Standard 3: Child Young Person and Family-centred Services : Department of Health

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National Service Framework for Children Young People and Maternity Services: Core Standards

Standard 3: Child Young Person and Family-centred Services

The National Service Framework for Children, Young People and Maternity Services establishes clear standards for promoting the health and well-being of children and young people and for providing high quality services which meet their needs.

Vision

We want to see:

Professionals communicating directly with children and young people, listening to them and attempting to see the world through their eyes.
Children, young people and their families having equitable access to high quality, child-centred health promotion, prevention and care services, which are responsive to their individual developing needs and preferences.
The views of children, young people and families being valued and taken into account in the planning, delivery and evaluation of services.

Standard:

Children and young people and families receive high quality services which are co-ordinated around their individual and family needs and take account of their views.

Markers of Good Practice

1. Every child, young person and parent is actively involved in decisions about the child's health and well-being, based on appropriate information.

2. Confidentiality and consent policies are developed and made explicit to children, young people and their parents.

3. Children and young people and their families have opportunities to access health and local authority primary care services, in a range of settings such as early years settings, especially children's centres, extended schools or drop-in centres.

4. There is an agreed process to plan local service provision in partnership and provide co-ordinated care.

5. Primary Care Trusts and Local Authorities work together with other agencies to develop a system so that information derived from an assessment of a child or young person and their family, can follow them and be accessible through their journey.

6. The views of children, young people and their parents inform the needsbased commissioning strategies, developed by Local Authorities and Primary Care Trusts and Children's Trusts.

7. Every organisation or service identifies a senior lead for children and young people to ensure that children and young people's needs are at the forefront of local planning and service delivery.

8. All staff working with children and young people receive training and are skilled in the Common core of skills, knowledge and competencies set out in this standard which enable them to communicate with children and young people and their parents, and assist them to achieve their full potential.

2. Rationale

2.1 Each child or young person needs to be seen as a 'whole', in the context of their family, carers, school, friends and local community. This should involve an understanding that, as children and young people grow up, their needs change.

2.2 For services to be effective, they need to respond to children and young people's individuality, developmental age and social circumstances and be coordinated around the child and family.

2.3 Children and young people and their families need to participate actively in designing services and in providing feedback on the care they received.

2.4 Services value diversity and plan to be inclusive for all groups of children, young people and their families who may be in the minority as a result of their culture, faith, race, ethnicity, sexual orientation, disability, geographical disadvantage such as living in rural areas, their social or family situation. To promote equity and reduce inequalities, professionals and services need to respect these differences and ensure equity of access to services which are appropriate for each individual.

Box 1: Child-Centred Services:

Consider the 'whole child', not simply the individual problem or illness being treated;
Treat children as children, and young people as young people;
Are concerned with the overall experience for the child and family;
Work with children, young people and parents as partners;
Integrate and co-ordinate services around the child and families' identified needs;
Graduate smoothly into adult services at the right time;
Work in partnership with children, young people and their parents to plan and shape services and to develop the workforce;
Follow best practice in obtaining consent and respecting confidentiality; and
Ensure the child is seen and communicated with using their preferred communication method or language.

Interventions 3. Listening and Responding To Children and Young People and Parents

3.1 Ensuring that the views of individual service users and the local population are sought and responded to is an increasingly important requirement of national and local government policy. The central theme of The NHS Plan1, as reiterated in the The NHS Improvement Plan, is to design and deliver services around the needs of the person using them, with an emphasis on developing partnerships between patients and professionals. This means seeing services through the eyes of the child and family, and planning and delivering services according to their needs.

Children have a right to be involved in decisions about their care (UN Convention for the Rights of the Child, Article 123). The need to secure sustained national improvements in NHS patient experience by 2008 is a target in National Standards, Local Action which specifies the need to ensure that individuals are fully involved in decisions about their health care.

3.2 Overview and scrutiny is a fundamental way for local councillors, as democratically elected community leaders, to voice the views of their constituents to decision makers and require them to listen and respond. This is particularly the case in relation to the power of health scrutiny that allows local councillors to scrutinise matters relating to public health and the NHS. Non-executive councillors are encouraged to look at both the services provided by their own authorities and issues of wider concern. Scrutiny of health issues should be in accordance with the statutory guidance issued by the Department of Health in July 2003.

