Children and Young People’s Health Support Group Meeting 1 May 2013
Conference Room 3, Victoria Quay, 10.30am
Present:
Malcolm Wright (Chair)NHS Education for Scotland
Jim BeattieNHS Greater Glasgow and Clyde
Mike BissetNHS Grampian
Mary BoyleNHS Education for Scotland
Jim CarleNHS Ayrshire and Arran
Sara CollierChildren in Scotland (representing Jackie Brock)
Linda de CaesteckerNHS Greater Glasgow and Clyde
Morag DorwardNHS Tayside (representing Jane Reid; Catherine Gorry)
Roderick DuncanScottish Committee of Surgeons
Andrew EcclestonNHS Dumfries and Galloway
Gavin FergieAmicus
Peter FowlieRoyal College of Paediatricians and Child Health
Gwen GarnerAction for Sick Children Scotland
Carrie LindsayAssociation of Directors of Education
Rosemary LynessDirector of Nursing
Bernie McCullochHealthcare Improvement Scotland
Sandra McFadyenCommunity Care Providers Scotland
Neil McKechnieEducation Scotland
Wendy PeacockNHS Health Scotland
Brenda Renz NHS Lothian
Judy ThomsonNHS Education for Scotland
Anne Marie PittNorth of Scotland Planning Group
Jan McCLeanSEAT (representing Jacqui Simpson)
George YoungsonEmeritus Professor
John FroggattScottish Government
Kate McKay Scottish Government
Mary SloanScottish Government
Anthony ChristieScottish Government
In attendance:
Terri CarneyNHS Education for Scotland
Emma HoggNHS Education for Scotland
Vivien SwansonNHS Education for Scotland
Maggie WattsScottish Government
Apologies
Jacqui SimpsonSEAT
Neil HunterScottish Children’s Reporter Administration
Kathy LeightonRoyal College of Psychology
Andrew DeansScottish Youth Parliament
Elaine LoveNHS Greater Glasgow and Clyde
Eleanor NisbetRoyal College of Nursing
Karen WilsonScottish Ambulance Service
Sharon AndersonWest of Scotland Regional Planning Group
Karen AndersonCare Inspectorate
Deirdre EvansNational Services Division
Caroline SelkirkNHS Tayside
Rachael WoodInformation Services Division
Safaa Baxter Association of Directors of Social Work
1 WELCOME AND APOLOGIES
1.1Malcolm Wright welcomed everyone to the meeting and gave apologies.
2CHILD PROTECTION
2.1Kate McKay presented on this item. Provision of Child Protection medical paediatric services is becoming a crisis because of lack of available paediatric medical expertise. All boards have been written to, to ask what their plans are for succession planning, as two retirees are leaving a gap at the expert level. She queried what the provision of paediatricians is and how we provide medical experts in this area. She stated that there are three Managed Clinical Networks which recognise that there is risk of no leadership; this is a gap which causes a high risk for Boards .
2.12She stated that new Police Partnership arrangements are being set up and NSD is providing secretarial support for a steering group at the end of May which will provide an overarching governance of Forensic services, including specialist forensic services – through which paediatric forensics will have a national platform.
2.13She commented that RCPCH recently carried out an audit of acute paediatric services in Scotland which suggests some units are not meeting standards and competence in terms of training of consultants in Level 3 Competencies in acute paediatrics. Some do not have level 3, which is a requirement.
2.14John Froggatt mentioned that there have been discussions about Child Protection over many years as it is a complex area which are both a challenge and an opportunity. He stated we have an opportunity to fix this. Kate commented further on the Intercollegiate Framework and the level 3 which all paediatricians should have. She mentioned that level 4, 5 and 6 haven’t been tied down in terms of complexity of cases. She commented that a two-tier level consisting of generalists and specialists is ideal, and that we can’t sustain a three-tier approach. She commented that the debate is still whether this should be regional or national networks providing out of hours advice and assessment for complex physical and sexual abuse in children; but regional is the first level of Out of Hours advice and Support that should be provided. She further stated that responses on Child Protection have been received from the NHS Scotland Boards. She also noted that a standardised process is needed on paediatric expertise.
2.15Kate further mentioned during discussion that the challenge for delivering a model of sustainable medical workforce issue, is to produce well trained general paediatricians and encourage them to develop more skills in child protection. There were plenty of educational opportunities, and the RCPCH had outlined a core level of child protection expertise for all general paediatricians but many of these consultants would also need mentoring and support to develop further. She commented that we need to get young paediatricians in but support them through not just education but also in a mentoring capacity. Ann Marie Pitt further argued that Child Protection doesn’t have a specified pathway to become a specialised paediatrician in Child Protection and that this is a major hindrance. Andy Eccelston commented that the way to achieve success is where everyone is contributing to the Child Protection process. He also said that there is a need to have access to training and mentoring, and that if that support mechanism exists, people will be less scared to go into it.
