« Previous | Contents | Next »
Listen
SECTION ONE: THE BASIS FOR CHANGE
CHAPTER FOUR: WHY CHILDREN AND YOUNG PEOPLE ARE DIFFERENT
The consultation document recognised that at the heart of the Action Framework, there is a need to ensure that the very different health needs and requirements of children and young people are prioritised and addressed in an appropriate manner, and that these are not lost within a healthcare system that is inevitably challenged by adult health needs. The 'Basis for Change' section of the consultation document set out a number of ways in which differing health and healthcare needs set children and young people apart from their adult counterparts:
- Patterns of Ill Health;
- The Need for Child Orientated, Age Appropriate, Family Centred Services;
- The Need for Protection and Advocacy;
- The Opportunity to Influence Long Term Health.
The following sections detail the key themes that emerged for each of these issues.
4.1 PATTERNS OF ILL HEALTH
In total, 77 consultees responded to the section relating specifically to Patterns of Ill Health. Seven of these commented on best practice which they presently carry out. All of those responding were in agreement to some extent with what was recognised within paragraphs 16 through to 21.
Two consultees were concerned about having Patterns of Ill Health as a starting point in the consultation document on the basis that it was inappropriate. One Local Authority made the suggestion that 'The Opportunity to Influence Long Term Health' should come before 'Patterns of Ill Health'. There were a further 2 mentions that the document would be better starting with a focus on maintaining and improving health services. As noted by one local authority,
"Rather than focussing on ill health, a more positive start would be a definition of 'good health' linked to the Scottish Executive's vision for children and young people."
Local Authority
Other suggestions (3) were in favour of focussing on areas such as 'prevention, health promotion and health improvement.
Responses in relation to Patterns of Ill Health, noted that there is a wide range of children's needs to be addressed. It was agreed by 13 consultees that gender and ethnicity related illnesses need to be recognised individually. The socio economic issues being addressed were welcomed by 8 consultees and one NHS Service Provider stated that,
"Poverty and socio-economic inroads also need to be met at a very local level in addition to wider and national levels. Consideration and addressing these underpinning areas will lead to development and perceived improvement/ impact in relation to patterns of ill health."
NHS Service Provider
Eight consultees noted that patterns of ill health are associated with wider inequalities such as socio-economic circumstances. Ten consultees were in agreement with the consultation document that the gender of a child impacts on their health as does their ethnic background.
There was also recognition that the workforce requires training, skill maintenance and the distribution of specialist facilities. The necessity of having appropriate training and development for staff in order for children with ill health to be catered for sufficiently was mentioned by 11 consultees. Five of these 11 consultees also noted concerns that additional funding would be required in order to fully train and develop different members of staff in order to equip them with the necessary skills.
Educational establishments and services were believed to have an equally important role to play in developing the health care needs of children (cited by 3 consultees), and 2 consultees noted the need for a link between the sustainability of hospital based paediatric services and neonatal care in maternity units at district general hospital level.
Paragraph 19 noted that many of the challenges are drivers towards a centralisation of children's services both at a regional and national level and recognised that children are also a patient group for whom local access is particularly important. The issue of access to health services for young people was mentioned by 13 consultees and there were concerns from 4 consultees over centralising health services for young children. One Voluntary/ Charity organisation stated that, "Young carers who have had access to local outreach mental health workers in remote and rural areas would suffer greatly if such services were centralised." Another noted,
"If services are to be centralised regionally and nationally then we would recommend that the impact of this on families is taken into account and provision made to factor in transport costs, accommodation and the need for transparent information for parents and carers when displacing access to centralised areas."
Voluntary / Charity
Another consultee, an NHS Service Provider, felt that there may be problems in sustaining local delivery for some children because of the nature of serious illness and the centralisation of services. One further point raised in relation to access to health services from a local authority was that access can often be affected by language barriers and that the needs of the increasing Eastern European population in Scotland should be considered when developing and providing services. In general, local access to healthcare that meets the needs of the child was felt to be important. There appears to be a recognition by many of the need to centralise services but there were concerns about the level of access versus the relative time taken for response time.
In relation to paragraph 19 specifically, an NHS Service Provider pointed out that specialist services becoming more centralised are in contradiction to the need for local access to services for children.
The Patterns of Ill Health section within the consultation document made reference to children requiring a specialist health service which caters specifically for their needs and all those responding to this section were in agreement and welcomed this. However, 1 consultee believed there is a gap in the transition phases from child to adult which is perhaps not catered for,
"Young people to age 19 with severe complex disabilities are often poorly catered for by adult (over 16 years) services. They need to be regarded as a special category. Transitional arrangements (starting well before transition to adult services) should be mandatory for adult as well as paediatric services."
