Guidance to support implementation in Scotland of Royal College of Paediatrics & Child Health recommendations on child health screening and surveillance activity.

2 policy context

2.1 The Scottish Executive is committed to ensuring that every child has the best possible start in life and is able to reach their full potential. Scottish Ministers have identified their expectations and aspirations for all children and young people in Scotland:

Children and Young People in Scotland should be valued by ensuring that they are:

  • Safe: Children and young people should be protected from abuse, neglect and harm by others at home, at school and in the community.
  • Nurtured: Children and young people should live within a supportive family setting, with additional assistance if required, or, where this is not possible, within another caring setting, ensuring a positive and rewarding childhood experience.
  • Healthy: Children and young people should enjoy the highest attainable standards of physical and mental health, with access to suitable healthcare and support for safe and healthy lifestyle choices.
  • Achieving: Children and young people should have access to positive learning environments and opportunities to develop their skills, confidence and self esteem to the fullest potential.
  • Active: Children and young people should be active with opportunities and encouragement to participate in play and recreation, including sport.
  • Respected & Responsible: Children, young people and their carers should be involved in decisions that affect them, should have their voices heard and should be encouraged to play an active and responsible role in their communities.
  • Included: Children, young people and their carers should have access to high quality services, when required, and should be assisted to overcome the social, educational, physical, environmental and economic barriers that create inequality.

2.2 These principles apply across agency, service and professional boundaries and are consistent with the principles enshrined in the United Nations Convention on the Rights of the Child 7.

2.3 Experiences and influences in childhood will have far-reaching and profound effects in adulthood and later life. Efforts to tackle key health and social problems common in the Scottish population must begin in the early years and continue throughout the primary school years and adolescence. Improving child health, welfare and opportunity, particularly for our most disadvantaged children and young people, is a priority across all Executive portfolios and departments.

2.4 The philosophy of Hall 4 is consistent with the Scottish Executive's emphasis on social justice and closing the opportunity gap between the most disadvantaged and the rest of society. This means that families should receive the help and support they need from our public services when they need it, unhindered by organisational boundaries and their care should be based on the best available evidence about what works. It also means that services should inform and involve children and their families in planning their care, and consult them about the kinds of services and support they want.

2.5 Hall 4, and this guidance on implementation, sits alongside other important initiatives to support children's development and welfare, all of which seek to:

  • Promote a step-change in Scotland's public health through implementation of an action plan for health improvement, Improving Health in Scotland - The Challenge8, which includes a focus on intervention in the early years and at vulnerable points of teenage transition.
  • Achieve seamless and more effective support for children and their families through implementation of For Scotland's Children9.
  • Support delivery of integrated children's services through national roll-out of Integrated Community Schools, with every school becoming a Health Promoting School by 2007, supported by implementation of A Scottish Framework for Nursing in Schools10.
  • Redesign assessment and support for children to help them achieve their full potential through the implementation of the Education (Additional Support for Learning) (Scotland) Act 2004 11.
  • Improve protection and help for children at risk of abuse and neglect through a programme of national child protection reform 12, informed by It's Everyone's Job to Make Sure I'm Alright13 and supported by the Protecting Children and Young People Charter14 and Framework for Standards15.

2.6 Early evidence from initiatives such as Starting Well 16 and Sure Start Scotland 17, tells us that a joint approach, combining active health promotion and other targeted input for vulnerable communities, can make an important difference to families. The second phase of the Starting Well demonstration project will pilot some elements of Hall 4 implementation.

Public health nursing

2.7 Following a national review of nurses' contribution to public health 18, new models of community based nursing are emerging which provide a good platform on which to base review and development of child health surveillance and promotion. The development of public health nursing brings together health visiting and school nursing into a single discipline with a renewed focus on health improvement. The introduction of public health practitioners in Local Health Care Co-operatives, now Community Health Partnerships, has also created a key public health focus for the development of inter-agency partnership working, acting as a catalyst for service change and development.

