Select Committee on Education and Skills Written Evidence


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


 
previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2005
Prepared 14 April 2005