LGA briefing on the report of the children and young people's health outcomes forum

Background

The Secretary of State for Health launched the development of a Children and Young People's Health Outcomes strategy in January 2012. A forum of independent experts from local government, the NHS and charities was set up to develop the strategy. It had the aim of bringing together all parts of the new health system and improving care for children and young people.

The Co-Chairs of the forum, Christine Lenehan and Professor Ian Lewis, published the forum's report on 26 July 2012. This briefing summarises the key recommendations and provides an initial LGA view.

LGA key messages

The LGA welcomes the report of the Children and Young People's Health Outcomes Forum. We urge the Government, and all organisations in the wider health system, to fully consider the forum's recommendations for improving the health and wellbeing outcomes for children and young people.

We urge the Government to set out how it intends to fund the implementation of the forum's recommendations. Local authorities are facing increasing funding pressures and will not be able to meet any new financial burdens within existing budgets.

Following the LGA's submission to the forum, we are pleased that the views of our members have been included in the report. In particular, we are pleased to see a greater focus on integration, health inequalities, the adoption of a life course approach by all health organisations and a greater focus on the voice of children, young people and their families.

The forum sets out a number of recommendations for safeguarding including the request for the accountability framework for safeguarding to be published as soon as possible. We agree with the forum's recommendation that the new multi-agency inspection framework should reflect how all services contribute to effective local safeguarding. However, the LGA also has a number of concerns including:

the delay of the accountability framework for safeguarding. It is imperative that all local partners understand and adequately discharge their safeguarding responsibilities and duties. We would like to see the accountability framework published as a matter of urgency.
the need for a sensible link between the accountability framework for safeguarding and the revised statutory inter-agency 'Working together to safeguard children‘ guidance to ensure all parts of the system are joined up.

We support the recommendation that Department of Health (DH) should work with other government departments and partners to achieve better integration of health with education, social care and other local authority-led services. The forthcoming Children and Families Bill is expected to ensure that services for disabled children and young people are planned and jointly commissioned between local councils and clinical commissioning groups (CCGs). We want to ensure that the legislation is clear about how health bodies will be held accountable.

Government should not use the proposed new indicators for the national outcomes frameworks to 'performance manage‘ health outcomes for children and young people at a national level. Local authorities need the freedom to determine the public health priorities and strategies to improve the health and wellbeing of children and young people in their local area.

The LGA is committed to working with Government and other stakeholders and partners to explore the impact of the recommendations from the report on member authorities.

Summary of main recommendations

Chapter 1: Introduction

The Secretary of State asked the forum to undertake three tasks:

to identify the health outcomes which matter most for children and young people.
to consider how well these are supported by the NHS and Public Health Outcomes Frameworks and by other information available to local areas, and make recommendations.
to set out the contribution each part of the new health system needs to make in order to achieve these health outcomes.

The strategy builds upon Professor Sir Ian Kennedy's report ‘Getting it right for children and young people‘ (2010), which identified the poor health outcomes and the lack of priority given to children and young people in the health system.

Getting it right for children and young people: overcoming cultural barriers in the NHS so as to meet their needs, Professor Sir Ian Kennedy, 2010 – on the DH website.

The report should be seen as the first phase in the new Children and Young People's Health Outcomes strategy.

Chapter 2: Putting children, young people and their families at the heart of what happens

Children, young people and their families struggle to get their voices heard and to be involved in decisions about their own health. They should be involved in designing health services and their voice should be heard across the system. The forum recommends:

Healthwatch England should demonstrate through its annual report how it has considered the voice of children and young people in informing its work programme. In addition, Local Healthwatch should include the voice of children and young people; it should be able to demonstrate this though it's reporting mechanisms.
All health organisations must demonstrate how they have listened to the voice of children and young people and how this will improve their health outcomes.
The NHS Constitution should be drafted in a way that applies to children, young people and their families.
All relevant partners should be brought together to co-produce a health charter, based on the principles of Article 12 of the UN Convention on the Rights of the Child ,the charter should be aligned to the NHS Constitution.

UN Convention on the Rights of the Child – on the UNICEF website.

