Review of targets and indicators for health and social care in Scotland

Independent national review into targets and indicators for health and social care.

Indicators of children's wellbeing

63. Extensive research tells us that the period before birth and the first few years of life are critical to wellbeing throughout life. The indicators relevant to children's wellbeing are mainly part of the National Performance Framework. The most important of these indicators is the one about child poverty.

Improve children's dental health ( NPF)

Increase the proportion of babies with a healthy birth weight ( NPF)

Increase the proportion of healthy weight children ( NPF)

Increase the proportion of pre-school centres receiving positive inspection reports ( NPF)

Improve children's services ( NPF)

Reduce children's deprivation ( NPF)

CAMHS Waiting Times ( LDP)

Early access to Antenatal Services ( LDP)

64. These indicators are all important and provide data which tells us about year on year progress in improving markers of children's wellbeing. For example, significant improvement in children's dental health, some improvement in healthy birth weight and the proportion of children with healthy weight tells us that child health is improving. Stillbirth rate and Infant mortality have also been improving in Scotland and these are important figures that allow international comparison.

65. Child and family poverty is an important determinant of poor outcome. The proportion of children in Scotland living in poverty varies depending on the definitions used. Depending how it is defined, between 10% and 26% of children could be said to live with a degree of poverty. The distribution of child poverty will not be equal across Scotland and, to support action in the areas most affected by this issue, consideration should be given to reporting the incidence, using a definition agreed with Third Sector organisations working with child poverty, by local authority or HSCP area.

66. The most important predictor of failure in terms of poor mental health, educational failure, offending and, ultimately poor physical health is exposure to Adverse Childhood Experiences ( ACEs), Studies in the US, England and New Zealand confirm that exposure to domestic violence, physical or emotional neglect, parental absence through incarceration or mental illness are strongly associated with poor outcome. The most important indicator of need for support for children is the identification of ACEs.

67. Outwith the framework of targets and indicators work is the Getting it Right for Every Child ( GIRFEC) [11] programme which uses its own data collection system to help identify children in need of support. Those working with children under the GIRFEC programme collect data on 8 domains. GIRFEC asks: are children Safe, Healthy, Achieving, Nurtured, Active, Respected, Responsible and Included ( SHANARRI). It is not clear how this system identifies ACEs and it would be helpful to see if there is a standard approach to identifying and managing neglect in babies. It would also be helpful if there was a coherent approach adopted in efforts to identify and manage adversity in struggling families.

68. Concern has been expressed about the length of time some children wait to be seen by CAMHS services. Access to the right treatment in a timescale that supports clinically effective treatment is clearly central to CAMHS. At the moment only around 1 in 3 children who require assessment or treatment are currently receiving it, and therefore it is appropriate to continue to focus on the 18 week RTT improvement standard that is in place for CAMHS. The complexities and overlap of assessment and treatment of mental health conditions means it is appropriate to have different standards to help drive improvement and to ultimately deliver parity in effective and appropriate mental and physical health outcomes.

69. Recommendations:

a) Stillbirth rate and Infant Mortality Rate should be included in the annual reporting of children's wellbeing.

b) For an agreed geographical area (such as local authority or HSCP) , the proportion of children living in poverty should be reported annually.

c) An information system to allow identification of exposure to adverse childhood experiences should be set up and a protocol for management of such cases should be agreed by a working group involving all parties who share responsibility for children's services.

d) At present, concern has been expressed by some that an 18 week referral time for CAMHS is too long. Some children will need to be seen more urgently than others. Advice on the appropriate protocols for urgent referral should be agreed.

e) Health Boards and Local Authorities should be supported with appropriate information systems to allow identification of those children and families needing support as a result of living in adverse circumstances.


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