Children and young people’s health support group meeting – monday 7 december 2009 conference room 3, victoria quay, leith, edinburgh minutes

Malcolm Wright, Chief Executive, NHS Education for Scotland (NES) - Chair

Safaa Baxter, Association of Directors of Social Work

Jim Beattie, Scottish Officer, Royal College of Paediatrics and Child Health

Mary Boyle, NHS Education for Scotland

Charles Clark, representing Linda de Caestecker, Faculty of Public Health

Zoë Dunhill, Child Health Consultant

Andrew Eccleston, Consultant Paediatrician, NHS Dumfries and Galloway

Mo Grant, Allied Health Professionals Scotland

Annie Ingram, North of Scotland Planning Group (by video conference)

Ann Kerr, Team Head, Healthy Living, NHS Health Scotland

Kathy Leighton, Royal College of Psychiatrists

Janice MacKenzie, Strategic Paediatric Educationalists and Nurses in Scotland (SPENS)

Jane Mallinson representing Pauline McCartan, Speech and Language Therapy

Neil McKechnie, HM Chief Inspector of Education

Caroline Selkirk, Director of Innovation and Change, NHS Tayside

George Youngson, Consultant Paediatric Surgeon, NHS Grampian (by video link)
Scottish Government

Kay Barton, Health Improvement Strategy

Lucy Colquhoun, Child and Maternal Health Division

Val Cox, Deputy Director, Positive Futures, Children, Young People and Social Care, Education Directorate

Christine Duncan, Change Manager, Maternity Services, Child and Maternal Health

Division, Health Directorate

John Froggatt, Deputy Director, Child and Maternal Health Division

Margo Fyfe, CAMHS Nurse Adviser, Mental Health Division, Primary and Community

Care Directorate

Chris Ridley, Integrated Children’s Services, Health Directorate

Nicola Robinson, Allied Health Professions, Health Promotion and Support in

Schools Team

Mary Sloan, Policy Manager, Child and Maternal Health Division
Apologies: Children and Young People’s Health Support Group (CYPHSG)

Sharon Adamson, West of Scotland Regional Planning Group

Michael Bisset, Consultant Paediatrician, Royal Aberdeen Hospital for Sick Children Bronwen Cohen, Chief Executive, Children in Scotland

Lorraine Currie, Chair, Child Health Commissioners’ Group

Deirdre Evans, Director, National Services Division

Gavin Fergie, Professional Officer for Scotland, Community Practitioners and Health

Visitors’ Association

Lesley Fraser, Deputy Director for Safer Children, Stronger Families, Scottish Government Education Directorate

Claire Gibson, Community Care Providers

Graham Haddock, Consultant Paediatric Surgeon, Royal Hospital for Sick Children,

Yorkhill

Ray Murphy, Association of Directors of Education in Scotland (ADES)

Eleanor Nisbet, Royal College of Nursing

Brenda Renz, British Psychological Society

Shirley Rogers, Scottish Ambulance Service

Jan Warner, Director of Patient Safety and Performance Assessment, NHS Quality

Improvement Scotland (QIS)

John Wilson, Chair, SEAT Children’s Regional Planning Group

Sheena Wright, Chief Nursing Officer Directorate
IN ATTENDANCE

Boyd McAdam, Getting it Right for Every Child Team, Scottish Government

Education Directorate

Caroline Mearns, Emergency Care, NHS Education for Scotland

Rory Mitchell, Scottish Public Health Observatory
ITEM 1 WELCOME AND APOLOGIES

1.Malcolm Wright welcomed everyone to the quarterly meeting of the Children and Young People’s Health Support Group and pointed out that Annie Ingram was joining the meeting by video conference. Malcolm particularly welcomed Val Cox to her first meeting. Malcolm also pointed out that Michael van Beinum had stepped down as Chair of the Section of Child and Adolescent Psychiatry, Scottish Division of the Royal College of Psychiatry, that Dr Kathy Leighton had taken over as Chair and would represent child psychiatry on the Group – he also welcomed Kathy to her first meeting.