Individual (Professional)
Finally, 3 consultees referred to children's growth and one noted that "the largely unknown incidence and prevalence of faltering growth is not included." Additional specific areas where ill health was felt to occur in children and should be given wider recognition were the vision of children, the special needs of children with congenital syndromes and children with learning disabilities.
4.2 THE NEED FOR CHILD ORIENTATED, AGE APPROPRIATE, FAMILY CENTRED SERVICES
This section of the consultation document (paragraphs 22-25) focused on four main areas within a child's life. Firstly a need to have health services and facilities specifically designed for children and not based upon models used for an adult population. Second, minimising wherever possible, the disruption to a child's educational, emotional and social life. Equally important, is the need to recognise that children and young people are very much dependent on the continuing support and care of their families. The needs, anxieties and expectations of parents need to be addressed alongside the provision of services and facilities in order to recognise the vital role played by parents and carers in addressing the wider needs of the family. Finally, that the dependence of children and the responsibilities of parents are reflected in their specific legal protections and rights. There is a need for staff to understand the issues surrounding this.
Eleven consultees provided examples of best practice in relation to this specific section of the consultation. In the main, the responses to this section of the consultation were largely in agreement with the context set out within paragraphs 22-25. Overall there was a feeling that in order to achieve the aims which have been set out, there is a role for various bodies to play in working collaboratively.
"The proposed child centred approach is welcomed and should be developed as a joint approach with key partners e.g. social work services. The need to address the needs, anxieties and expectation of parents is supported and again should be part of an agreed approach with partners."
Local Authority
Another example was provided by an Individual (Professional) who acknowledged that children who are currently treated in adult Accident and Emergency hospitals are not able to benefit from having child orientated accommodation or paediatric trained nurses caring for them. This consequently results in children being exposed to other patients or situations normally unsuitable for a child to witness.
In contrast to this, another Individual (Professional) believed that "services have a long way to go in terms of considering the social and educational impact upon children and families." Another aspect which an Individual (Professional) felt should be considered was that children's needs are different from young peoples' needs, yet they are both different to adults needs. They noted that "It is more appropriate to have young peoples services with children's than adults but best practice is separate. There should be different sections for young people to clearly identify differences."
In particular reference to paragraph 24, there were a number of mentions (10) welcoming the recognition that the needs of parents need to be addressed as part of caring for the child. Some of the consultees felt this aspect could be more widely replicated within other sections of the consultation document, as the following comment from one Local Authority illustrates, "given the importance of this acknowledgement, there is not sufficient focus throughout the document of family focussed approaches and services."
Of those consultees who were supportive of more to be done to address the needs of parents, there are some who felt that support should not stop simply with the parents. It was felt that the wider family, foster parents, carers and residential unit staff also need to have more support. Specifically in relation to support parents, one Individual (Professional) believed that families require more in the way of information and access in order to better understand child illnesses. An NHS Service Provider stated that, "Perhaps the term, 'parents/ primary care should be used instead of purely parents." Another Individual (Professional) agreed with the actions being raised and addressed within paragraphs 22-25 but raised concerns over the length of time it will take for all the services to be fully developed.
While welcoming this particular section, a group responding on behalf of an NHS Service Provider recognised that the economic or financial imperatives of the NHS may often be in conflict with the needs of children and their families and in particular this group would like to see
"…an increased focus on health promotion activities which are Child Orientated, Age Appropriate and Family Centred."
4.3 THE NEED FOR PROTECTION AND ADVOCACY
Paragraphs 26 to 33 examined the issue surrounding the protection of children and young people in Scotland. It was stated that 'everyone' has a role to play in the protection of children and young people. The overall message laid out within these paragraphs related to the need for integration in relation to addressed social inclusion and the need for advocacy.
Eighty-one consultees voiced their comments or suggestions about this section of the consultation and all were in agreement that there is a need for protection and advocacy, with one Education consultee pointing out that, "advocacy could be strengthened within this document."
A number of consultees pointed out that the sectors within which they currently work already provide subjective advocacy. An Individual (Professional) who currently provides subjective advocacy stated that, "young people need independent advocacy services especially those identified in paragraph 31 and those with engaging health problems." Providing child protection is something that some consultees believe they already provide and one Voluntary / Charity voiced their concern that,
"Any revision to the approach to child protection should ensure that such organisations are not prevented from continuing to offer the support, assistance and service currently being provided. Nor should any revision introduce further bureaucracy that impacts on the organisation's ability to provide direct resources to the child or young person."
