Recommendations to improve care, support and treatment for children and young people with special needs
This article outlines the Review, ‘These are our children’, and certain recommendations of Dame Christine Lenehan, Director of the Council for Disabled Children (January 2017), to improve care, support and treatment for children and young people with special needs (learning disabilities, mental health, autism and behaviour challenges). To understand her recommendations the article looks at current issues or problems faced by children with special needs.
She notes that there is a problem around children’s rights, as they are being denied. She states that ‘when we believe that the people we interact with are less then fully human we build a culture which leads to degradation and abuse’. She recommends that children with special needs deserve to have their rights promoted, their voices heard and develop to their full potential as per our obligations under the ‘United Nations Convention on the Rights of the Child’. In order to do this she recommends, for example, that ‘at a local level, commissioning and delivery of all services for our children should acknowledge and respect their right to a childhood’.
Another problem she has found is that children with special needs are not being given appropriate care or appropriate care in the right places. To resolve this issue, she recommends that a separate piece of work should be undertaken to look at the role of Residential Special Schools and Colleges for this group of children. She also recommends that the Department of Health, Department for Education and NHS England undertake an urgent review into the needs of the young people aged 18-25s covered by the Review currently in inpatient provision (whether they are in acute inpatient, mental health or learning disability beds). The Review should look at numbers, routes of admission and destinations to ensure this group of young people do not face a lifelong future in institutional care and we stop under-18s becoming the next adult inpatient cohort.
There was a problem in that the managers/clinicians she spoke to want to do their best, but it was difficult to see a clearly articulated vision for the outcomes for ‘our group of children’s’ lives and, therefore, the service interventions needed to support these outcomes. At a philosophical level there is a strong degree of consensus to what a good model of care should look like. The ‘operationalisation’ of the model needs more thinking. The issue is that it does not exist in practice except in small parts of individual services. She recommends that NHS England work with the Department for Education, Transforming Care Partnerships, the Association of Directors of Children’s Services, and the Local Government Association to develop an effective model of care for these children and young people.
In regard to professional responsibility, there was an issue in that in many areas each agency believed that the other should be more engaged, more proactive, more responsible. This was even the case when she spoke to all partners in a locality. She recommends that the Royal College of Psychiatrists, the Royal College of Paediatrics and Child Health and the Royal College of General Practitioners working with other relevant Colleges and groups urgently undertake discussions to clarify the responsibility of medical and other professionals for children and young people with special needs. She also recommends that they develop national jointly owned guidance to ensure respective roles are widely and consistently understood.