Integrated children's services planning

2.8 The Scottish Executive has published new guidance for the preparation of integrated children's services plans 19. This is intended to support rationalisation of local planning activity and encourage agencies to agree consistent improvement objectives and delivery strategies across universal and targeted services for children and young people. Planning for implementation of Hall 4 should be part of the new integrated children's services planning arrangements.

Integrated Assessment Framework

2.9 The Scottish Executive will shortly be consulting on a draft Integrated Assessment Framework for Scotland's Children20. As children grow and develop they routinely have contact with numerous professionals in health and education. Some children and young people have particular health, learning or other needs which require assessment and support from a range of different services and agencies. The Integrated Assessment Framework is intended to ensure the consistency and quality of assessments by introducing a common structure for assessing the needs of children and young people.

2.10 The aim of the Integrated Assessment Framework is to provide a means by which all services for children - universal and specialist - will be able to gather and share appropriate information, assess needs, plan and co-ordinate services for individual children. Core information collected for all children will connect with specialist assessments necessary to meet the needs of those children and families requiring additional support. The Integrated Assessment Framework will ensure that the child's experience is maintained at its centre and that account is taken of strengths, achievements, and the personal resources of the child and family as well as needs and risk of harm. This is considered further in the Identifying and Targeting Support section of this guidance.

2.11 As part of the Integrated Assessment Framework development work, the Scottish Executive is working with a number of professional groups, including health visitors, to establish common methods for recording information to ensure consistency and promote quick transfer of information within organisations and to other appropriate agencies when it is required.

Improving support systems for children in need

2.12 The Scottish Executive Review of the Children's Hearings system 21 has identified that although there are measures that can be taken to improve the Hearings system, the impact on the lives of children would be significantly greater if the wider network of support services was improved. There are concerns that at present, children are not receiving support when they need it, and that many are referred to the Children's Reporter when more effective local action would have been more appropriate.

2.13 As For Scotland's Children22 notes, "we do need a much more robust approach to putting children and families at the centre of the service network. That will be facilitated by treating all services for children as part of a Children's Services System and by all staff perceiving themselves as operating within that single system". The Scottish Executive will shortly be consulting on phase 2 of the Hearings Review, including options to strengthen individual agency and collective responsibility for identifying and addressing children's needs.

2.14 This will link with, and build on, the work to develop an Integrated Assessment Framework, outlined above, and with the developments underway within the child protection reform programme.

Community Health Partnerships

2.15 This guidance is published as Community Health Partnerships ( CHPs) are beginning to take shape across Scotland. CHPs will have a significant influence on the organisation and delivery of person-centred locally integrated services. They will be a focus for integrating primary and specialist health services at a local level, will help advance and deliver the health improvement agenda, and will influence the deployment of resources. They will also have a lead role in the delivery of services for children and young people at a local level.

2.16 Statutory guidance 23 has been published to support the establishment of CHPs. Supplementary advice 24 has also been issued on how CHPs should inform local approaches to the integration of children's services. The guidance and supplementary advice recognise that one model does not fit all, and that approaches will develop to fit local circumstances.

Participation and involvement

2.17 In 2001, the Scottish Executive published a framework for Patient Focus and Public Involvement ( PFPI) 25, charging NHS Boards with the development of a local framework for sustainable patient and public involvement, identifying how the NHS Board would involve patients, carers, staff and the public in decision making at every level of the health service. The aim is to achieve a service where people are treated with respect, treated as an individual, and involved in decision making at all levels of planning and delivery of health services in NHSScotland. The principles of the approach are that patients and the public are treated as equal partners in decision making.

2.18 The involvement of children and young people is also seen as being a key element in providing and developing services to meet their needs. The United Nations Convention on the Rights of the Child ( UNCRC) underpins the legislative and cultural progress in involving children and young people in making decisions. In particular, Article 12 of the UNCRC gives children the right to express their views freely in all matters affecting them and states that these views will be given due regard. The UNCRC was ratified by Great Britain in 1991 and in Scotland, the Children (Scotland) Act 1995 incorporated its principles by giving children and young people a right to express their views on a range of decisions which affect them.

2.19 Parents, carers, and where appropriate, children and young people, should be involved in local Hall 4 implementation planning.

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