3.3 Particular efforts should be made to ensure that children and young people who are often excluded from participation activities are supported in giving their views eg. disabled children or looked after children. The Healthy Care Programme (NCB 2002) promotes participation by children, young people and their carers in decisions about service development for looked after children.

3.4 Parents' views are important in determining local service provision and should be considered in planning and service development. The views and opinions of very young children should also be sought in appropriate ways.

3.5 Inclusiveness can be promoted by providing a welcoming and responsive environment for discussions with children, young people and their families, and ensuring that meeting times and locations are sensitive to providing local access, travel, childcare and other personal needs.

Professionals from all agencies adopt a systematic approach which enables children and young people to contribute to discussions about their needs, care or treatment during consultations or meetings and to express their views. This includes children with communication needs or who use non-verbal communication.

Local authorities use their overview and scrutiny role to scrutinise local health and social care issues of concern to children and their parents in accordance with the Overview and Scrutiny of Health (DH 2003).

Children, young people and their parents participate in planning, evaluating and improving the quality of services. User participation follows the principles set out in Learning to Listen: Core Principles for the Involvement of Children and Young People. Findings from user participation consultation, in all settings, are reviewed at Board level, reflected in improvements in services and are available to children, young people and their families.

NHS Patient Advice and Liaison Service (PALS) provide confidential assistance to children, young people and families in resolving problems and concerns quickly as well as explanations of complaints procedures and how to get in touch with someone who can help. PALS act as a focal point for feedback from children, young people and families and provide valuable information to trusts to inform service improvements.

Formal working arrangements are in place for the provision of link workers, advocates to support children and young people, interpreters and/or support workers for children in special circumstances or from minority groups, to represent their needs during individual consultations and on multi-disciplinary review and development groups.

4. Respecting Children and Young People and Parents

4.1 Children and young people and their parents are not always treated withrespect, sensitivity, or courtesy. They have rights that are not always understood or respected. There are many children and young people whose needs may differ from the majority by reason of their race, culture, faith, ethnicity, sexual orientation, disability, social or family situation.

4.2 All children and young people require care and support which meets their developmental needs and provides them with the opportunity to achieve, or maintain, their optimal standard of health, development and well-being, regardless of their individual circumstances or those of their families and communities.

4.3 Respecting the role of parents is a significant part of providing services for children and young people. It is important to ensure that the views of parents are sought and their concerns responded to. As children mature, their changing needs are sometimes ignored - for example, their increasing concern for privacy and autonomy.

Primary Care Trusts and Local Authorities ensure that a wide range of communication strategies are used to obtain the views of children, young people and their parents and to respond to their needs. See Standard 3

Children and young people are offered choices wherever possible, for example, in the location of care or treatment, treatment options or the gender of the professional that they see. Play techniques can help children understand the options and exercise choice.

Children, young people and their families are informed about children's rights and are able to make a complaint where necessary, supported by an advocate where appropriate.

5. Information about Support and Treatment for Children and Young People and their Parents

5.1 In order for children, young people and their families to participate actively in their own health and social care, they need appropriate information about services, problems or specific health conditions and the choices which are available to them. Duties under the Disability Discrimination Act need to be taken into account when considering the provision of information in appropriate formats and language.

5.2 Information provision is a 'process' which will vary during the child or young person's journey. Information needs vary at different parts of the child or young person's journey. See Standards 2 and 4

Commissioners and providers of services for children work with other agencies to provide comprehensive information about all relevant local services for children, young people and their parents, including specialist and voluntary services. The material signposts all relevant local and national resources.

As part of the Information Sharing and Assessment Programme, all Local Authorities have an electronic 'service directory' covering all service providers in the area which is accessible to practitioners, parents or carers, children and young people. Information is accessible in a range of community settings e.g. youth clubs, community pharmacies.

All information resources (both written and oral) for children and their families are sensitive to developmental, cultural, social and language differences and are available to the child or young person, as well as to the parent or carer. Specific provision is made for disabled children with high communication needs or who use non-verbal communication. Processes are in place to ensure that the information remains up-to-date.