2.Malcolm went on to extend his welcome to Rory Mitchell from the Scottish Public Health Observatory who would give a presentation on data availability, and to Boyd McAdam from the Getting it Right for Every Child team. Malcolm then explained that the meeting would follow a different format. Items 2-4 would be taken, followed by Breakout Groups to discuss the issues raised in the presentations. Items 5-6 would then be taken, again followed by Breakout Groups.

ITEM 2 DATA AVAILABILITY

3.Rory Mitchell informed the Group he was a Public Health Information Manager working on children and young people projects at NHS Health Scotland’s Public Health Observatory Division, which is part of the Scottish Public Health Observatory (ScotPHO) Collaboration.  He went on to say ScotPHO is a collaboration of various organisations working to provide a clear picture of population health: it aims to improve data collection and promote its use: it produces reports and runs a website.  Its main sources of data are surveys and routine Scottish national data schemes. 

4.The website presents and communicates data.  It is divided into sections, eg behaviour, clinical risk factors (eg obesity), life circumstances etc.  There is not yet a children and young people’s section although information on children and young people can be found in several sections, including Health, Wellbeing and Disease.  Population dynamics can be found on the website too, providing information on children and young people’s population demographics and a pregnancy and births sub-section.  The website contains key headline statistics and commentary.  More detail can be obtained from the data sources, eg from Information Services Division (ISD). 

5.Rory went on to give an example of the type of data the website holds:

• 
  The obesity section contains a summary page of the data held.   Data is available by age group and there is a subsection on children
  
• 
  The Health, Wellbeing & Disease section includes data on inequalities in oral health (e.g. oral health by deprivation)
  
• 
  Information on hospital admissions includes children’s emergency admissions
  
• 
  Children and Young People information for the Behaviour section  mainly comes from the Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) and includes alcohol consumption.
  
• 
  The community profiles include 61 indicators for health and wellbeing, reported at Community Health partnership level
  
• 
  Links to resources, eg national data schemes, key national surveys (Growing Up in Scotland).
  

6.ScotPHO has undertaken one-off reports for specific policy needs, eg on young adult smokers and obesity epidemiology.  Ongoing projects include the development of ScotPHO children and young people profiles which are aimed at Community Health Partnerships and will probably list 40-45 indicators for health and wellbeing.  The age range will be from conception to 24 years.  The profiles will be available in the latter half of 2010.  The indicator domains are likely to include: substance use; social care; transport; ill health and injury; and pregnancy and birth. 

7.Rory suggested a key gap in the data available to support ScotPHO’s children and young people profiles was mental health at local level and there was nothing yet about young people and diet.  A large scale consultation on the data people would like to see in these profiles showed strong support for indicators of mental health, maternal and infant nutrition, and physical activity.

8.The children and young people’s data section would be added to the ScotPHO website during the next business year. 

9.During discussion, the following points were raised:

• 
  A children and young people’s section would be welcomed as would a section for children and young people to use themselves: Rory acknowledged this hadn’t yet been considered but would be in the future
  
• 
  Separate information on families would be helpful, eg children in households with adults who had alcohol problems.  Data on families and structure, family relationships etc were available but relevant health information is limited
  
• 
  The data should not all be about services  – the impact on children of adult circumstances should be recorded
  
• 
  ScotPHO seeks feedback on the data people need and try to deliver it
  
• 
  Work has begun on developing children’s mental health indicators, led by Jane Parkinson, also of Health Scotland’s Public Health Observatory Division.  A seminar is to take place on mental health indicators on 1 March 2010 – Rory Mitchell could give further information.
  

10.Malcolm concluded by thanking Rory and by saying the presentation and discussion had been very helpful.  The suggestion for ScotPHO to present to the Group arose from a discussion at the previous meeting around the Lancet study on mortality of young people.  The Group would welcome sections on children and young people and on children’s mental health services.  The ability for children and young people to access the data should be considered.

ITEM 3 WORKFORCE AND EDUCATION & TRAINING

11.Mary Boyle and Caroline Mearns from NHS Education for Scotland were invited to present this item and presented the attached slides.

12.During discussion, the following points were raised:

• 
  A lot of work was ongoing, but were there any gaps and what should the priorities be?
  
