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CHAPTER FIVE: THE NATIONAL POLICY CONTEXT FOR CHILDREN AND YOUNG PEOPLE IN SCOTLAND
The national policy context for children and young people in Scotland has been built firmly on four key areas:
- Integrated Planning and Delivery of Services
- Child Protection
- Health Improvement
- Social Justice and Inclusion.
The following sections discuss the key themes emerging from within each category.
5.1 INTEGRATED PLANNING AND DELIVERY OF SERVICES
This portion of the consultation document (Paragraphs 41-42) highlighted the main objective of the Scottish Executive's Cabinet Delivery Group: to ensure the aspirations and needs of children and young people are met. This Group is driving forward a challenging agenda to deliver the vision and improving outcomes through improving delivery, integrated assessment and information sharing, quality improvement and joint inspection and workforce development.
The priority given to children and young people is reflected in the Scottish Executive's commitment to addressing health inequalities, the social justice agenda and the emphasis on health improvement to improve health outcomes not only for children and young people but the wider community in general.
Of the 65 consultees responding to this section, most fully supported the Action Framework relating to 'Integrated Planning and Delivery of Services' and this was across a variety of different bodies:
"The group welcomed the high level vision for children and young people as agreed by Scottish Ministers."
NHS Service Provider
"Those of us working in the community would absolutely endorse the need to plan services with other children service providers and have an integrated approach to their care."
Professional Body
Despite this support, a number of consultees also expressed concerns in relation to a variety of aspects associated with this section of the Action Framework and the following provides a brief summary:
- Lack of funding and resources (6 mentions)
- Scepticism over reality of framework (4 mentions)
- Linkages - necessary in action plan, strategic plans, operational delivery and practical implementation (3 mentions)
- Lack of clarity on who the consultation document is aimed at, if multi-agency should be made specific from the start (2 mentions)
- Confusion over vast array of policies (1 mention)
- Competing priorities e.g. cancer, heart disease and stroke (1 mention)
- Staff morale and stress levels in Social Services (1 mention)
- Territorialism, a problem with 'joined-up working' i.e. rivalry between services trying to ensure jobs, funding or projects can be kept going, leading to an unwillingness to relinquish any part of their remit that overlaps with another (1 mention)
- Lack of explicit reference to the role of the Voluntary sector throughout report (1 mention)
The consultation document (paragraph 42) featured a list of key documents and policy initiatives and three consultees provided positive feedback in relation to the compiled list. Views were mixed and while 3 consultees were satisfied with the list of documents and policy initiatives listed in the consultation document, 3 other consultees commented on the omission of certain documents/initiatives: the HMIE Quality Indicators document, a Scottish Framework for Nursing in Schools and Health for All Children in Scotland (4 th Edition). One consultee stated "The list of documents at paragraph 42 is neither comprehensive nor well-chosen" and another consultee suggested:
"It would be helpful to include all relevant documents in one section at the beginning of this framework and to update the list to reflect policy developments since the consultation document was developed i.e. a curriculum for Excellence (Scottish Executive) is not referenced or the Equalities Review consultation document (2006)".
Local Authority
In relation to the Cabinet Delivery Group, 7 consultees made comments. The main topic of discussion was surrounding the precise role, achievements and future plans of the Group:
"Welcome that there is a specific Cabinet Delivery Group for children and young people, however there is little knowledge in the service of what the Group has achieved to date. We need to ensure that any successes are widely communicated."
NHS Board
Two consultees also expressed their opinion on the composition of the Cabinet Delivery Group. One consultee from the Voluntary/Charity sector was frustrated "That the 'top level cabinet group is made up of health related professionals, with token input from other allied agencies" and believed this was a missed opportunity. Another consultee also from the Voluntary/Charity sector believed "It would be beneficial that the membership of the Cabinet Delivery Group included someone knowledgeable on Profound and Multiple Learning Disability ( PMLD) issues."