2.16Kate commented that additional essential elements of the child protection process were necessary to allow medical paediatricians to use their skills and time to see the most complex medical examinations. Triage of all referrals should be done with timely, appropriate provision, which is GIRFEC-related and a community-based system. Judy Thompson agreed that the workforce issues raised are being thought about in the correct way. She further said there is need for general and specific competencies to apply to different departments beyond medicine and a more detailed discussion should be set up.
2.17There was some final discussion around feeding this information into the Care Inspectorate, and Kate mentioned a meeting had been set up with Lawrie Davidson.
Action: Malcolm Wright to write to Chief Executives.
Item to be taken forward as agenda item in next meeting.
ITEM 3FETAL ALCOHOL SPECTRUM DISORDERS
3.1Maggie Watts presented on this subject (slides attached). She provided a background to the topic with information on why fetal alcohol harm could be an issue for Scotland with the high rates of alcohol use in women of childbearing years. She highlighted the key features with which children affected by fetal alcohol harm can present and commented on the factors that help reduce secondary disabilities in affected individuals, emphasising that early diagnosis is important.
3.12 She outlined the approach being taken in Scotland based on prevention, detection and diagnosis, and management. She concluded her presentation with a list of next steps, involving working towards a national policy on FASD.
3.13There was some follow-up discussion and questions around Maggie’s presentation. Brenda Renz commented that 10% of children are in behavioural trajectory and that a huge amount of resource needn’t be spent on this. Mary Boyle stated that NES is producing the electronic learning resource. Andy Eccleston commented about the population basis for the work done in Canada, and whether this was a native American issue. Maggie Watts responded that Canada and the United States are both increasingly recognising FASD is an issue for both white and non-white populations. Kate McKay stated that FASD is poorly recognised in paediatrics and queried what the cross-over was with mental health and the drug population. Maggie Watts replied that new evidence is emerging that shows that some illicit drugs are causing damage in babies but not on the same scale as that of alcohol.
3.15With regards primary prevention, she commented that this is about getting the whole population approach where we need to reduce alcohol consumption. She commented that this is especially needed for pregnancy. Linda de Caestecker commented that women will not say they are drinking while pregnant and queried how work is going with this in Scotland. Maggie replied that the research knowledge stems from work being done post-natally. She further stated that it is important that antenatal alcohol screening and brief interventions are non-judgemental and that there is no attribution of blame in relation to drinking in pregnancy, in order to encourage openness. Morag Dorward commented that diagnosis by the age of 6 seems late as the first 1000 days is crucial. Maggie Watts stated that this is why the 27-30 month review is so important.
ITEM 4LOOKED AFTER CHILDREN
4.1Kate McKay and Jim Carle presented on this item. Kate commented that this group of children were recognised as Children with very poor outcomes for health and educational attainment, and therefore services delivered by Local Authorities, Health, Justice and Third sector were high on political and strategic outcomes for Ministers. The LAC Strategic implementation group (LACSIG) is chaired by Aileen Campbell and reviews a range of work going on across Scotland. She mentioned that the Children and Young Person’s Bill proposes a range of duties on Local Authorities and Health Boards which will impact on the delivery of better outcomes for LAC. This will include a duty to provide all children with a Named Person, including all those children who are LAC. In addition there are specific duties placed on Health Boards as the ‘Corporate parents’ for LAC. Another indicator of the profile of LAC health is the Education and Culture Committee who are inviting Child Health Commissioners on 21 May to give evidence on neglect and the issues of permanence. Jim Carle is suggesting we draft a 3-4 page document for this.
4.12Kate is chairing a SLWG and looking at producing a standardisedcare pathway.She mentioned that there was a responsibility on Boards to deliver on CEL 16, and that Care Pathways should have been developed to deliver on the recommendations in CEL 16.However there is marked variation in Boards responses.There are plenty of other current evidence being produced on the health care assessment for LAC. NICE has produced guidance with useful pathways. RCPCH are producing Intercollegiate Guidance on Health care standards for children in secure settings which includes secure accommodation and secure inpatient facilities for mental health issues and Young Offender Institutions. Local Authorities are working together to produce a framework for the procurement of residential care for children and wanted health input to this process to ensure health needs are incorporated during matching placement. The costs of such residential Care is in the region of £100 Million per year. Therefore agreeing which children should be placed in which institution is important to establish best value, which is a cost-effective strategy. Kate stated that she is meeting with Scotland Excel on May 2 about the important steps regarding health which will be taken forward in the Children’s Residential Framework.