• 
  Succession planning around the Emergency Care Framework was at risk when NES stepped down
  
• 
  The Hall 4 Implementation Network was concerned about public health nursing – there was a 30% Health Visitor vacancy across Scotland
  
• 
  Work has started on generic skills for CAMHS – CAMHS need more staff. A maintenance programme is underway for people to upskill – health visiting is being considered
  
• 
  A health framework is being considered for social services drawing on the NHS Career Framework and what courses were transferable to social skills. A standard practice statement for working with children was in place
  
• 
  A health and social services course was considered but the Scottish Social Services Council wanted a benchmark set up first.
  

13.Malcolm concluded by thanking Mary Boyle and Caroline Mearns and pointed out that comments and feedback would be welcome during the breakout groups, especially on any gaps and deficiencies.

ITEM 4 ALLIED HEALTH PROFESSIONS/EDUCATION WORKING GROUP, AND THE CHANGING ROLES OF AHPs

1. 
   Nicola Robinson reported that a joint AHP and Education Partnership Working Project is currently developing guidance on partnership working between AHPs and education practitioners. It is focusing on the three therapy services: occupational therapy, physiotherapy and speech and language therapy as the AHPs most closely working with schools and local authorities to meet the needs of children. The national guidance is applicable to the wider group of AHPs and to all health practitioners working collaboratively. Two secondees are working on the two year Project, one from the AHPs and one from education. The Project has been looking at what is current good partnership practice and what the barriers are to partnership working. Wide engagement with practitioners and a broad group of stakeholders and service users has informed the content. A web resource will accompany the printed hard copy published in June 2010.
   

2. 
   The aim of the Guidance is to improve experiences and outcomes for children, young people and their families, to promote sustainable, consistent partnerships and to support Scottish Government policies for children. The Project has linked to the wider policy agenda for children and young people e.g. Equally Well, Getting it Right for Every Child, Curriculum for Excellence and the Early Years Framework. The Project workers have met with a wide variety of interested parties who will be approached again during the consultation exercise.
   

3. 
   The guidance is written to serve as a self-evaluative CPD tool. It describes emerging key features of good practice, links to service user voices, the policy agenda and the evidence base. The inclusion of questions to consider and signposts to improvement enable practitioners to reflect and improve impact on outcomes for children. It will also contain practical examples of existing good practice to share, for example, of joint interventions and joint planning, how to build capacity of education staff to support children, developing leadership skills and working with parents as partners.
   

4. 
   The challenges to partnership working include: understanding roles, particularly of AHPs, interpersonal skills, communication and relationships, and resources or funding. Although the benefits of partnership working need to be better evaluated, the advantages are clearly and consistently reported to include observed and measurable progress of children; building on and sharing skills and resources; and reduction in conflict. Working across health boards and local authorities can be a challenge. Speech and language therapy (SLT) is typically additionally funded by local authorities through service level agreements. Recently local authorities have experienced increasingly competing demands resulting in reduced budgets for SLT. Single Outcome Agreements need to have good line of site with local AHP service provision to meet national outcomes with community planning able to link the two. Recruiting AHPs to work in paediatrics can be a problem.
   

5. 
   The guidance was issued for consultation on 4 December and will run until February 4^th 2010. It can be accessed at
   

14.Nicola suggested the Support Group recognise and link with the services of paediatric AHPs through a) supporting their role in implementing the National Delivery Plan for Children and Young People’s Specialist Services in Scotland in terms of providing vital continuing community care b) making stronger links between CAMHS and schools c) considering that Hall 4 may have impacted on early AHP referrals d) the AHP role within the Community Child Health team (CCH21) e) their pivotal role in delivering the Early Years Framework and f) the value identified by the Equally Well health and wellbeing test sites of therapy support services in meeting the health needs of children.

15.Nicola suggested the joint CYPHSG/QIS visits could look at the early signs of risk, eg communication skills, at training and at the impact of services on outcomes for children and young people. Nicola went on to suggest key questions could be asked about aligning resources to the most significant outcomes, ensuring AHP services are included in Single Outcome Agreements, partnership working and responsibilities. Nicola concluded by inviting the Group to look at, and comment on, the guidance.

16.During discussion the following points were raised:

 A lot is going on that AHPs can contribute to

 Is the data collected on AHP services meeting our needs or should it be refined?

 What should the future priorities be for AHPs?

 What are the priorities for the AHP workforce training and development?

