Royal College of Nursing memorandum to
the House of Commons Education and Skills Select Committee inquiry
into Every Child Matters
INTRODUCTION
With a membership of over 370,000 registered
nurses, midwives, health visitors, nursing students, health care
assistants and nurse cadets, the Royal College of Nursing (RCN)
is the voice of nursing across the UK and the largest professional
union of nursing staff in the world. RCN members work in a variety
of hospital and community settings in the NHS and the independent
sector, and in the field of children and young people they also
work in education and social care settings. The RCN promotes patient
and nursing interests on a wide range of issues by working closely
with Government, the UK parliaments and other national and European
political institutions, trade unions, professional bodies and
voluntary organisations.
The RCN welcomes the opportunity to contribute
to the committee's inquiry. We strongly support the initiatives
in "Every Child Matters", and we have welcomed the opportunity
to work closely with the Department of Health and the Department
for Education and Skills on its implementation. We are particularly
encouraged by the focus on the five specific outcomes for children,
however we retain some concerns around how services will be integrated.
1. THE PLACE
OF HEALTH,
SOCIAL SERVICES
AND EDUCATION
WITHIN INTEGRATED
SERVICES
1.1 Health services perform an absolutely
vital role within integrated teams. Children's nurses, community
nurses and school nurses are an important first point of contact
for children who may be at risk. Nursing staff also have a significant
role to play in the public health agenda providing health education
and health promotion services around the issues of obesity, sexual
health and smoking. School nurses in particular play an important
role in enabling children and young people to make healthy life
choices. As a result the RCN welcomes the recognition of the importance
of healthcare in children and young people's services in many
of the initiatives under the umbrella of Every Child Matters.
2. THE PRACTICAL
IMPLICATIONS OF
THE "DUTY
TO COLLABORATE"
INCLUDING THE
EFFECT ON
FUNDING STREAMS
AND LOCATION
OF STAFF
AND FACILITIES
2.1 The RCN is hopeful that the duty to
collaborate will lead to an increase in the co-location of universal
services at local level. The Chief Nursing Officer Review of the
nursing, midwifery and health visiting contribution to children
and young people[1],
recognised the importance of the co-location of services in safeguarding
the welfare of children and young people. The report identified
strong support for nurses, midwives and health visitors to be
co-located in community and school based children's teams, such
as extended schools, Sure Start and children's centres. The RCN
believes that the co-location of children and young people's related
services in health, education and social services must be the
logical outcome of greater collaboration between professionals.
2.2 The move towards a duty to collaborate
is welcomed by the RCN however we feel that on a practical level
it is important to develop a model of how integration will work
in practice. The model should not be overly prescriptive but greater
clarity is required to provide guidance to professionals on how
they should work together on a day to day basis. Currently services
are moving towards a joint commissioning approach. Whilst this
is a positive development we feel there is a danger of a lack
of consistency in the approach to joint commissioning. Developing
a model of integration would help to ensure consistency across
all services.
2.3 A further implication of the duty to
collaborate is the need to develop agreements between health,
education and social services on shared governance arrangements.
In the sphere of health this is particularly important as care
can be delivered by a range of individuals other than nurses,
including parents, carers, and learning support assistants. Although
their education and training is usually supplied by nursing staff,
this can lead to problems within services around vicarious liability.
As a result the care of children can become unnecessarily complicated
and the focus is not always on what is best for the child. The
RCN believes that staff in health, education, social services
and voluntary organisations would benefit from a more joined up
approach by developing clear principles for staff involved in
carer roles. The RCN believes that this would help to ensure that
integrated services are more child focused and less organisation
focused.
2.4 It is important to recognise that the
duty to collaborate will require a significant change in culture
among all of the services involved and this may take some time
to become embedded. It will be important to emphasise the importance
of working across teams, particularly in areas such as information
sharing. The use of shared language and a greater emphasis on
training is crucial and should be supported and facilitated by
management and integrated organisational systems and processes.
Whilst co-operation between teams exists at present, there are
no formal structures in place and instilling a culture of collaboration
will be key to success.
2.5 The RCN also believes that establishing
accountability and responsibility among service providers should
be a priority from the outset. As soon as a service is commissioned
an individual should be identified who will take the lead on children's
services. At the moment whilst individual practitioners in health,
education and social services have clear lines of responsibility,
this becomes less clear when services become integrated.
3. STAFF AND
MANAGEMENT NEEDS;
TEAM-BUILDING,
LEADERSHIP AND
TRAINING
3.1 In the implementation of Every Child
Matters it is vitally important that all healthcare staff
who come into contact with children and young people, receive
the appropriate training in order to ensure the appropriate skill
mix among staff. In order to achieve this, the RCN supports the
development of core competencies for those working with children
and young people. The CNO Review of nursing, midwifery and health
visiting also highlighted the need for core competencies among
nursing staff, making specific reference to safeguarding children
and young people, effective communication with children and young
people and child development and behaviour. Providing training
to all healthcare staff in these core competencies will help to
ensure early identification of need and where necessary, ensure
the appropriate intervention.
3.2 The RCN also feels that there is a lack
of core data about those working with children and young people.
In particular our members feel that information such as the numbers
of nursing staff working with children and young people, and their
roles and responsibilities would help in future workforce planning.
