Children and Social Work Bill [Lords]

Written evidence submitted by the Royal College of Nursing (CSWB 51)

Key summary

The number of looked after children is currently at its highest point since 1985 [1] and their health and wellbeing has been consistently found to be poorer than that of children and young people who have never been in care. The Children and Social Work Bill presents an opportunity for the Government to rectify this by ensuring that vulnerable children and young people get the timely access to the services they need and deserve.

We support the following amendments to the Bill:

· NC11: ‘Safeguarding: provision of personal, social and health education’: We encourage Members to support this clause to place a requirement on local authorities to ensure that pupils educated in their area receive appropriate Personal, Social and Health Education (PSHE).

· NC 18: ‘Assessment of physical and mental health and emotional wellbeing needs’: However, we are calling for this provision to be further strengthen ed to ensure these assessments are performed by a health practitioner with sufficient mental and physical health knowledge, skills and competence" , including the right child specific experience.

· NC 19: ‘Duty to promote physical and mental health and emotional well-being’: We encourage Members to support this clause which will strengthen existing expectations on the NHS to appoint dedicated designated doctors and nurses for looked after children in each local area.

Remaining concerns

· We remain concerned by the reintroduction of NC 2-NC 9: ‘Power to test different ways of working’. We believe there may be significant unintended consequences of the proposed new ways of working and we are calling for additional scrutiny of the clauses to fully understand how they will operate in practice .

Areas for additional scrutiny

We are calling on Members to use the Public Bill Committee as an opportunity to address longstanding concerns about cuts to the children’s nursing workforce. We believe the Government’s aspiration to drive up physical and mental health outcomes for children and young people must be underpinned by the implementation of a sustainable nursing workforce strategy, with the appropriate child specific skill mix. We believe cuts to the children’s nursing workforce since 2010 make the accomplishment of this goal challenging. School nursing has experienced a 13% decrease in posts since 2010 [2] , and both school nurses and looked after children’s nurses report increasing caseloads and funding cuts to services, limiting their ability to provide personalised care.

Amendments

NC2-NC9: Power to test different ways of working:

We remain concerned that the reintroduction of these provisions in the Bill which would give local authorities powers to pilot new ways of working, may introduce a postcode lottery. We welcome additional amendments tabled by Government to provide some assurances, particularly, by placing a duty on the Secretary of State for Education to publish an annual report on their use. However, we are concerned that a shift from nationally agreed "gold standard" rights of the child, as set out in the Children’s Act 1989, to a ‘local offer’ from local authorities may see these rights watered down and eroded. There is a clear risk that variation in local offers may serve to worsen child health inequalities and lead to further unacceptable variation in outcomes. NHS England are currently undertaking a project regarding unwarranted variation in health provision for looked after children, due for completion in March 2017. We believe that this amendment could undermine these efforts to improve the health of looked after children.

We are calling on Members to seek additional clarity around the proposals and a commitment from the Government that safeguards will be put in place to prevent the unintended consequence of eroding the rights of the child.

NC11 Safeguarding: provision of personal, social and health education

We are calling for personal, social and health education (PSHE) to be made a mandatory subject for all schools in England and the devolved nations. School nurses can play an important role in delivering PSHE education, including through leading sex and relationship programmes in schools.

We encourage Members to support New Clause NC11, which proposes to place a requirement on local authorities to ensure that pupils educated in their area receive appropriate PSHE, the provision of which would be inspected by Ofsted.

NC18: "Assessment of physical and mental health and emotional wellbeing needs"

We support the provision for mental and physical health assessment s . However, this should be further strengthen ed to ensure it is performed by a health p ractitioner with sufficient mental and physical health knowledge, skills and competence" , including the right child specific experience.