Information about treatment and care is based on the best available evidence, and tailored to the needs, circumstances and wishes of the individual and family to allow for shared decision-making and development of self-management.

6. Seeking Consent from Children and Young People for their Treatment

6.1 Consent has to be explicit, treatment-specific and involve the child or young person. Developmental issues relating to competency should be considered. Standard 7, Children in Hospital, sets out advice on consent including the use of restraint. See Standard 7 sections 3.21 to 3.24

6.2 Staff have a duty to understand and meet their legal responsibilities towards the children and young people they are caring for (Children Act 19898). This includes the legal and ethical position on real or potential conflicts between the interests of the child or young person and those of their parents. See Standard 7

Organisations and professionals follow relevant legislation, government guidance and policy, and professional codes of practice on seeking consent. (9, 10, 11, 12) Policies on consent in health and social care organisations address the needs of children and young people specifically.

Professionals are familiar with the concept of 'competence' in giving consent. Specific guidance on this has been issued by the Department of Health in the context of contraceptive, sexual and reproductive health services for young people under 16 (13). Consent policies include what to do when there is disagreement between a competent young person and their parents, and also address the situation where health care professionals believe that a particular treatment is crucial for a child but the child, young person, parents refuse to give consent.

Systems are in place to ensure that staff in all services are able to obtain legal advice regarding consent and the process for this is clearly understood. Services are provided in line with statutory guidance and makes it clear that in the context of protecting children from harm, it is the child whose interests are paramount. See Standard 5

7. Improving Access to Services for Children and Young People

7.1 The ability of children, young people and their families to access services easily, depends on a range of social, economic and service specific factors.

7.2 Primary Care Trusts and Local Authorities are responsible for providing services for children and young people who are registered with primary care providers and are on school rolls. They are also responsible for those in their resident population or who are not registered with a primary care provider or do not attend school. This is a particular issue for looked after children, children who are under five years, travellers, children of asylum seekers and unaccompanied minors. A more systematic approach to ensure that all children are known to services is needed, to reduce the risk of children falling through the net.

7.3 Legislation will provide the framework for the establishment of information sharing systems that will facilitate the sharing of information between agencies about the children they are working with.

7.4 Specific effort is needed to ensure that accessible and good quality health services are available to all, particularly to children and young people in special circumstances. The provision of community-based services (including some traditionally provided in a hospital setting) can be effective in improving access for children and young people in rural areas (or with transport difficulties) or those who are reluctant to attend traditional services. Extended schools can provide community-based services: a significant increase in funding (2004) will further support schools to develop as extended schools and offer a range of services including health services. Services that extended schools might offer in partnership with others include those listed in Box 2.

Box 2: Services offered by extended schools

Ante/Post Natal Provision
Immunisation clinics/advice
Parenting/family learning opportunities
Family Support services
Parent Education services
Advice on accident/injury prevention
Healthy Eating Clubs
Speech and language therapy
Sports/exercise opportunities
Leisure services
Counselling provision
Stop Smoking Services
Sexual Health Advice

7.5 Ensuring that high quality services are also accessible to children and young people who live in rural areas is an important factor in improving the delivery of services for children and young people. For example, the distance that families have to travel to access health services can have a negative effect on the health outcomes for children and young people from rural communities, as well as adding an extra level of stress and exertion.

7.6 Children or young people failing to attend clinic appointments following referral from their general practitioner or other professional may trigger concern, given that they are reliant on their parent or carer to take them to the appointment. Failure to attend can be an indicator of a family's vulnerability, potentially placing the child's welfare in jeopardy. It can equally be an indicator that a service is difficult for families to access or considered inappropriate, and requires reviewing.

7.7 National Standards, Local Action4, which sets out the Planning Framework for the NHS, sets out the access targets which apply to all ages groups including children and young people. See Standards 6 to 11

Local Authorities and Primary Care Trusts, working together, increasingly through Children and Young People's Plans and Children's Trusts, assess the needs of their local population of children and young people to ensure that their access requirements are being met. Primary Care Trusts take steps to ensure that all children are registered with a local primary care provider. Strategies are in place to encourage access for those least likely to use services, e.g., children in special circumstances, families with disabled children or or children of disabled parents, and minority ethnic groups.