There is a need for robust mechanisms to capture data in order
to ensure that the needs of local populations receive the best
possible service.
3.3 For nursing staff working within integrated
teams it is vitally important that they have access to professional
leadership. When establishing integrated teams there should be
clear lines of professional accountability and nurses should be
able to easily access continuing professional development, clinical
supervision and practice development, even though they are working
as part of a collaborative team.
3.4 The RCN considers it essential that
nurses are able to develop the appropriate leadership skills in
order to work in partnership across agencies. Consequently the
RCN has developed a leadership programme for health professionals
with responsibility for child protection. It focuses on enhancing
their communication skills and their ability to speak out for
children as well as engage with and form coalitions with other
agencies.
4. INSPECTION
4.1 The RCN believes that there is a need
for greater clarity around the inspection of services. In particular
it is essential that all services are inspected at the same level
and to the same standard. In health it is essential to ensure
that this uniformity of approach is applied regardless of where
the health service is accessed.
4.2 Currently, integrated inspection teams
have been established in some areas of the UK and those that do
exist are moving in the right direction. However there remains
a concern that there is a need for the inspection teams to involve
practitioners working at the grass roots level. Staff working
in the local area should be consulted in order to use their knowledge
and expertise of what areas should be focused on in an inspection
and how the results can be evaluated. Similarly there is need
to involve both children and parents in the inspection process
so as to ensure that the standards which services are being evaluated
on are the standards which service users would expect.
5. LISTENING
TO CHILDREN;
THE ROLE
OF THE
CHILDREN'S
COMMISSIONER
5.1 Listening to children is of utmost importance
and the RCN is keen to emphasise that this must be done in an
active way. The RCN advocates that organisations working with
children should be given guidance on the best ways to engage with
children and young people. There are many instances of good practice
in listening and engaging with children, however the situation
is inconsistent across the UK. In order to ensure that listening
to children is a more active process the RCN believes that appropriate
training should be available to all healthcare staff not only
those who work directly with children and young people.
5.2 The RCN warmly welcomes the creation
of the post of Children's Commissioner for England in the Children
Bill, however we feel there are aspects of the post which still
need to be addressed. In particular we believe it is imperative
that the Commissioner has extensive experience of working directly
with children and young people. We also hope that children and
young people will be actively involved in the recruitment process
following the example of Wales and Northern Ireland.
5.3 We feel that it is important the Commissioner
has a proactive function through the power to carry out investigations.
Doing so will enable the Commissioner to properly safeguard the
interests of children and young people. However we appreciate
the workload constraints on the Commissioner and understand that
inquiries into individual cases will not be possible in every
instance. Under the terms of the Children Bill as currently drafted,
the Commissioner's qualified powers of inquiry allow for investigations
into cases which raise issues of relevance to other children.
The RCN believes that this power, coupled with the need to have
regard for the UN Convention on the Rights of the child is fundamental
to the role of the Children's Commissioner as a champion for children
and young people.
6. WORKING WITH
PARENTS
6.1 Nurses, midwives and health visitors
are the largest group of health professionals who have direct
contact with parents. They are therefore ideally placed to engage
with parents and if necessary facilitate access to support mechanisms
such as voluntary organisations. The RCN believes that this role
could be strengthened further if there was a greater understanding
and awareness of the key role of health professionals among other
professional groups working with children. In addition the process
would benefit from greater shared learning opportunities across
professional groups and agencies.
7. THE CREATION,
MANAGEMENT AND
SHARING OF
RECORDS, INCLUDING
ELECTRONIC DATABASES
7.1 The RCN strongly endorses the principle
of information sharing as a means of strengthening child protection.
The failure of different agencies to share information was recognised
and highlighted in both the Laming and Bichard inquiries. It is
therefore imperative that this joined up approach is adopted.
7.2 The Children Bill proposes the creation
of more than one database and whilst we recognise the reasons
for this we would stress the need to ensure that the information
can be cross referenced. We also have concerns around the information
which will be stored on the databases as it is currently unclear
exactly what information will be recorded. In particular, the
Bill makes reference to the inclusion of any "cause for concern",
however currently what constitutes a concern is left to the judgement
of the individual practitioner meaning there may be a lack of
consistency in the type of concerns recorded and subsequent action
taken.
7.3 The RCN also has concerns about access
to the database. Whilst it is important to ensure that appropriately
trained and experienced healthcare staff have access to the information,
this needs to be balanced against the need to protect sensitive
information. We feel it would be important to consult with and
engage children and young people's representatives on this issue
as highlighted in Every Child Matters. Ultimately the success
of any database of this kind depends on those who operate it.
The RCN also believes that there must be clearer guidelines on
what information can be disclosed and what must remain confidential.
If there is no clear delineation of confidentiality there is a
grave danger that children and young people will no longer feel
able to trust and confide in the professionals working to protect
them. We therefore underline the need for training for healthcare
staff in operating the database to ensure information is recorded
accurately and sensitively and that staff are fully aware of their
code of professional conduct and accountability issues.
November 2004
1 Chief Nursing Officer Review of the Nursing, Midwifery
and Health Visiting contribution to children and young people,
August 2004. Back
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