Children and Young People’s Health Support Group Meeting 1 May 2013
Conference Room 3, Victoria Quay, 10.30am
Present:
Malcolm Wright (Chair)
Jim Beattie
Mike Bisset
Mary Boyle
Jim Carle
Sara Collier
Linda de Caestecker
Morag Dorward
Roderick Duncan
Andrew Eccleston
Gavin Fergie
Peter Fowlie
Gwen Garner
Carrie Lindsay
Rosemary Lyness
Bernie McCulloch
Sandra McFadyen
Neil McKechnie
Wendy Peacock
Brenda Renz
Judy Thomson
Anne Marie Pitt
Jan McCLean
George Youngson
NHS Education for Scotland
NHS Greater Glasgow and Clyde
NHS Grampian
NHS Education for Scotland
NHS Ayrshire and Arran
Children in Scotland (representing Jackie Brock)
NHS Greater Glasgow and Clyde
NHS Tayside (representing Jane Reid; Catherine Gorry)
Scottish Committee of Surgeons
NHS Dumfries and Galloway
Amicus
Royal College of Paediatricians and Child Health
Action for Sick Children Scotland
Association of Directors of Education
Director of Nursing
Healthcare Improvement Scotland
Community Care Providers Scotland
Education Scotland
NHS Health Scotland
NHS Lothian
NHS Education for Scotland
North of Scotland Planning Group
SEAT (representing Jacqui Simpson)
Emeritus Professor
John Froggatt
Kate McKay
Mary Sloan
Anthony Christie
Scottish Government
Scottish Government
Scottish Government
Scottish Government
In attendance:
Terri Carney
Emma Hogg
Vivien Swanson
Maggie Watts
NHS Education for Scotland
NHS Education for Scotland
NHS Education for Scotland
Scottish Government
Apologies
Jacqui Simpson
Neil Hunter
Kathy Leighton
Andrew Deans
Elaine Love
Eleanor Nisbet
Karen Wilson
Sharon Anderson
SEAT
Scottish Children’s Reporter Administration
Royal College of Psychology
Scottish Youth Parliament
NHS Greater Glasgow and Clyde
Royal College of Nursing
Scottish Ambulance Service
West of Scotland Regional Planning Group
Karen Anderson
Deirdre Evans
Caroline Selkirk
Rachael Wood
Safaa Baxter
Care Inspectorate
National Services Division
NHS Tayside
Information Services Division
Association of Directors of Social Work
1
WELCOME AND APOLOGIES
1.1
Malcolm Wright welcomed everyone to the meeting and gave apologies.
2
CHILD PROTECTION
2.1
Kate 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 .
2.12 She 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.
2.13 She 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.
2.14 John 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.
2.15 Kate 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.
2.16 Kate 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 communitybased 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.
2.17 There 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 3
FETAL ALCOHOL SPECTRUM DISORDERS
3.1
Maggie 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.
3.13 There 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.
3.15 With 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 4
LOOKED AFTER CHILDREN
4.1
Kate 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.
4.12 Kate is chairing a SLWG and looking at producing a standardised care
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.
4.2
Jim 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.
4.21 Carrie 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 .
4.15 Judy 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 5
YOUTH HEALTH IMPROVEMENT
5.1
Emma 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.
5.12 Emma 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.
5.13 She 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.
5.14 There 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.
5.15 Kate 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 6
PSYCHOLOGY OF PARENTING PROJECT
6.1
Brenda 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.
6.12 Brenda commented on the PoPP Dissemination Plan, which involves a
Scotland-wide focus on the top 10% of 3-4 year olds who show significantly elevated
levels of disruptive behaviour; building a workforce capacity so that one third of
parents of these children can have access to Incredible Years and two thirds have
access to Triple P groups delivered with fidelity; and a health-led initiative promoting
interagency delivery aligned with Local needs; GIRFEC; EYFT priorities; National
parenting strategy; and Mental health strategy.
6.13 Brenda commented on the PoPP implementation framework and their three
stage implementation plan, involving preparation, Installation and Initial
Implementation.
6.14 Brenda commented that a phased roll-out is planned. Three wave 1 sites
have been identified and some further wave 2 sites are planned to start up in 201314. The long term goal of the PoPP is to deliver capacity for 9000 high risk families
to access the parenting groups.
6.15 There was some further discussion around the Birmingham study. This
suggests that Triple P was not as effective an intervention. Brenda responded saying
that the PoPP team continue to monitor developments in relation to the evidence
base. Triple P was not delivered with a robust implementation framework in
Birmingham. As this is a central feature of the PoPP plan, at present it is concluded
that no dramatic changes are indicated in the PoPP plan.
ITEM 7
PSYCHOSOCIAL INTERVENTIONS FOR CHILDREN AND YOUNG
PEOPLE
7.1
Terri Carney presented on this item (slides attached). She firstly gave a
background on the work being taken forward. She commend on the development of
building psychological capacity in Scottish Paediatric Healthcare and the Scottish
Government Health Directorate Policy document ‘Better health, better care: national
delivery plan for children and young people’s specialist services in Scotland’. This
led to the commissioning of the development, delivery and evaluation of an
educational programme on Psychosocial Interventions to improve adherence, selfmanagement and adjustment to physical health conditions for Children and Young
People.
7.12 She commented on the Educational Resource Published which have been
designed for all paediatric staff, to raise awareness beginning from the core level.