Chapter 3: Health outcomes that matter for children, young people and their families

A limited number of new indicators and the extension of existing indicators were identified. These indicators were chosen for areas where progress is needed to improve health outcomes. The forum recommends:

Data about children and young people should be presented in five-year bands between the ages of 0-24 years, to allow comparisons of key outcomes at significant transition points at international, national and local level.
Four new outcome indicators should be included in the NHS Outcomes Framework:
- time from first NHS presentation to diagnosis or start of treatment
- integrated care – developing a new composite measure
- effective transition from children's to adult services
- age appropriate services – with particular reference to teenagers.
Evidence-based outcome measures and indicators for key conditions should be developed.
A life course approach should be applied to the Public Health Outcomes Framework. An extension of age ranges and new indicators looking at mental health of the mother, issues affecting the early years and lifestyle issues for example, drink and drug use will reinforce the benefits of a life course approach.
Patient experience measures should be strengthened, the DH and the NHS Commissioning Board (NHS CB) should incorporate the views of children and young people in existing national patient surveys by 2013/14.
Two new surveys should be developed; one looking at trends in health and wellbeing and another to support the measurement of outcomes for children with mental health problems.
The NHS CB should use the report to position children and young people in the final Commissioning Outcomes Framework.
The NHS number should be used as a unique identifier to bring together health, education and social care and criminal justice records for children and young people.
Existing databases and systems such as the pupil database and child health information systems should be adapted to allow subdivision of information. The Pupil Level Annual Census should be adapted to capture more detailed data about unknown health conditions of children and young people at school entry.

Chapter 4: Acting early and intervening at the right time

Reducing inequality and disadvantage can improve life chances across the life course, it can reduce financial burdens on health and non-health organisations. The forum recommends:

All organisations in the new health system should adopt a life course approach and address the different stages in life and key transitions.
Maternity, child health and perinatal mental health should receive a greater focus. DH should explore the development of a new outcomes measure on perinatal mental health and implement it as soon as possible.
A greater focus on improving the health outcomes of looked-after children (LAC) including:
- ensuring the joint strategic needs assessment (JSNA) includes comprehensive data on LAC, those with disabilities and long-term conditions and in contact with the criminal justice system
- CCGs and local authorities provide sufficient clinical expertise and local leadership, including a designated doctor and nurse.
- care leavers and LAC in early adulthood (18-25) are recognised in commissioning plans
- social care staff ensure LAC are registered with a GP
- the NHS CB only accepts GPs on the local performers list who demonstrate the level 3 competencies set out in 'Looked-after children: knowledge, skills and competencies of healthcare staff".

Chapter 5: Integration and partnership

Integration of care around the needs of children, young people and their families is fundamental to improving health outcomes, to achieve this, the forum recommends:

The revised national curriculum includes the promotion of health and wellbeing within the ‘statutory aims'.
The NHS CB and Monitor prioritises and promotes the issue of integrated care provision in their regulatory and performance roles within the NHS, and work with the Care Quality Commission (CQC) and Ofsted to develop a framework across non-health providers.
DH works with other government departments and partners including the LGA to support better integration of health with education and social care and other local authority led services.
DH supports health and wellbeing boards to use a broad range of quantitative and qualitative evidence.
As a matter of urgency DH should provide clarification on information sharing between professionals and across systems.
A pathway approach with a focus on the life course is adopted to assess risks such as gaps in services and to improve integration.

Chapter 6: Safe and sustainable services

The whole pathway for children and young people's physical and mental health needs to be addressed within healthcare. The forum recommends:

Networks and partnerships are developed at all levels of the system to reduce fragmentation. The NHS CB should implement a national, strategic network which brings together maternity, neo-natal care, children and young people's services and pathways.
CCGs develop local networks and partnerships with providers to deliver sustainable services and care closer to home.
The NHS CB with CCGs address service configuration to meet the needs of children and young people and to ensure a safe and sustainable service.
Issues around medication errors, licensing and testing of medicines are urgently addressed. This should include relevant indicators in the NHS Outcomes Framework, developing interventions to reduce errors and the DH to commission a study in 2013 to address concerns.

Chapter 7: Workforce, education and training

All health care professionals and those working with children and young people should have the right skills and knowledge to meet their specific needs. The forum recommends:

There should be early strategic direction for workforce planning, education and training from Health Education England (HEE).
GP's training should be extended to include adequate training in paediatrics, physical and mental child health.
Continuing Professional Development for GPs should include caring for children and young people and adequate training for all general practice staff.
There should be named medical nursing lead for children and young people at general practices.