4.2Jim Carle carried on the presentation. He commented that Ayrshire and Arran are working with residential care providers and local authority partners to develop a Health Promoting Care Establishment Framework. He mentioned that the Care Inspectorate highly appreciate partnerships with local authorities. He stated that work is going across all Health Boards in this area and that NHS Scotland agreed to take the reins in this process. Jim recommended that NHS Education Scotland be approached regarding supporting the educational needs of residential care workers regarding the health promotional activities, including the mental health promotion of the residential care population. He mentioned that was to be an established process to involve CAMHS professionals, but that the staff member who was to take this forward has been ill. Jim reiterated the meeting with the Education and Culture Committee on 21 May and that comment will be taken from this group.
Jim commented on the New Children’s Hearing (SCOTLAND) Bill, about which implications for health were not recognised. He stated that we are not in a good position nationally to take suggestions made forward and that clarity is needed on the minimum standard.
4.21Carrie Lindsay commented that from a Local Authority perspective, the appropriate matching and placement processes were poor and care placement tends to break down quickly often due to behavioural and emotional health difficulties which may not require the services of CAMHS but do need a mental health approach. She mentioned that while the Framework was a step in the right direction, there will still be a lot of emergency placements and the challenge will be to get this right. Linda de Caestecker commented that looking at the health promotion materials and actions for tobacco might be useful as this was work that was already done.She mentioned that work going on in terms of permanency in Glasgow would be useful. Kate McKay added that there has been a CEL (03) released this year which describes the Responsible Commissioner, particularly for children placed in residential care establishments out with their home area Health Board. Jim Carle mentioned the difficulty with the Units being opened in some Board areas as the Units which were not addressing the specific requirements and needs of the LAC population .
4.15Judy Thompson mentioned that NES have been approached by CAMHS to discuss a proposal. Mary Boyle stated that NES have done work with LAC nurses around the competency and education of LAC nurses.This had been published in 2009, which has now translated into a course.
Action: Mary Boyle to send this information to Anthony Christie, to share with the group.
Action: Item to be taken forward as agenda item in next meeting.
ITEM 5YOUTH HEALTH IMPROVEMENT
5.1Emma Hogg made a Power Point presentation on this item (see attached). And circulated papers around the group. She commented on cross board views identified via the local health board strategic leads group for youth health improvement, specifically: that young people’s health is important; that young people have a limited profile in current public health efforts; that there is a need to think more holistically; that there is a need for more interagency ownership; that more needs to be done to engage those who experience the most barriers to engagement; that health services need to be more youth friendly; and that mental wellbeing is a key underpinning issue.
5.12Emma commented on outputs to date from the group, including a paper summarising local board views on youth health improvement, a youth health epidemiology briefing paper, a briefing paper on high level evidence of effectiveness for youth health improvement, and an SG policy overview.
5.13She commented on work in progress, which involves: a briefing paper on a life course approach to youth health improvement; a briefing paper on the importance of young people’s health; a multi-agency advisory group reviewing evidence and theory for health behaviour development and change applicable to young people; work on youth unemployment and health improvement; a consensus statement on youth health improvement; and the development of a strategic outcome-focused national approach to youth health improvement. Emma concluded her presentation by stating that the NHS youth health improvement group are now planning to pursue wider partnership engagement through setting up a National Partnership Group tasked with developing a shared understanding of priorities for action.
5.14There was some further group discussion. Sandra McFadyen commented that a joined up approach was important. She added that there was lots of potential though there were gaps in this age group. Kate McKay mentioned that taking the life course approach is good but for service delivery, we know it is difficult and the life course approach won’t work here. George Youngson mentioned that this was true for tertiary services but not for primary care. He stated that this is a problem related to diversity of profiles and noted the specialists involved. He commented that it is the 15-24 are range that we struggle with. Primary care are the people charged with the overview. It was also noted that the issue of youth health improvement is large and complex. Emma Hogg commented that priorities have been identified in other similarly large and complex areas and so the same should be possible for youth health improvement.
5.15Kate commented that understanding child mortality, data and data linkages, e.g, suicide, was crucial, and would be interested in the youth health epidemiology paper mentioned. John Froggatt suggested that it was critical that the Youth Health Improvement work be linked to the Early Years Collaborative and that primary care is linked into this. Additionally, he mentioned that this should be a stratified approach and made clear what the key parts are to be taken forward.
ITEM 6PSYCHOLOGY OF PARENTING PROJECT
6.1Brenda Renz presented on this topic (slides attached). She outlined the projects’ aims: improving outcomes with significant levels of early-onset disruptive behaviour problems; increasing workforce capacity around evidence-based parenting interventions for such children and their families; assisting services in shifting towards preventive early years spending; and promoting effective early years partnership working.