She mentioned the National skill-based training which are delivered annually and
added that there are applications to talk about difficulties following these training
days. She commented on Local Training for trainers, which aims to deliver training
responsive to local educational needs. Terri offered an additional sample of current
work, including a level 3-4 training event; funding of the Hospital Passport; which
prepares children and young people for going into hospital; an online education
resource; and a presentation paper at the paediatric psychology network conference
in June.
7.13 Jim queried the funding of this organisation. Terri responded that funding will
be until the end of the year but that they would love to continue.
ITEM 8
MINUTES OF PREVIOUS MEETING
The minutes of the previous meeting were agreed.
ITEM 9
AOCB
Roderick Duncan requested spending time on surgery in childhood in general
hospitals. He mentioned that there was no change since George Youngson
produced the ‘National Steering Group for Specialist Children’s Services: General
Surgery of Childhood Report’ in 2007. Roderick suggested a focus on treating
common surgical issues in children, which there has been a reduction in. He
mentioned that he would be happy to do this.
John Froggatt mentioned that this report slipped off the radar and that elective
elements were catered for following the report. He commented to make a
recommendation like this and that there was sustainability of fixes 5 or 6 years ago.
Michael Bisset commented that the NSD subgroup have been looking at this and
that the bigger issue is making sure people are trained.
Action: Rosemary Lyness and Mary Boyle to update group on on-going work.
ITEM 9.1
COMMUNITY CHILD HEALTH
9.12 John Froggatt presented on this item. He commented that since Zoe Dunhill’s
report, things have moved on a lot. He listed some of the work that has been
underway in Government and Parliament, including GIRFEC, the Children’s Bill, and
the debate on “Scotland: Best Place To Grow Up”. He mentioned that this has led to
a change in the thinking about what Community Child Health means. He asked how
we would ensure that the evidence-base for effective intervention in practice could
be fitted in, and how all of the work, and information, can be fed into something that
can be presented to the Cabinet Secretary at the end of the year. He commented
that we need to have something that includes inappropriate attendance at A&E,
surveillance and electronic systems, so needs to include Primary Care, as well as
growing the child protection cadre. He said we are looking to bring together these
strands and that we are looking for assistance and input. He stated that a significant
element is the paper on Community Child Health.
9.13 Michael Bisset commented that Zoe’s report makes useful recommendations.
He said that as it isn’t a policy paper from SG and so some are ignoring it. He stated
that we can’t ignore this but that we should push ahead with what has been
described and this will help the CCH agenda.
9.14 Andy Eccleston commented on job plans and tasks. He mentioned that it
becomes critical that post-graduate training is set up to make sure gaps are filled. He
stated that there is more community training going on, which is happening in WoS.
This means taking people out of acute posts and putting them into community posts.
John Froggatt commented that supply issues make these kind of issues more acute.
George Youngson added that there is a mismatch, and a review, the Greenaway
review, currently underway to look at this. He mentioned that taking it in the isolated
Scottish context is not particularly helpful and asked if there is a Scottish service
input to this. Malcolm Wright commented that the Greenaway Review is substantial
in this and that it is currently taking oral evidence.
9.15 George Youngson asked whether there was any merit in this group getting
information on this process because it is important to know what’s happening. Peter
Fowlie stated that the curriculum for training in community paediatrics is in place and
it is relatively recently that the man-power issue has been put on the agenda. He
commented that there are not enough trainees being provided and that there is a
significant risk in the next decade. There are highly experienced experts retiring
which has not been factored in. Jim Beattie mentioned that the Greenaway report will
be available in the next few months. John Froggatt commented that by the next
meeting, the Cabinet Secretary will have looked at the work in this area. Also the
Spending Review will have taken place. He stated that he expects that health
budgets will be protected.
Action: Item to be taken forward as agenda item in next meeting.
ITEM 9.2
TRANSITION
9.21 John Froggatt presented this item to the group and asked whether it was
appropriate that the Children and Young People’s Health Support Group should be
taking it on. He commented that this will be a hugely complex piece of work and will
involve a lot of time and staff resource
9.22 There was some further discussion and examples. Jim Beattie gave an
example of a child with severe health problems which crossed a number of adult
specialities. He explained that adult services are sympathetic but can’t match
paediatric services because of the different service model. Michael Bisset
commented that adult services are becoming so specialised which leads to some
children and young people with complex problems not fitting in to single adult
services, creating a confusion and difficulty in understanding roles and
responsibilities.
9.23 George Youngson mentioned that because some services don’t yet exist in
adult provision, because of changes in survival there can be no transition and as a
consequence children “bounce back”. He gave the example of how, in some places
in America, they keep children until they become adults. He stated that the
perception is that care is best in certain environments and that that is provided by
expansion of paediatric young person services. Peter Fowlie commented that
services differ in different localities. He stated that there cannot be one solution;
rather several different models should be used. He mentioned that in some hospitals
children may get a limited range of services, yet they often also need services from
specialists several miles away.
9.24 John Froggatt mentioned the age-appropriate care report which sets out the
age range at that time. He stated that when discussing transitions, all sorts of
transitions could be covered, for example long-term conditions; looked after children;
and transfers between schools or out of school. He commented that this could, in
theory, involve taking into account every possible transition for every child.
9.25 Malcolm Wright concluded the item by saying this will need further discussion.
He cited the differences across specialities and wondered whether there are models
of good practice which can be used.
NEXT MEETING: 11 SEPTEMBER, CONFERENCE ROOM 3, VICTORIA QUAY.