At present, there is an anomaly in existing statutory guidance [3] which states that only a medical practitioner should undertake an initial health assessment for a looked after child. The term ‘medical’ refers to doctors and physicians on the General Medical Council register and therefore precludes named or specialist nurses for looked after children who have successfully completed an advanced paediatric nurse practitioner programme from carrying out the assessment. In practice registered named and specialist nurses for looked after children, providing they have completed the required formal education and training as stated in the intercollegiate framework [4] , will have acquired the knowledge, skills and competences to carry out this vital assessment.

We are calling for the Bil l to rectify this requirement to named and specialist nurses for looked after children who have successfully completed an advanced paediatric nurse practitioner programme . T his will support earlier intervention and where required, help to fast track these vulnerable children to the most appropriate source of help and support to meet their individual needs.

NC19 Duty to promote physical and mental health and emotional well-being

Statutory guidance currently states that clinical commissioning group are required to have access to the expertise of a designated doctor and nurse for looked after children. The role of these professionals is to assist commissioners to fulfil their responsibilities to improve the health of looked after children. However, members report the designated nurse role in some areas is incorporating additional responsibilities, such as infection control, splitting the intended focus and potentially undermining its impact to provide a strategic focus on the needs of vulnerable children and young people.

The Bill is an opportunity to strengthen existing expectations on the NHS to appoint dedicated designated doctors and nurses for looked after children in each local area. Primary legislation is necessary to improve understanding and recognition of looked after children’s needs both at a strategic level and on the frontline.

Background: the children’s nursing workforce

School nurses, health visitors, children’s nurses and specialist children’s mental health nurses are at the forefront of providing care to children and young people, promoting physical psychological and emotional wellbeing in families and local communities, and identifying and sign posting at risk children to the services they need.

Looked after children nurses

‘Designated Nurses’, ‘Named Nurses’ and specialist nurses for looked after children provide vital expertise in supporting children in care, including bringing together key partners to commission and deliver strong, integrated support for those in the care system. Worryingly, an RCN survey of nurses working with looked after children found that a lack of service capacity, role clarity and understanding of the importance of health care received by looked after children, are significant barriers to these nurses effectively carrying out their roles. 2

School nurses

There has been a 13% decrease in school nursing posts since 2010 [5] and the result of removing school nurses can have a serious impact on children and young people's health and well-being by cutting the link between health services, schools and families. School nurses are increasingly providing care and support to children with additional health needs as well as child protection activities.

School nurses are in a unique position to develop relationships with education colleagues to raise awareness and help young people talk about how they are feeling. However, we know the level of support available varies between schools and a survey of our members highlighted how increasing caseloads against the back drop of cuts to school nurse numbers, funding and increasing student numbers is resulting in serious strain being placed on school nursing services [6] . This has been echoed by the National Children’s Bureau [7] as well as the Children’s Commissioner who reported that "paper work, bureaucratic tasks and reactive work, are reducing their face-to-face time with children to an alarming extent" [8] , undermining their ability to build relationships with children and advise them about their health and wellbeing.

About the Royal College of Nursing

The RCN is the voice of nursing across the UK and the largest professional union of nursing staff in the world.

January 2017


[1] House of Commons Library, Children in Care in England: Statistics, October 2015. Available here.

[2] NHS Digital, Health and Social Care Information Centre, Provisional NHS Hospital & Community Health Service (HCHS) monthly workforce statistics, August 2016

[3] Department of Health and Department of Education, Promoting the health and well-being of looked-after children Statutory guidance for local authorities, clinical commissioning groups and NHS England, March 2015.

[4] Intercollegiate Role Framework, Looked after children: Knowledge, skills and competences of health care staff, March 2015. Available here.

[5] NHS Digital, Health and Social Care Information Centre, Provisional NHS Hospital & Community Health Service (HCHS) monthly workforce statistics, August 2016

[6] Royal College Nursing, RCN School Nurse Survey, 2016

[7] National Children’s Bureau, Nursing in schools, September 2016

[8] Children’s Commissioner, Lighting Review: School Nurses, September 2016.

 

Prepared 9th January 2017