Primary Care Trusts and Local Authorities maximise the provision of health and social care services to children, young people and their families in accessible community settings, including early years settings, children's centres, extended schools and drop-in centres that are open outside school hours and term time to cater for working parents.

Planning ensures that children and young people and their families from rural communities have the same range of services accessible to them as their urban counterparts. The needs of those children and young people who are not in school and who may be the most vulnerable to health and emotional problems are also considered.

A local system is in place to identify children or young people who do not attend an appointment following a referral for specialist care, so that the referrer is aware they have not attended and can take any follow-up action considered appropriate to ensure that the child's needs are being met (which may include a home visit or telephone contact to find out, for example, whether the appointment is no longer necessary).

All NHS providers review their DNA rates for children and young people to ensure their services are meeting need.

8. Services which are Integrated around Children and Young People's Needs

8.1 For children, young people and parents, one of the greatest sources of frustration is the lack of integration between different services within an organisation or between organisations.

8.2 Whilst the majority of children and young people will generally need access to some health or social care services, those with more complex needs will require services from more than one agency, simultaneously or on an ongoing basis.

8.3 The highest degree of integration and co-ordination is required between agencies when a child or young person is suffering abuse or neglect and local safeguarding children procedures are being followed. See Standard 5

Primary Care Trusts and Local Authorities, work together, increasingly through Children's Trusts, to ensure that there is an agreed process to plan service provision in partnership, and to provide joined-up, co-ordinated care packages (e.g. through integrated child and family teams).

In order for agencies to work together effectively, there is local agreement regarding:

Common agreed outcomes across services and a system for auditing outcomes;
A common approach and commitment to planning and commissioning services;
A shared understanding about criteria for signposting and accessing a range of services, and
A shared information system which recognises the legal and ethical issues concerning confidentiality.

Assessment of Children and Young People to Safeguard and Promote their Welfare

8.4 From birth, all children will become involved with a variety of agencies, particularly in relation to their health and education. A range of professionals, including midwives, health visitors, school nurses, nursery staff, general practitioners, teachers and Connexions workers will have a role in assessing children's general health, development and well-being through the different stages of the child's life. Social services, health and education professionals may also be required to provide more specialist assessments.

8.5 A Common Assessment Framework is being developed to help reduce the duplication between agencies and provide an assessment tool used across all professionals working with children. It aims to reduce the time spent in repeated assessments of the same child by different practitioners, encourage multi-agency working, provide a common language and initiate action where it is needed.

8.6 The Common Assessment Framework is in its development stage, but it is anticipated that it will bring the Framework for Assessing Children in Need and their Families together with other similar frameworks in a way that encourages multi-agency working and supports the sharing of information between agencies.

8.7 The Framework for Assessing Children in Need and their Families, which identifies children's developmental needs, their parents' capacity to respond to their needs and environmental factors (see Box 3), provides a systematic way of analysing, understanding and recording what is happening to children and young people within their families and the wider context of the community in which they live.

8.8 The assessment is designed to be used for identifying need and planning care for children and young people in all settings and can be used as a basis for referral to more specialised settings. Where the assessment identifies concerns that the child or young person is at risk of harm, a referral can be made to social services or the police. See Box 3 and Standard 5

Download Box3.Childrensframework.pdf (PDF, 56K)

Box 4: Types of Assessment

Common Assessment - undertaken by staff in any of the agencies or organisations providing services for children, young people and their families (based on the Assessment Framework)

Initial Assessment - undertaken by social services staff - led by social services staff with the involvement of other professionals, the child and family

Core Assessment - undertaken by social services staff - led by social services with the involvement of other professionals, the child and family

Other specialist assessments - undertaken by health, education or other specialist professionals

Primary Care Trusts and Local Authorities work together with other agencies to

Use the forthcoming Common Assessment Framework to assess the needs of a child and their family;
Develop a clear referral process for specialist help;
Develop a system whereby information derived from the assessment about a child or young person and their family can follow them and be accessible through their journey;
Ensure that children and young people are seen and can participate actively in their own assessments. Family members are also actively involved in the assessment. The assessments always identify a child or young person's and their family's strengths as well as their needs and difficulties, and
Ensure all staff undertaking an assessment are competent in carrying out an assessment and are aware of the range of services that children and young people and their families may need to access.

