Keeping a focus on children and young people

Victoria Watkins, Deputy Chief Inspector for Primary Medical Services and Integrated Care, highlights some of the work CQC are doing to keep a focus on children and young people.

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Victoria Watkins, Deputy Chief Inspector

In today’s blog, I want to talk about children and young people (CYP) and highlight some of the work we have been doing to keep a focus on services for CYP. But I also want to start by thanking everyone working in health and social care. You’ve been working hard through challenging times. I know how difficult that has been and the real difference you’ve made to people’s lives.

Children and young people (CYP) make up almost a quarter of the population in England. In health and social care, we all have direct or indirect contact with CYP, including at CQC. CQC is responsible for inspecting all registered health services that children and young people use. We think about children and young people accessing primary, community, mental health, hospital and specialist care.

Our specialist Children’s Services Inspection Team works together with Ofsted and others, delivering a wide range of specialist inspections. These include:

· Children Looked After and Safeguarding special reviews (CLAS)

· Joint Targeted Area Inspections (JTAI) with Ofsted, HMI Probation, HMI Constabulary, Fire & Rescue Services (HMICFRS) and HMI Prisons

· Special Educational Need and Disability (SEND) inspections with Ofsted.

Our Health and Justice Team also carry out multi-agency inspections for CYP. These include:

· Youth Offending Team (YOT) inspections with HMI Probation

· Secure Training Centre (STC) inspections with Ofsted.

Are we listening?

Our 2018 report, ‘Are We Listening? Review of Children and Young People’s Health Services,’ highlighted the importance of schools’ role in supporting CYP’s mental health.

A recent joint report from Ofsted, CQC, HMICFRS and HMI Probation looked at how partners in six local authority areas are working together to help children with mental ill health. The report is based on JTAIs carried out between September 2019 and February 2020.

The report found strong partnership working, with the needs of the child at its heart. This is a testament to the tireless effort of people working in the system to improve the experience of children and young people.

Unfortunately, as we reported in 2018, some young people still wait too long for their needs to be identified or to access the mental health support that they need. There is still also a risk that we focus on immediate issues, such as disruptive or challenging behaviour, missing the opportunity to address any mental health needs that might also be present.

It’s vital that we build on the progress made and good practice we have seen. Holding onto these lessons as the whole health and care system continues to respond to the pandemic and any impact it has on services.

This week, Ofsted published a report on the impact of COVID-19, including findings from joint SEND inspections with CQC. This report found that the disruption caused by this pandemic has been far reaching — impacting people who use services and those labouring tirelessly to support others, often as they both adapt to new ways of working.

As we found in our State of Care report, COVID-19 is magnifying inequalities in care and risks disproportionately affecting some more than others. While much has been achieved through the dedication of people working in services and the use of digital solutions, it is vital that we do not lose sight of CYP, especially those with special educational needs at a time when the integrated support they need might be harder to access.

Think Child

Beyond the work we do directly with children’s services, we are encouraging all colleagues and services that we monitor, inspect, review and regulate to ‘Think Child.’ Whether that is because children use your services, their parents and carers use the services, or they visit other adults in those services. We need to make sure that we ‘think child’ in all our work, and importantly, at the current time when considering the impact of COVID 19.

We have made sure to do this in our latest Provider Collaboration Reviews (PCRs), which looked at how providers were working together to ensure urgent and emergency care (UEC) provision in eight areas in October and November. During our reviews, we looked at new models of collaborative provision across systems. This included access to care; the flow of people through the system; and ensuring people using urgent and emergency services receive high-quality, safe care. Looking at inequalities and access, we also looked at what collaboration took place to help care for CYP.

Full findings from these will be published in January 2021. Our initial findings show that, much like in Ofsted’s October SEND report, quality of existing relationships between local providers played a major role in the coordination and delivery of joined-up services to meet the needs of the local population. We also found inequalities in some areas, meaning some CYP may have missed out on the care they needed.

When looking at how staffing across UEC was affected during the pandemic, we found lots of cases of providers going above and beyond to ensure that employees had the right skills to cope with the increased demand.

In West Yorkshire and Harrogate, children’s safeguarding training at level 3 was turned into an online version and included topics that were emerging during lockdown, such as the risks in online medical consultations. In Hampshire and the Isle of Wight, the ‘Think Child’ model was strengthened through staff training. Ambulance crews were taught to ‘think child’ to strengthen their assessment of potential safeguarding issues for children.

It is important we do not underestimate the impact COVID-19 has had for children, young people and their families. As the nation continues to navigate COVID-19, winter is also upon us, a time when additional pressures are well recognised. This includes services for CYP.

As well as our ongoing work to support and review CYP services, we will continue to highlight good practice and encourage all services to consider plans for children, young people and their families. We look forward to continuing to ensure a spotlight on children and young people through our PCR programme. In the meantime, I want to encourage everyone working in health and social care to think about how they can best serve the needs of children and young people during these challenging times.

Thank you for all the hard work you are doing and keep safe.

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

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