Voluntary / Charity
Another Voluntary / Charity welcomed the acknowledgement of the importance of child protection in health and of the important role that advocacy can play in ensuring that the voice of children and young people is heard. This particular consultee raised the question of how this is planned to work in practice when currently it is difficult to source advocacy services for children and young people with complex health needs who may have limited verbal communication. This consultee went on to state, "an advocate for children and young people should not be a person from an official agency or social worker. A peer advocate might be a good idea, because they would have a better idea of things that were important and what to ask."
Seven consultees agreed with the points being raised in this section but felt that there are a number of additional children and young people who require Protection and Advocacy other than those from socially deprived backgrounds. One Individual (Professional) pointed out that, "there are a significant number of children from affluent backgrounds with mental health problems." A Local Authority also made reference to the point that all the factors surrounding the ill health / mental health / physical health problems that emerge within children and young people cannot always be linked to poverty or a child's physical environment.
The need for consideration of protection issues surrounding the unborn child was raised by an NHS Board.
Some consultees raised the point that in order for the proposals to be fully implemented and work, staff needs have to be addressed with one NHS Service Provider stating that,
"The staffing has not been increased to cope with the demand and enhanced need."
NHS Service Provider
In addition to this, an Individual (Professional) made a particular reference to paragraph 33 and mentioned that " Scotland has a unique Guidance Pastoral Care system in schools that is not given enough credit and prominence in the report to reflect the real contribution this group of teachers make to the health of young people." Another, a Public Body, acknowledged that training is essential to ensure that everyone who has contact with children understands their responsibility in identifying vulnerable children. This consultee also noted that, "It is also important that staff delivering a service to children recognise that issues affecting health of parents and other family members can also have an impact on the children. It is also vital that those working with adults are aware of and alert to child protection issues."
Furthermore, it was highlighted by 3 consultees that there was a,
"Need to develop a framework for ensuring a child's education continues whether the child is in hospital or at home and unable to attend school due to ill health. There should be designated teachers or staff who have links to hospital units to ensure a child's education is maintained."
Individual (Professional)
Services working together and sharing information was welcomed by 7 consultees. One Local Authority stated, "a multi-agency approach to staff training is essential if we are to ensure clear communication and achieve an effective collaborative response from key agencies."
On the subject surrounding the sharing of information, another Local Authority stated,
"Paragraph 27 still uses words like 'may involve sharing information': this sounds weak in current climate and gives the wrong message to staff groups who hide behind the Data Protection Act."
Local Authority
Another Local Authority believed that under the section 'The Need for Protection and Advocacy', that 2 separate sub-groups (social inclusion and advocacy) might be more appropriate. Furthermore, another Local Authority who was in agreement with paragraph 31 felt that greater importance and emphasis could be placed on these groups of individuals throughout the consultation document.
Eleven consultees provided examples of best practice, highlighting areas where they feel they are already contributing to the proposals which are being addressed.
4.4 THE OPPORTUNITY TO INFLUENCE LONG TERM HEALTH
Paragraphs 34-37 within the consultation document noted that promoting the health and improving the health-related behaviours and attitudes of children and young people lead to the potential to have a generational effect upon Scotland's health.
In total, 65 consultees commented in response to the points raised within paragraphs 34-37 and all were in strong agreement that actions need to be taken in order to improve and secure the future health across the population of Scotland.
Fourteen consultees made a direct reference to early prevention and health promotion being crucial in order for the proposals to be successful, as the following quote from one Local Authority illustrates,
"under the Opportunity to Influence Long Term Health, it would be pertinent to include a sentence on the importance of securing healthy lifestyle patterns in the early years. It should be made clear that this means in many instances from birth, rather than somewhere before the age of 6."
Local Authority
Another Local Authority in agreement with the proposals believed, "the role of health promoting schools needs to be incorporated into this section" and also noted that, "There is little point in educating children and young people in health if families and communities are not provided with education and support." This view was shared by 4 other consultees.
A few consultees also noted that in order for the suggested proposals to work in the long term, there needs to be an acceptance of these issues by parents and carers. As a Professional Body stated, "a recognition that without parental/ carer 'buy-in', it is difficult to improve health related behaviours and the life styles of children and young people."
There were a small number of consultees (3) who commented that this section should be earlier in the consultation document.
« Previous | Contents | Next »