Finally, three consultees discussed the importance of providing locally based services wherever feasible in addition to ensuring highly specialised care is available. This included one Voluntary/ Charity employee who stressed the difficulties that young Gypsy/ Travellers and young Refugee/ Asylum Seekers face in accessing necessary health services and health information due to the lack of a permanent address and, in the case of young Refugees/ Asylum Seekers, language barriers.
5.2 CHILD PROTECTION
Child Protection has been identified by the Scottish Executive as a major area requiring action and Paragraphs 43-44 examined the issues surrounding child protection. Paragraph 43 of the consultation document referred to the published document ' Protecting Children and Young People: The Charter (2004) which outlined the need and expectations of children and young people in relation to their protection from harm by another person. Also referred to was the complementary publication headed ' Protecting Children and Young People: Framework for Standards (2004) which was aimed at all staff and agencies involved in the protection of children. Standards are also being met through ' Integrated Children's Services Plans'. Paragraph 44 discusses the formal reform programme. While there is much to be done to embed the necessary practice within and across all agencies and professionals to ensure they are working together effectively; this has not been revised within the Action Framework.
Of the 46 consultees commenting on this section of the consultation document, many were in agreement with the points raised in Paragraphs 43 and 44. A Royal College stated "We strongly agree that child protection is a key issue and welcome all efforts to promote better inter-agency working to promote the safety of children". A small number of consultees illustrated examples of best practice concerning child protection but recognised there was a need for improvement:
"As we see the importance of this agenda we have set up a child protection committee."
Local Authority
"Our own school policies are in place and fully implemented but there is always room for improvement in the wider context to prevent referrals slipping through the net within the many different agencies involved"
Education
One point raised by 3 consultees concerned the issues of milestones and audit. An NHS Board thought "It would be valuable to have milestones which reflect the continuing need to embed child protection in our systems". Similarly, another consultee was concerned that by not revisiting the work of the child protection programme (Paragraph 44) "The unfortunate consequence of this is that there are neither targets, milestones or actions which relate to Child Protection". Additionally, one NHS Management and Strategy Group believed:
"The Integrated Children's Services Plan should demonstrate the shared agenda for action to endure that standards are met - however only self-assessment, audit and inspection will demonstrate whether they are being met."
NHS Management & Strategy
Two NHS Management & Strategy Groups recognised the importance of good communication and information sharing and stated they would like to see more emphasis placed on this. A further two NHS Service Providers were concerned about information sharing in respect of the Child Protection Reform Programme and vulnerable children specifically, stating "Investment is too little and too slow to allow electronic information sharing. Need major investment across all agencies".
One further point highlighted in relation to Child Protection was the issue of training. One Local Authority was of the opinion that "Joint education/ training for professionals is essential to develop understanding and appropriate service delivery". An NHS Board also felt:,
"Mandatory training is required especially for medical staff. Level one awareness training especially should be mandatory for all staff. At local levels the capacity of staff to delivery this training would need to be reviewed. Medical attendance at case conferences should be expected and encouraged".
Additionally, one Professional Body stressed the necessity of pharmacists being able to contribute to local policies and participate in multidisciplinary training. Finally, one Local Authority maintained "There is still a need for inter-agency training and workforce development".
Of the 46 consultees who made comments on this section of the consultation document, a few (5) considered the section did not adequately address the issue of child protection in terms of what was included or not included. The following quotes provide examples of this,
"It would be helpful if there was explicit reference to what is being done in a health context (including what still has to be done) and also some good practice examples given."
Local Authority
"This section lacks local context."
Local Authority
"Child protection should have a higher profile in the action framework if only to ensure that service providers continue to prioritise this."
NHS Management and Strategy Group
"Greater emphasis on child protection should be included as although the national review is ongoing there still are many aspects of health service provision and practice that require to be addressed."
NHS Service Provider
In contrast to the above, one Professional Body believed that while child protection is an important issue which deserves interest, it should be ensured that those children with other needs are not disadvantaged, with staff concentrating only on this area of work.
Substance misuse/ abuse was a further issue that 2 consultees (both Local Authorities) believed warranted recognition in the Action Frame work. One Local Authority acknowledged child protection links to mental health and substance misuse need to be recognised; the other said there should be more emphasis on "Children and young affected by substance abuse either as a user themselves or affected by a parent/carers misuse. Role of Drug Action Teams ( DATs) in prevention and education should be highlighted in the document".