Sharing Information and Confidentiality

8.9 Where policies and services relating to sharing Information and confidentiality for children and young people are developed, they should be designed to achieve the objectives in Box 5.

Box 5: The Objectives of Information Sharing and Confidentiality

To ensure that a child receives the most appropriate treatment at the right time;
To identify when a child has particular needs and to provide for those needs in order to promote the child's well-being and welfare;
To identify when a child might be at risk of harm and, therefore, in need of protection, and to ensure that appropriate action is taken promptly to safeguard that child;
To ensure that professionals maintain access to information about a child when he or she has been referred to another professional until they are satisfied that appropriate action has been taken;
To protect the rights of children, in statute and in common law, to make their own decisions about procedures and treatment and to have those decisions kept confidential by professionals. This is particularly important in the context of contraceptive and sexual health services
To protect the identity of third parties who make allegations of, or voice their suspicions about, child abuse or maltreatment of a child by parents;
To protect the statutory and human rights of a mother to confidentiality about the identity of the natural father of her child, subject to specific legislative requirements to disclose information on the identity of the natural father of the child;
To protect the statutory and human rights of natural and adoptive parents;
To secure better services for children by enabling information about them, suitably anonymised, to be used for monitoring activity and outcomes on a larger scale, and
To protect the rights of care professionals by ensuring that they act within the law when disclosing or not disclosing information in all circumstances.

8.10 The Data Protection Act 1989 (15) sets out the circumstances in which personal data and sensitive personal data may be lawfully processed. Both types of data may be shared without consent in accordance with a statutory duty. In other circumstances, personal data may also be shared where there is consent to do so (on a 'need to know' basis) and sensitive personal data may be shared where there is explicit written consent.

Many agencies working with children and young people prefer to work with consent as the norm, even where it is not required under legislation, because this approach engenders trust, ownership and self-management. Seeking consent to share personal data, and explicit written consent for sensitive personal data, is the best practice approach in the first instance, but may not always be possible until a relationship has developed with the child, young person and/or family.

All relevant agencies share information on the basis of explicitly, informed and signed consent from children, young people and their families unless to do so would place the child or young person at risk of harm. All agencies have guidance for staff on when they may share information without having sought or obtained consent.

8.11 The Human Rights Act 1998 (16), the Data Protection Act 1998 (15), the Crime and Disorder Act 1998 (17) and the Common Law Duty of Confidence enable agencies to share information without consent about children at risk of harm.

8.12 The guidance for Caldicott Guardians (18) stresses the importance of having protocols for information sharing and protecting children, to ensure appropriate sharing of Patient Identifiable Information. Appendix 3 of What To Do if You're Worried a Child is Being Abused (19) addresses information sharing and promoting the safety of children under the Children Act 1989 (8).

In each local authority area, progress is demonstrated of action, in place across relevant statutory and voluntary agencies (including health, social care, education, police and probation) to:

Audit and improve information sharing practices, and introduce information sharing protocols between agencies, with particular attention to vulnerable children and children in need, and
Produce clear guidance for practitioners on how to seek consent to share information from children, young people and their parents, and when information may be shared, with and without consent.

Information Sharing and Confidentiality policies are clearly visible and professionals discuss the issues with children, young people and families, and have the skills to do this, including the ability to decide when information is appropriately kept confidential.

The permission of children, young people and their parents is sought, where appropriate, before sharing information with others, unless seeking this will place a child at risk of harm.

Health and social care organisations have Caldicott Guardians in place.

Health, social care, housing and education professionals demonstrate a responsibility to children and young people who move out of the area, and ensure that all necessary records have been transferred promptly.

8.13 Parents are generally given a Personal Child Health Record either in the ante-natal period, or as soon as possible after the birth of their child. This is a valuable record which records data such as the child's growth and immunisations, and can be supplemented with local information.