 How can CYPHSG best consider the issues and support the implementation of the Guidance?

17.Boyd McAdam began by admitting that Getting it Right for Every Child (GIRFEC) was not yet impacting on health as much as hoped. The Scottish Government’s National Framework focuses on outcomes for government, local authorities and voluntary organisations. The Scottish Government wants every child to get the best possible start in life and to develop a child’s potential.

18.Boyd continued by saying GIRFEC was not a separate policy, it is a way of working and promotes transformational change. The evaluation of the Highland Pathfinders which was published on 23 November shows progress to date across health, education, police, social work, in developing the Getting it Right approach.

19.Outcomes can be improved. The GIRFEC approach streamlines beaurocracy – agencies have to come together. Previously in Highland there had been 29 processes which required up to 63 meetings resulting in up to 108 documents depending on how the child had entered the system. Now there is one plan and one meeting. GIRFEC is about reducing meetings and creating a common language.

20.GIRFEC puts the child at the centre within and across agencies. Health would probably identify need in young children, education would take over in later years – health visitors could continue to engage but would need the skills to identify need.

21.GIRFEC is a concept built from the Children’s Hearing Review. It is well liked but it now needs to be put into practice. It is moving from the development to implementation stage. The lessons from the Pathfinders must be built on – the steps to do that need to be identified and time for training was also needed. Boyd reported there was cross party support for GIRFEC. A structure must be put in place to move towards early intervention.

22.Boyd repeated the GIRFEC approach was to put the child at the centre, and to build on family support. Extra help is identified, universal services are in place, targeted multi agency interventions are put in place when necessary. Professionals must think all the time what they can do and what information they need. GIRFEC has developed a wellbeing wheel with the child at the centre. This supports other policies, eg Equally Well. The GIRFEC approach identifies need and works to alleviate problems, even if the child, or an adult, has to be removed from the household.

23.The wellbeing concept includes analysing information to identify strengths and weaknesses, and to plan to improve outcomes. The Practice Model which has been developed, and is included in the new Scottish Personal Child Health Record (Red Book), helps to explain services to parents. For effective information sharing, there has to be a common language and common understanding amongst health, education etc. Multi-agency training has to take place. Clarity around roles and responsibilities is needed. Every child should have a named person to facilitate coordinated services.

24.In Highland, of the children identified to follow the GIRFEC approach, one-third had shown improvement in all the outcomes, eg they engaged better, felt better supported and were more involved.

25.Regarding implementation, Boyd reported the Scottish Parliament is in favour of the GIRFEC approach but local community partnerships have to plan what it means for them. Practitioners’ tools had to be developed further: electronic systems also had to be developed to help identify and disseminate best practice – this is being done through the eCare system. A big issue is confidentiality and when to release information, eg for child protection. There is also a need to improve connections to improve delivery nationally and within the SG; for engaging and implementing locally; for performance, for better data, for scrutiny and inspection; and for improving practice. A way of measuring a child’s outcomes is in place, GIRFEC has to be seen to make a difference. Better engagement with community planning partnerships is needed. A question remained whether GIRFEC should be inspected.

26.Boyd suggested that to implement GIRFEC, professionals need to understand it better; leadership and commitment are also needed. Difficulties have to be identified and its profile has to be raised in health but how could that be done? Awareness training, to include GPs, would be very important and should be built into existing training programmes.

27.During discussion, it was pointed out:

• 
  GIRFEC isn’t a policy it is a methodology – a set of principles in how services should be delivered. Evidence is available to show that this works and efficiencies can be achieved too
  
• 
  Health professionals need to be more aware
  
• 
  The Highland report will be crucial for the rollout to the rest of Scotland - an approach has been developed which is transferable
  
• 
  GIRFEC promotes a “named person” approach to take an overview of the needs of the child and to coordinate services. The named person could be from health, education, housing, social work etc. Evaluation of the named person would be published imminently
  
• 
  The hook to better engage with health boards could be the benefits gained from GIRFEC, eg better working across sectors
  
• 
  It would take 2½ -3 years from committing to use the GIRFEC approach before outcomes for children would be seen.
  

