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EXECUTIVE SUMMARY
BACKGROUND OVERVIEW
The consultation on "Delivering A Healthy Future: An Action Framework For Children And Young People's Health In Scotland" was published by the Scottish Executive on 10 th April and ran until 7 th July 2006.
Findings from the analysis of consultation responses will be used to inform formal Scottish Executive guidance to assist NHS Scotland and its partners to deliver measurable improvements in the health outcomes and health services for children and young people in Scotland.
The consultation posed a series of questions within 3 main sections under 17 headings:
- The Basis for Change:
- Why Children and Young People are Different;
- The National Policy Context for Children and Young People in Scotland;
- Health Services Fit for Children and Young People.
- Delivering Change:
- Health Improvement;
- Providing Care Locally;
- Emergency Care;
- Hospital Services;
- Specialist Services;
- Mental Health Services;
- Complex Needs;
- Remote and Rural Care.
- Supporting change:
- Involving Children, Young People and their Carers;
- Workforce;
- Education, Training and Development;
- Planning and Commissioning of Children and Young People's Services;
- Models of Care;
- Performance Management - Quality Improvement.
OVERVIEW OF CONSULTEES
A total of 165 responses to the consultation were received, comprising 129 responses from organisations and 34 from individuals, although 2 consultees did not state which group they belonged to. While the 27 consultees responding as individuals with a professional interest in the consultation comprised the largest group, among organisational responses the largest number of responses received was from Voluntary/ Charity Groups and from NHS Service Providers.
OVERVIEW OF RESPONSES
This was a very technical consultation and many of the responses contained detailed suggestions. Each consultee responded to the sections of particular interest to their own organisation, role or speciality. Although there were some themes that were common across the consultation, it was agreed that the report should be written on a section by section basis following the structure of the consultation document and of the Action Framework. This will allow for those redrafting the Action Framework to access the points made at each individual section and allow those reading the report to identify the chapters of particular interest to them.
The main themes emerging across the consultation were:
Targets and Milestones
There was majority agreement with the targets and milestones laid out in the Action Framework The long term nature of many of these must be taken into consideration.
The need for a holistic approach
Across the consultation, many consultees noted the need to ensure a truly holistic approach to development of the Action Framework. This focused on one key issue, to ensure that this takes into account the full range of individuals and organisations working within the sector. While there were calls from many for partnership working between different agencies and organisation, there were allied concerns over how, in reality, these would work effectively together. There were calls for a multi agency approach to ensure clear communication between all services and an effective collaborative service. For example, there was a perceived need for community health partnerships, community planning, or those involved in educational establishments to be included in this in order to promote initiatives such as Hungry for Success.
Also noted was a need for multi-disciplinary working, not just at the strategic planning level but also in delivery of frontline services.
Allied to this, a number of consultees noted a need for early prevention (from the age of 0 upwards) and health promotion across the full range of services involved in delivery. Some consultees also noted the importance of communication between agencies and between services providers and users, again emphasising the importance of partnership working and information sharing.
Defining Children and Young People
At a basic level, a number of consultees noted the need to ensure that services take into account the differing needs of those aged 18 and under and that patterns of ill health reflect wider inequalities, so ill health cannot be looked at in isolation. A wide range of needs should be addressed, in relation to gender, ethnicity, socio-economic background and so on. Additionally, there needs to be a focus on the needs of specific groups, such as those with learning disabilities, mental health, young carers, LGBT young people, children with complex needs and so on. Furthermore, it needs to be borne in mind that factors in relation to behaviour and lifestyle changes can take a long time to be brought about.
The Action Framework considers the needs of a wide range of ages, and it was noted that children's needs are different to young people's needs and, in turn, these are different to adult needs. Services need to be tailored to meet the needs of different ages. In support of this, there is also a need for family focussed approaches and services.
A need was identified to consider the requirements of different age groups and that children and young people cannot be treated as a homogenous group of individuals. For example, 14-16 year olds would benefit from adolescent wards and should not be nursed alongside infants or children. Allied to this, there were also calls for standardised age criteria for transition for all services, for example, the age at which adolescents enter adult mental health services is variable across different areas, with some supporting young people to the age of 21, whereas others cease at 16 or 18.
Timescales
While views were largely positive about the targets and milestones in the Action Framework, there are concerns expressed as to whether timescales are realistic, particularly given the wide range of organisations to be involved in implementation. Comments often focused on the various actions and plans that all feed into development of the Action Framework and consultees noted that many of these are interdependent.
Funding
Key comments in relation to funding are that there is a need for more funding in general in order to support the Action Framework, particularly in relation to training for staff. Another specific issue emerging was the need to find funding to provide cover for staff undergoing training and development. Importantly, many consultees also raised the issue of the levels of funding, both currently and in the future, needed to enable recruitment of the necessary staff to help make the Action Framework a reality. There were calls for funding to fully train and develop staff to equip them with the necessary key clinical skills on a multi-disciplinary basis.
Staff recruitment and retention, Training and Skills Maintenance
Many consultees noted a need for appropriate training and development for staff and that this needs to be delivered on a joint basis for multi agency staff.
Another key issue in relation to staff recruitment and retention was how to develop the skills of those staff already working within the sector and an allied need to allow for development of their skills.
Service Delivery
There was an acceptance from many for the need to centralise services. However, there are allied concerns that this could remove local delivery of services, which is seen to be of particular importance for children and young people. There were calls for local access to healthcare wherever possible, and where this is not possible, there is a need to minimise any disruption to children and young people.
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