8.14 More detailed clinical information will be recorded on the child's NHS Care Record. The Personal Child Health Record may feed into the development of the NHS Care Record Service as this becomes available. The NHS Care Record Service, part of the National Programme for Information Technology, will provide a summary of all the child's clinical data and will follow them through from birth to adulthood. Information and guidance on the Personal Child Health Record as well as a version designed and recommended by the key professional groups may be obtained from

personal child health record (opens new window)

8.15 The integration of information systems across health agencies, led by the Department of Health's National Programme for Information Technology (NPfIT), will facilitate the sharing of information, including the development and use by all agencies of common data items with common definitions to improve the transfer of data from one agency to another and to improve communications between agencies.

Primary Care Trusts introduce a Personal Child Health Record based on national guidance, supplemented by local information, compiled after local service user consultation. All professionals understand how to use and update the Personal Child Health Record and young person held health record.

9. Quality and Safety of Care

9.1 Clinical governance in health services and best value/quality assurance in social services and education agencies are frameworks through which organisations can manage their accountability for maintaining high standards and continuously improving the quality of their services. Where possible these should be carried out jointly or co-ordinated. See Standard 7

All agencies ensure high quality services through effective clinical governance and quality assurance which includes:

Involving children, young people and their families;
Undertaking clinical audit or practice audits and monitoring outcomes;
Identifying and addressing the factors that are known to be linked to poor outcomes for children (including incorporating recommendations from national and local inquiries);
Effective allocation of resources;
Providing continuing professional development and supervision;
Implementing the findings from inspections of children's and young people's services, and
Self-assessment of individual services to identify and address areas for improvement.

Health, education, social care and other agencies providing services to children and young people have a clinical governance or best value/quality assurance lead to ensure continuous improvement in the quality of these services.

Health, education, social care and other agencies report regularly on the outcomes of their care or treatment practice audits or other quality assurance systems.

Systems are in place within all organisations to ensure that all staff who come into contact with children or who have access to information about children are checked by the Criminal Records Bureau.

9.2 All organisations, which provide care for children and young people need to ensure the safety of their service users at all times. This includes ensuring a safe environment, developing systems to ensure safe practice and developing a culture of learning within organisations.

Primary Care Trusts and local authorities work with partners to ensure: Systems are in place within all organizations to ensure that all staff who come into contact with children or have access to information about children are checked by the Criminal Records Bureau.

All agencies and organisations review the security arrangements for services they provide to children and young people to ensure that access is limited to those adults who need it.

All agencies and organisations providing services for children and young people have robust incident reporting systems; these are used to inform future delivery of services. See Standard 7

10. Planning and Commissioning

10.1 In each locality, Strategic Health Authorities, Primary Care Trusts and Local Authorities need to work together, and with other local strategic partners, to oversee the commissioning process. The process should include identifying the needs of the local population, by undertaking audits of equitable access, accessibility and outcomes across the area and consulting with all stakeholders, including children and young people, their parents, professionals, providers and the wider community; and planning, purchasing and delivering universal and targeted services accordingly.

10.2 Local Authorities and Primary Care Trusts in some areas will increasingly co-ordinate and integrate the planning, commissioning and delivery of local health and social care services and education through a Children's Trust. See Setting the Scene

10.3 A 'service mapping' methodology will be developed nationally to provide high quality information on community and hospital services for children and maternity. Children's Trusts, or similar commissioning partnerships, will be able to gather this information and other information in the course of local needs assessments; this will inform the Children's and Young People's Plan, which the Government is planning to introduce via the Children Bill.

10.4 When planning and commissioning services to improve service delivery, Strategic Health Authorities, Primary Care Trusts and Local Authorities should recognise the unique contribution the voluntary and community sector makes to local communities and the voice they give to local neighbourhoods. The sector can expand the range of local services, add value and significantly improve public service outcomes.

10.5 In 1998 the Government committed to facilitating partnership working between the public sector and the voluntary and community sector through the Compact on Relations between the Government and the Voluntary and Community Sector. Following from this, the Department of Health signalled its commitment to partnership with the strategic partnership agreement, For the benefit of patients: a Concordat with the Private and Voluntary Health Care Provider Sector (2000).