Chapter 8: Knowledge and evidence

Good quality data and information is key to system improvement. However, much patient-level data does not include information or separately identify children and young people under the age of 19. This needs to be addressed in order to improve healthcare outcomes. The forum recommends:

Public Health England (PHE) develops national campaigns focused on children and young people, the campaigns should seek input from children and young people.
The establishment of an electronic child health record which is accessible by patients and professionals. It should track the outcomes at age 2-2 ½, Improving access to psychological therapies (IAPT) and outcomes for children with disabilities and complex conditions.
Intelligence networks for children and young people should be set up to drive up standards and effective use of data.
The Quality Standards work programme should be expanded to ensure it applies to children and young people and research and development programmes should be set up to improve child health related research.

Chapter 9: Leadership, accountability and assurance

New organisations in the system should build in mechanisms for improving health outcomes for children and young people from the outset. Leadership and accountability for improving health outcomes should be demonstrated across the whole life course and should be embedded and demonstrated throughout the system. The forum recommends:

DH, PHE, the NHS CB, Monitor, CQC, local authorities and CCGs clearly set out their responsibilities for children and young people and their families across the life course. They should set out how accountability will be exercised and should be transparent about the funds spent on child health.
DH and the NHS CB should hold to account every statutory organisation that it funds for improving health outcomes for children and young people.
Local commissioners including CCGs and local authorities should identify a senior clinical lead for children and young people. These leads should be a part of the Health and Wellbeing Board advisory process.
Monitor, CQC and Ofsted should collectively produce a joint statement demonstrating how they will work together to foster integration of key services and partnerships across sectors.
A number of recommendations were made around safeguarding including;
- urgent publication of the full accountability framework for safeguarding children in the wider health system
- as part of the new multi-agency inspections CQC should consider how all relevant parts of the health system including relevant adult services contribute to effective local safeguarding.
- further work on developing indicators on protecting and improving child welfare. Including indicators focusing on measuring the effectiveness of early help/early intervention
- a Quality standard for safeguarding children

Chapter 10: Incentives for driving service improvement

The structural and commissioning changes taking place in the health and social care system will result in changes to funding flows. It is important to ensure that these funding flows do not become a barrier to good service provision or result in perverse incentives. The forum recommends:

DH keeps an oversight of the pattern of funding flows across the NHS, local authorities, public health and wider care and wellbeing to ensure perverse incentives do not adversely affect patient care or service provision.
Appropriate incentives within the Quality Outcomes Framework for general practice are developed to provide quality care for children and young people.
The NHS CB and Monitor should prioritise and promote the issue of integrated care provision in their regulatory and performance roles within the NHS. DH should address this issue across government for those services that fall within the remit of local authorities, education and government departments.
Monitor and the NHS CB should continue with the development of Payment by Results (PbR) currencies and tariffs in child health related areas.
The NHS CB and CCGs are mindful of potential consequences to providers of general and specialist services. They consider how they will adopt a risk sharing approach between different provider organisations in developing their commissioning plans for delivering care closer to home. Monitor should ensure PbR mechanisms are flexible to reflect these tensions.
PHE should develop an incentive scheme to address improvements in public health outcomes.
The NHS CB should include children and young people's healthcare outcomes in the next phase of the Quality, Innovation, Prevention and Productivity programme. It should work with local commissioners to develop a Commissioning for Quality and Innovation scheme to drive improvement.

Chapter 11: Conclusion

The report should be seen as the first phase in the new Children and Young People's Health Outcomes strategy.

Consistent attention and further development of the strategy is required. The forum urges Government and all organisations in the wider health system to accept and act upon these recommendations.

Next steps

The Government is due to publish its response on the report of the Children and Young People's Health Outcomes Forum in September 2012.

The LGA view is broadly supportive of the report of the Children and Young People's Health Outcomes Forum. We are committed to working with Government and other stakeholders and partners to explore the impact of the recommendations for councils, particularly with regards to funding.

Children and Young People's Health is a priority for the LGA. Our work programme is overseen by the member-led Children and Young People Board and the Community Wellbeing Board. We are fully committed to working with councils to help them take a leading role in improving health and wellbeing outcomes for children and young people in the new public health system.

Visit the LGA dedicated webpage on children's health