing children’s services of the need
to do things differently.
“Thinking behind services does need to change. The key NSF elements
are ‘family-friendly, pathway-based and quality assured’. When
fully implemented it will have profound implications for the way
that services are commissioned, delivered and inspected across all
agencies,” he says.
“A pathway starts with prevention, goes on to early identification
of the problem, then comprehensive assessment of the problem and
its impact on the child and family. A range of interventions
follow, and if not curative, then they will need ongoing support
and sometimes palliative care. All of these elements may be
provided by different services and it will need a managed network
of care professionals to achieve a good outcome.”
This opportunity to radically change course is welcomed by Meryl
Thomas, deputy president of the Royal College of Midwives, who
co-chaired the working group that created the NSF’s standard on
“Attitude shift is going to be the thing. This is about improving
maternity services from the point of view of improving services to
children. The system midwives have found themselves working in
hasn’t supported them in trying to get that for women before,” she
Thomas highlights the need for collaboration between professionals
as key to achieving the shift in approach required by the NSF.
Steps are already being taken to develop managed clinical networks
at a December conference jointly hosted by the RCM, RCPCH and Royal
College of Obstetricians and Gynaecologists.
At the Association of Directors of Social Services, John Coughlan,
co-chair of the children and families committee, explains that the
NSF is particularly timely as social workers look towards the
implementation of the Children Bill.
“It will be of critical importance as we engage with the health
services. Health has been driven by pressure in the acute sector
and its own performance framework in which children so far haven’t
figured very highly,” he says, explaining that child and adolescent
mental health is one of the areas where the ADSS has high hopes for
“From a social services perspective, it is hugely significant in
terms of bringing in integrated [mental health] services aimed at
prevention. Hopefully, it also increases the ease with which
looked-after children can obtain child and adolescent mental health
services (Camhs) support, because we know that as a group they are
significantly more likely to experience turmoil. As adults they
would have a right to access, and we feel that these children
should have the same right when they need it.”
Claire Turner, Barnardo’s principal policy and practice officer
agrees that the NSF is a major step forward when it comes to
tackling access to Camhs.
“It’s very welcome, particularly around the markers of good
practice, flexibility and age-appropriate services. There is also
an acknowledgement of current gaps in the transition of 16 and 17
year olds between child and adult services,” she says.
However, Turner has concerns: “The mental health aspect of the NSF
is very ambitious and demanding, not just in terms of needing to
address the quality of the service, but also in terms of addressing
the geographical gaps. Looking at resources in terms of staff and
money, I don’t feel that has been answered, and we need to look at
the next steps and implementation.”
One of the challenges for the voluntary sector, she says, will be
working out how to link in with statutory services; many charities,
including Barnardo’s, work with children and families with
physical, mental and social care needs, and will need to ensure
they are included in the care pathway “loop”.
Perhaps the overwhelming message from the framework comes in the
emphasis across all 11 standards that children and families should
be consulted throughout the formulation and delivery of their care.
This element, says Chris Osborne, principal policy adviser at the
Children’s Society, is a welcome and long overdue approach. As the
NSF was drawn up, the charity submitted testimony from both
disabled and able-bodied children that highlighted children’s
intense desire to be listened to and taken seriously.
Delivering this, particularly in the case of disabled children,
will take more than just a change in attitude, Osborne points out;
it will need the resources to allow professionals to discover what
children’s point of view is.
While expressing approval for the standards as a whole, Osborne was
disappointed that one particularly vulnerable group of children
appear to have been missed. “We would have liked more reference to
children in detention – children in prison and children of asylum
seekers who are held in detention centres. We feel that this group
could have had a standard dedicated to their specific needs, and
this was something we said early on.”
Just as there has been a general welcome for the framework, equally
there is general concern that it should be implemented
“The whole of the NSF has been held up in terms of pulling it into
line with Every Child Matters, and we have concerns about how the
two government departments will be working together on delivery of
this,” says Osborne. “Many staff at the Department of Health
working on children’s services transferred to the Department for
Education and Skills with the creation of the Children and Young
People’s Unit, and in the DoH it’s not entirely clear which
officials are responsible for children now.”
And change can’t just be required of the people delivering the
services, says Lenton – the culture shift has to go deeper than
that across all agencies.
“Changing commissioning, so that we commission pathways rather than
services, and then making sure that we quality-assure and inspect
along pathways are both essential elements of change.
“Targets do focus the mind, but rarely lead to real learning and
long-term improvement. I think, instead, we need to be looking at
measures at key points along the pathway and then, if these
measures do not reflect best practice, asking questions and
improving the service. If we could just get that right, year on
year, services would get better.”
The 11 standards contained in the NSF explore new ways of
working to deliver child-centred care in the following areas:
- Promoting health and well-being, identifying needs and
- Supporting parents or carers.
- Child, young person and family-centred services.
- Growing up into adulthood.
- Safeguarding and promoting the welfare of children and young
- Children and young people who are ill.
- Children in hospital.
- Disabled children and young people and those with complex
- The mental health and psychological well-being of children and
- Medicine management for children.
- Maternity services.