10.6 Making Partnership Work for Patients, Carers and Service Users: A Strategic Agreement between the Department of Health, the NHS and the Voluntary and Community Sector (2004), brings together the principles of the Concordat with the recommendations of HM Treasury's Cross Cutting Review and the subsequent Futurebuilders fund that supports Government and NHS investment in voluntary and community sector organisations to increase their capacity for service delivery within the health and social care context.

In the context of Local Compacts and Local Strategic Partnerships, Strategic Health Authorities, Primary Care Trusts and Local Authorities support voluntary and community sector providers to move into mainstream service provision by :

Involving the voluntary and community sector in the assessment of health and service needs, and the planning of local services; and
Recognising the voluntary and community sector's ability to deliver some areas of services differently, with greater flexibility, and often better, than NHS organisations traditionally have done.

10.7 The following sets out principles which may be useful in commissioning services to deliver the National Service Framework. Work is underway to further develop and agree these principles across government. They are likely to be published in final form in guidance following the Children Bill, as principles guiding all commissioning of children's services. More detail will be included in the National Service Framework and Change for Children delivery strategies.

Every organisation or service has an identified Senior Lead for children and young people to ensure that children and young people's needs are at the forefront of planning and service delivery.

Commissioners ensure that safeguarding children and promoting their welfare is at the heart of the commissioning strategy. The strategy should focus on enabling children to be healthy, stay safe, enjoy and achieve, make a positive contribution to the community and to society, and on their economic well-being.

Commissioning strategies empower children, young people, their families, carers and communities by reflecting their views about services and, where possible and appropriate, including representation from these groups in developing the strategy. Primary Care Trusts and Local Authorities work with other agencies, increasingly through Children's Trusts, to ensure that commissioning decisions are based on priorities identified through health equity audits, and that services are targeted at the neediest communities.

The commissioning strategy is based on a comprehensive analysis of the current and anticipated future needs of the local population of children young people and their families taking into account the diversity of that population. The commissioning strategy is developed through a multi-agency approach to ensure that services are provided both locally and, where appropriate, across a wider area to meet the needs of children and young people.

Commissioners develop strong and effective partnerships with the statutory, voluntary, community and private sectors to draw up a commissioning strategy and secure its implementation. Strategies take account of the need to ensure sustainability and build capacity where appropriate.

Commissioning strategies improve outcomes for children, young people and their families by providing a choice of high quality services to meet their different needs.

Commissioning strategies are developed on the basis of robust information about quality and cost-effectiveness of services.

Innovative commissioning and contracting is undertaken by professionals who have expertise in the specific children's service area which is being commissioned, together with staff who are skilled in contract negotiation and contract monitoring and management.

Joint commissioning strategies are developed across local and regional boundaries where appropriate to deliver services which meet the needs of the local population.

Priorities identified in Local Delivery Plans/social services plans for children are implemented through the development of local delivery strategies, focusing on, for example, health promotion and supporting parents.

11. Staff Training and Development

11.1 The health, social care and education workforce which provides services to children, young people, parents or carers is large and includes professionals and support staff from a wide range of backgrounds. As children and young people's needs differ from those of adults, so the knowledge and skills required by staff working with them requires specialist training. All staff should be well-led, supported and competent in knowing what actions to take to keep children safe.

11.2 Training programmes to support these core competency areas should be based on the Skills for Health National Occupational Standards as these become available. Such training should be delivered as far as possible on a multi-professional and multi-agency basis to facilitate shared understanding and break down professional and cultural barriers. Primary Care Trusts and Local Authorities need to work with other local partners to develop local strategies to provide this training across agencies. In addition, where possible, these skills should be taught as part of pre-registration training programmes, foundation degrees and national vocational qualifications.

11.3 Skills for Health in collaboration with TOPSS has been commissioned to develop a UK-wide competence and skills framework for the children's workforce. The project is now in its second phase - see www.skillsforhealth.org.uk. Skills for Health is the UK-wide sector skills council for health that aims to train the workforce so patients will have quick access to people who have the right mix of skills to suit their needs. Skills for Health is empowered by the Department for Education and Skills to influence education and training spend.

