Concerns over integrated services after inspectorate omits health

Improvements in children’s services could face a setback
as health is left out of the children’s inspectorate,
writes Mithran Samuel.

The government’s decision to exclude health from the single
children’s inspectorate has reinforced worries about the
NHS’s place within integrated children’s

Social care and local government leaders had called for its
inclusion but they failed to persuade the government.

There is a widespread belief in local government that the NHS is
not being encouraged to engage with the children’s

Ian Birnbaum, director of children’s services at Sutton
Council,  says the south west London borough has made great
progress in integrating services despite structures.

He adds: “There’s little incentive for any primary care
trust to engage in the children’s agenda. Most of the things
that count to their star rating are on the adult side.”

Tony Lewis, deputy chair of the Local Government
Association’s children and young people board, agrees:
“Even if you are sitting around the table with people who
have the will to engage, you can’t get away from the fact
that the inspectors are judging them on different

Norman Glass, the man credited with creating Sure Start and now
chief executive of the National Centre for Social Research, says
the  health targets’ regime reflects the priorities of the
tabloid press and the NHS’s pecking order.

“The targets that matter are rarely connected to improving
the life chances of young children,” he says. “They are
about waiting lists, cleanliness or whatever catches the
imagination of the Daily Mail.

“The people who carry weight locally [in the NHS] are the
consultants. Community paediatricians come very low on the pecking

The Children Act 2004 and its complement, the National Service
Framework for Children, Young People and Maternity Services, were
supposed to have aligned council and health services priorities

The act placed a duty on PCTs and health providers to co-operate in
promoting children’s well-being, and established three-yearly
joint area reviews assessing the contribution of all services to
its five outcomes.

The NSF, according to the Healthcare Commission, provides “a
crucial measure” against which it will inspect.

Guidance on the duty to co-operate stresses the responsibilities on
all partners but calls for “sophisticated leadership of a
high order” from directors of children’s services to
secure the full engagement of all.

Birnbaum says: “The director of children’s services has
a huge responsibility in relation to the Children Act. He or she is
not only responsible for council services but for making sure
co-operation occurs.”

The three-yearly area reviews will evaluate council services
– notably children’s social care and education –
but only evaluate the others “where there is sufficient

Also, the NSF has been criticised for its lack of concrete targets,
and such arguments have fuelled the case for health to be included
in the single inspectorate.

But this is disputed by the Healthcare Commission. Kathryn Tyson,
its head of children’s strategy, denies any bias towards
adults. She says children are the only population group to have
their own core standards, and adds that the NSF’s lack of
targets reflects a “mature approach to service
development” that emphasises local flexibility.

A single inspectorate should not include health, she says, because
health care services for children have “more in common with
health care services for adults than they do children’s
social care or education”.

The three-yearly area reviews have been piloted in four places and
will be rolled out across England from next month. They may settle
the debate.

But only if they provide “sufficient evidence” of what
the NHS is – or is not – doing to promote
children’s life chances.

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