5.3 HEALTH IMPROVEMENT
Paragraphs 45-49 concentrated on the issues surrounding 'Health Improvement' which in addition to healthcare providers, other agencies have a key contribution to make. Children should be helped to develop "the skills required to take care of their own bodies" and for older children, the 5-14 National Guidelines on Health Education ensures that health education is part of a comprehensive programme of personal & social education. By 2007 all schools are required to be health promoting for example in respect of the physical, social, spiritual, mental and emotional well-being of all pupils. They are also required to offer an important opportunity to influence dietary intake and attitude via 'Hungry for Success' which sets out nutrient standards for school meals but also encourages a focus on healthy eating across the curriculum in order to help young people make healthy eating choices throughout their lives.
Seventy six consultees provided comments and suggestions concerning the issue of 'Health Improvement' and the majority agreed with the points discussed in the consultation document. One consultee stated "Education is a key field of improvement for children's and young people's health as the consultation document rightly asserts". Another consultee from the Voluntary and Charity sector added "We strongly support the role of education services in health promotion and prevention". However the same consultee also pointed out "That education services have, of necessity, a different core task from health services which can lead to potential difficulties". One Education consultee was also keen to ensure schools genuinely become 'health promoting' rather than "going through the motions".
Seven consultees demonstrated examples of best practice in terms of health improvement within their establishments.
A range of consultees emphasised the importance of the School Nurse's role in implementing health improvement within the education sector. A Local Authority noted that "Unique role of school nurse needs more emphasis as it provides an essential link between education and health services." Two consultees however mentioned the lack of availability of school nurses to help achieve health prevention/promotion.
The necessity of training in health related issues was highlighted by 6 consultees. One consultee from a professional body stated:
"Enabling children to develop healthy lifestyles requires input from personnel and carers with the skills, knowledge and attitudes. Training will be required to address these needs".
One Individual (Professional) stressed the necessity for co-ordinated and national training for members of Guidance and Pastoral care staff who are at the forefront of implementing changes.
The section relating to Heath Improvement focussed primarily on the education sector:, although there were comments that this needs to extend further than education.
"Educational services have a key role to play in health improvement. However the ethos and practice of health improvement needs to extend beyond the education environment".
Individual
Six consultees were of the opinion that the health improvement agenda should not be limited to school education establishments but should apply to ALL children's services - public or private - because, as one Local Authority stated "Often children and young people who are most vulnerable may not be attending school or early years provision and the most effective way of communicating with them will be through less formal channels." Consultees suggest the following establishments should be included:
- Hospitals;
- Recreation facilities;
- Residential children's units;
- Secure schools;
- Child and family centres;
- Colleges;
- Universities;
- Private Schools;
- Nurseries;
- Care homes.
Parents and the family were viewed by some consultees as having an integral part to play in the promotion of health and well being of children and young people:
"Health promotion activity for young people must run in parallel with similar education and messages being given to parents, extended family and the wider community."
Local Authority
One Local Authority however pointed out "A major omission is the lack of parental/ carer role in health improvement" and a further consultee added "Excellent at targeting early years but what about support for parents and family?"
Additionally, and linked to the above is a child's and young person's lifestyle and how this determines health improvement. The following three quotes illustrate this point:
"These targets reflect the population as a whole and hide the stark contrasts in the health experiences of children from differing socio-economic background."
Local Authority
"There is a clear recognition that the societal problems associated with alcohol and substance misuse, smoking and diet which affects parents and carers, place children at similar risk".
Other
"The health improvement targets are lifestyle oriented. These will be very difficult to influence and change unless the underlying life circumstances of the child are also addressed".NHS Management and Strategy
One NHS Service Provider was of the opinion that positive change is more likely when families' life circumstances are improved and all agencies have a role in this.