ITEM 6 EQUALLY WELL REVIEW

28.Kay Barton reported that the Equally Well Ministerial Task Force is to reconvene in 2010 to review progress and suggested the Support Group could get involved. The Review will look at inequalities generally, will do a stock-take and will look at the experiences gained from GIRFEC and the Equally Well test sites. The Review will then make a few statements and recommend actions, focusing on what is most important for local change and improvement. Kay went on to suggest GIRFEC could be the glue to help ensure Equally Well actions relating to children are implemented. Kay repeated that she was looking for feedback from the Support Group.

29.During discussion the following points were raised:

 Boyd’s questions around aligning children’s services with the GIRFEC approach/language: friction points: how to raise the GIRFEC profile; and is there a clear line between GIRFEC and the Early Years Framework/Equally Well policies should be taken into account

 Equally Well should be high priority in the Single Outcome Agreements

 Equally Well should be included in the CYPHSG/QIS visits

 Very few people know what GIRFEC is. It should be seen as a tool for implementing the Early Years Framework and Equally Well and as part of a 5-10 year change management process. GPs should be targeted, amongst others.

 GIRFEC should be a high priority but the profile needs to be raised: should it be taken to the Chief Executives’ meeting?

30.The minutes of the previous meeting were agreed as a correct record.

ITEM 8 MATTERS ARISING

31.There were no matters arising.

ITEM 9 AOCB

32.There was no other competent business.

ITEM 10 DATES FOR FUTURE MEETINGS

33.CYPHSG meetings will take place in 2010 on 26 April, 26 August and 13 December, all in Conference Room 3, Victoria Quay, Leith, Edinburgh.

ITEMS TO NOTE

34.Malcolm explained to the Group that it was intended to request updates from the Leads and members would be invited to note the papers rather than each topic being an agenda item. He reminded the Group that its membership had been reviewed and augmented since the June development day and the Core Group had also reviewed the areas the Group should continue to be involved in. Malcolm suggested that the Group had assisted in many areas, eg the inpatient beds issue had moved on - £2m funding had been secured. Malcolm also suggested that the HEAT targets focused minds. He then asked if Leads wished to highlight any points from the papers which they had submitted.

NATIONAL DELIVERY PLAN IMPLEMENTATION GROUP

35.Caroline Selkirk reported that a meeting was to take place the next day to discuss the Year 3 bids. She thought the Implementation Group was making good progress. She appreciated that the funding was protected and was conscious of the need to recruit. John Froggatt’s letter to HR departments had been helpful. The Government was clawing back underspend. Malcolm commented that the chairing of the Implementation Group was not to be underestimated.

HALL 4

36.Zoë Dunhill reminded the Group that Health Boards would be using the new WHO growth charts and the new Scottish Personal Child Health Record (Red Book) from 1 January 2010.

COMMUNITY CHILD HEALTH FOR THE 21^st CENTURY (CCH21)

37.John Froggatt reported the review would begin in January and would last 6 months.

CYPHSG/QIS VISITS

38.Malcolm stated he was pleased to see planning had begun for the joint CYPHSG/QIS visits. He felt strongly that the Support Group should go out to help Boards, and that GIRFEC should be one of the topics covered.

39.George Youngson said it was good to have a national approach to patient safety across Scotland and that it fitted in well with the Scottish Government’s quality strategy. He also acknowledged the National Delivery Plan funding which was to be put into this.

MATERNITY SERVICES ACTION GROUP UPDATE

40.Christine Duncan drew attention to the bullet points in the paper which had been circulated. She suggested that maternity services are part of the early years work. Pregnancy has an important impact on children’s outcomes – that needed to be communicated and thought had to be given to the interface among midwives, children and adults. Thought also has to be given to what is meant by universal services. Christine requested time to explore these points at a future meeting.

41.Malcolm concluded the meeting by saying he would welcome feedback on the new format. He went on to say he considered the work of ScotPHO was important and he would like the Group to influence its children and young people’s website. He also suggested good work was taking place regarding education and training for AHPs. He had found the discussion on GIRFEC and the early years helpful and highlighted that health needs to be more aware of GIRFEC. He went on to say that good progress had been made on CAMHS, the National Delivery Plan, Hall 4, CCH21 and the joint CYPHSG/QIS visits. He also acknowledged that National Delivery Plan funding was to be used for the patient safety workstream.