Key challenges from the Kennedy & Laming reports : care always subordinated to demands of adults lack of concern for vulnerable individuals ignoring rights which demand protection quality of care less than it should be fragmentation and lack of responsibility lack of effective planning failure to listen to patients and carers lack of effective leadership

Every Child Matters: context Five Outcomes: Be Healthy Stay Safe Enjoy and Achieve Make a Positive Contribution Achieve economic well being

The National Service Framework for Children, Young People and Maternity Services Aims to improve lives and health of children, young people and pregnant women by setting mandatory standards of quality for health and local authority services. Defines the way forward to modernise services over next ten years Produced after massive consultation A key component of delivering the Every Child Matters agenda Structure for each standard: –Vision; Rationale & evidence base; Interventions; Delivery strategy

The Core Standards (1-5) 1. Promoting health and well-being, identifying needs and intervening early 2. Supporting parents and carers (including fathers) 3. Child, young person and family centred services 4. Growing Up 5. Safeguarding and promoting the welfare of children and young people

Health Promotion (standard one) New Child Health Promotion Programme puts in place a comprehensive system in care, which includes: promoting good health, multi-agency health promotion, childhood screening, immunisation etc. Services to target those who do not take up services, such as children who are not registered with a GP, LAC and juvenile prisoners. Early intervention services

Supporting Parents or Carers (standard two) A range of services to make sure that parents get the support they need, when they need it. Provide support to families where parents have specific need, such as those who have physical or mental health problems or parents of disabled children. Info on managing minor illness & problems Giving adoptive parents high quality support.

Child, Young Person and Family Centered Services (standard three) Services are needed which are coordinated around the needs of the child or young person, respond according to their age and are easy for children to access. Multi- agency planning/commissioning- development of a Common Assessment Framework to reduce repeated assessments & encourage agencies to work, plan and share appropriate information. Senior lead to ensure that children and young people's needs are taken into account when services are planned. Common skills, knowledge and competencies.

Growing Up (standard four) Professionals to support young people to develop confidence in accessing services, with emphasis on the importance of addressing young people's concerns over confidentiality, information & how to access services. Educating and supporting young people e.g. informed choices regarding their health and well-being, Nutrition Substance misuse Mental healthInjury Sexual and reproductive health Services to provide effective transitions from child to adult services.

Safeguarding and Promoting the Welfare of Children and Young People (standard five) Each local authority will be required to have a children and young people's plan which shows how key agencies will work together to promote the welfare of children and young people. Identifying children and young people at risk of harm or who have been harmed by compiling a profile of the local population. Agency roles & responsibilities clarified, effective supervision, contemporaneous records.

Five Specific Standards (6-10) 6. Children and young people that are ill 7. Children and young people in hospital 8. Disabled children and young people and those with complex health needs 9. Mental and psychological well- being of children and young people (NB: must be seen to be cross cutting over all standards) 10. Medicines management for children + Standard 11- Maternity

Children and young people who are ill (standard six) Comprehensive and integrated local services provided through managed local children's clinical networks. Children, young people and their families are provided with enough information about their illness to enable them to manage it effectively in partnership with professionals. Evidenced based guidelines/protocols, locally audited. Improved Pain Management. Integrated CCN’s Teams.

Hospital Standard (standard seven) launched April 2003

Services for Disabled/Complex Children (standard eight) Extension for Government's Early Support Programme. Disabled children (0-3) will receive high quality intervention and family support. Multi-agency coordinated services from identification/ assessment/delivery of interventions to meet their individual needs. Social Inclusion. Key worker. Integrated diagnosis & assessment processes. Appointments at school or outside school hours to ensure a minimum absence from school. Palliative Care/terminal care. Multi-agency transition planning.

CAMHS (standard nine) Biggest change is that children's mental health services will be extended to 16 and 17 year olds. PCTs and LAs must ensure that there are policies and protocols in place to deal with the emergency mental health needs of children. Ensuring 24 hour cover to meet children's urgent needs with a specialist mental health assessment undertaken within 24 hours/during the next working day. Mental health promotion and early intervention. Care Networks / multi agency, specialised commissioning & planning.

Medicines Management for Children (standard ten) PCTs ensure that a child's age, weight and intended dose in mg/kg is included on all prescriptions for medicines of high risk. Prescribes consider medicines which need to be administered only once or twice a day so they can be outside school hours. Unlicensed/off-label medicines complies with local safety standards- need to oversee and monitor. Safe medication Practice- training, CPD, systems to ensure safety.

Maternity (standard 11) All NHS Trusts strengthen services for women from disadvantaged, minority groups and communities by having a staffing profile which, reflects the profile of the local population. Every pregnant woman attending A&E for complaints other than obvious injuries is seen by a midwife/ obstetrician or they are consulted by phone. Policies & protocols for identifying/supporting women who are high risk of developing a serious postpartum mental illness. Care pathways & managed care networks with maternity/neonatal. Improved pre-conception/pre-birth care.

The NSF will improve the lives and health of children by: Ensuring that care is centred on the mother and her child, with appropriate, evidence based and needs led services accessible at the right time, with children and their families, including fathers, taking an active part in making decisions about their care. Improving the experiences and satisfaction of mothers, children, young people and their carers with the services provided for them.

What will be different? The NSF standards will deliver services that are: Quicker and easier to use Better co-ordinated Better at involving people in decisions about their care Personalised - more closely matched to individual mothers, children and young people and their families, and tailored to meet their needs Available equally to all Better at achieving good outcomes for children and young people;

The Child’s Journey A way of thinking for a needs-based approach : Take a child’s condition or circumstance then define: Milestones Needs of child and carers at each milestone Competencies to meet the needs Opportunities for Choice Information, research evidence of best practice Current services Workforce, budget and safety Design of appropriate services and their configuration, especially through managed networks and children’s trusts

Fine words by themselves will do nothing! Change for the better will occur only through local understanding, support, involvement, action and upward pressure for change from parents, carers, voluntary organisations and professional staff. This depends upon people, leadership and support from the very top of organisations

For full copies of the NSF Executive Summary Core Standards Document 5 Specific Standards Maternity Standard Asthma Exemplar Autism Exemplar Key issues for Primary Care Parents Version, Young Persons’ Version, Children’s Version, Easy Read Version and click on Children’s services or DH Publications Orderline PO Box 777 London SE1 6XH Tel: Fax: / See also NSF Information Strategy (follow same path as above)