A few consultees broached the subject of school dinners. One Individual was concerned over school children being released into the surrounding urban areas for purchasing lunch and snacks and thought that sit down meals and healthy choices for both the primary and senior schools is essential. One Professional Body also suggested the provision of universal free school meals and the potential this has to deliver long term health benefits.
Another consultee from the Voluntary/Charity sector welcomed the inclusion of health as part of the school curriculum, but was concerned over the continuing promotion of fizzy drinks and fast foods in schools which they believe sends conflicting messages.
Finally, the value of physical education to long term health was raised by various consultees. One Individual recommended "At school children could get P.E. daily as was the case in the USA… an alternative would be to have sports or gymnastics available immediately after school for children to attend on a weekly basis". A Professional Body concurred with this and suggested:
"If the proportion of young people participating in exercise and sporting activities is to be increased, it is essential that, as schools are built or refurbished, they should be provided with appropriate number of gymnasia, sports halls, swimming pools and playing fields".
5.4 SOCIAL JUSTICE AND INCLUSION
Paragraphs 50-62 within the consultation document focussed on Social Justice and Inclusion; The Support Group and The Action Framework.
Forty nine consultees responded with their comments on the proposals outlined under the section titled 'Social Justice and Inclusion' and all comments were supportive of the points raised and proposals stipulated. The following quote from an NHS Service Provider illustrates well, the overall theme that emerged:
"(We) Welcome recognition of the inclusion agenda and shared commitment across agencies."
In contrast however, while no consultees disagreed with any of the points, one Individual (Professional) did indicate the importance of shared commitment and stressed "This is not easy to put into practice, even at small local level."
Parents and the family play an important role in the health and well-being of children and young people and a number of issues specifically relating to parents and the family in terms of childcare, economic and social deprivation and access by family members to children were discussed.
In relation to the issue of child care specifically, two consultees suggested childcare needs to be 'affordable' and sustainable to impact on social inclusion and that child care needs to be flexible and not just 'office' hours. One Local Authority suggested financial incentives to support mothers/fathers/carers who choose to stay at home to care for children. In addition, a Professional Body maintained resources for parenting programmes need to be identified, and a representative from the Voluntary/Charity sector highlighted a greater need for specialist childcare to support parents back into the workplace if they wish".
One consultee ( NHS Board) made reference to those children and families who are affected by economic and social deprivation and explained that social exclusion is a key negative influence for health gain and therefore support must be available to help children, young people and their families overcome the many challenges they face.
Finally, an Individual stressed the importance of the family and stated they would like to see the right of grandparents and aunts and uncles being given access to children on a regular basis irrespective of the parent's wishes. This was especially relevant to parents who had divorced, single parents and multi-parent households. The consultee believed "Children should have access to people who can give them another source of knowledge and care on a temporary basis who are related to them."
Concerning the subject of 'special needs', 4 consultees made comments. One Individual (Professional) stated:
"The need for special schools still exists for young people with complex needs and establishments providing differentiated levels of support in these areas have an important role to play."
An NHS Service Provider stressed the need to monitor surveillance changes in Hall 4 to ensure children with special needs/communication difficulties are being identified. A different NHS Service Provider welcomed the inclusion to the reference to children with additional needs. Finally, one consultee stated:
"Special educational needs is no longer a recognised term and should be replaced with 'additional support needs'.
Voluntary/Charity
Of the 49 consultees who made comments on this section of the consultation document, a small number of these (2) believed the section failed to include what they believed to be relevant 'health' related information. For example, two Local Authorities were of the opinion that the paragraphs within the Social Inclusion and Justice section were not written in a health context. One consultee said "The Action Framework document seems to be weak on the health characteristics of some of the most vulnerable and excluded groups of children and young people" (e.g. those involved in substance misuse, young carers, homeless families and those affected by domestic abuse).
Finally, a few consultees laid out their response in the form of best practice examples:
"We welcome the reinforcement in point 50 of this section, where the educational attainment of looked after children is seen as a priority. In our Council Educational Psychologists are working closely with children's unit staff and teachers, to develop evidence based practice which has positive effect on educational resilience and attainment of LAAC."
Local Authority
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