11.4 The strategy to ensure that there are the right numbers of staff with the right skills to deliver high quality services is driven by the National Workforce Development Board which oversees new workforce development arrangements. These will be designed to ensure full integration across staff groups and care providers, and across service, workforce and financial planning at local, regional and national levels.

11.5 DfES are developing a workforce reform strategy to improve the skills and efficiency of the children's workforce in liaison with local employers and staff. The strategy will review rewards, incentives and relativities across children's practice with the aim of moving towards a framework that fairly rewards skills and responsibilities, and ensures effective incentives to enable practitioners to stay on the front line.

Primary Care Trusts and Local Authorities develop staff training programmes to ensure that staff at all levels within organisations have a common core of skills, knowledge and competences which are appropriate to their responsibilities and degree of contact with children, young people and families.

A common core of skills, knowledge and competences may include:

Child and young person development (physical and psychological);
Safeguarding and promoting the welfare of children, including risk and protection factors;
Effective communication and engagement (listening to and involving children and working with parents, carers and families);
Supporting transitions (maximising children's achievements and opportunities and understanding their rights and responsibilities);
Multi-agency working (working across professional and agency boundaries), and
Sharing information.

Depending on their role, staff working with children may also need training to ensure that they are competent in the following areas:

Assessing children and young people's developmental needs and their parents' capacity to respond to their needs, in the context of their family and environmental factors including their school and community;
An understanding of the impact of disability on the child and family;
Understanding the specific needs of children in special circumstances and responding to their needs, including through referral and joint working;
Identifying the early signs of developmental disorders (such as autistic spectrum disorder and language disorder) and mental health problems (such as attention deficit hyperactivity disorder, depression, eating disorders, substance misuse and deliberate self-harm);
Recognising inequalities and ethnic diversity and addressing them proactively;
Promoting healthy lifestyles and directing families to local services;
Issues of confidentiality and consent;
Record-keeping, and
Complaints, advocacy and rights.

References

1 Department of Health The NHS Plan: A Plan for Investment - A Plan for reform The Stationery Office July 2000 www.dh.gov.uk

2 Department of Health NHS Improvement Plan - putting People at the Heart of Public Services The Stationery Office June 2004 www.dh.gov.uk

3 United Nations Convention for the Rights of the Child 1989 [Ratified by the UK government in 1991]

4 Department of Health National Standards, Local Action: Health and Social Care Standards and Planning Framework 2005/06 - 2007/08 2004

5 Department of Health Overview and Scrutiny of Health - Guidance July 2003

6 Chambers H., Howell S., Madge N. and Ollie H. Healthy Care Building an Evidence Base for Promoting Health and Well-being of Looked After Children and Young People National Children's Bureau 2002 www.ncb.org.uk

7 Children and Young People's Unit Learning to Listen: Core Principles for the Involvement of Children and Young People November 2001 www.cypu.gov.uk/corporate/participation/coreprinciples.cfm

8 Department of Health Children Act 1989 The Stationery Office

9 Department of Health Reference guide to consent for examination or treatment 2001 www.dh.gov.uk

10 Department of Health Seeking consent: working with children 2001

11 British Medical Association Consent, Rights and Choices in Health Care for Children and Young People December 2000 www.bmjpg.com/consent/

12 Department of Health Confidentiality: NHS Code of Practice November 2003

13 Department of Health Best Practice Guidance for Doctors and other Health Professionals on the Provision of Advice and Treatment to Young People under 16 on Contraception, Sexual and Reproductive Health 2004

14 Department of Health, Department for Education and Employment and the Home Office Framework for the assessment of children in need and their families The Stationery Office 2000 www.dh.gov.uk

15 Data Protection Act 1998 The Stationery Office

16 Human Rights Act 1998 The Stationery Office

17 Crime and Disorder Act 1998 The Stationery Office

18 Department of Health Protecting and Using Patient Information - A Manual for Caldicott Guardians March 1999 www.dh.gov.uk

19 Department of Health What To Do if You're Worried a Child is Being Abused The Stationery Office 2003 www.dh.gov.uk

20 The Home Office and the Compact Working Group: The National Compact (November 1998)

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