P 71
Ymchwiliad i’r Adolygiad Blaenoriaethau ar gyfer y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon
Inquiry into the Priorities for the Health, Social Care and Sport Committee
Ymateb gan: Plant yng Nghymru
Response from: Children in Wales
Consultation response - Priorities for the National Assembly for Wales Health Social Services and Sport Committee
Introduction
Children in Wales is the national umbrella organisation in Wales for children and young people’s issues, bringing organisations and individuals from all disciplines and sectors together. One of our core aims is to make the United Nations Convention on the Rights of the Child (UNCRC) a reality in Wales. Children in Wales campaigns for sustainable quality services for all children and young people, with special attention for children in need and works to ensure children and young people have a voice in issues that affect them.
For further information on the work of Children in Wales, please see www.childreninwales.org.uk and www.youngwales.wales
Our Response
Children in Wales welcomes the opportunity to aid the Committee with its planning by sharing our views on some of the areas the Committee has already identified for inclusion in its longer term programme.
United Nations Convention on the Rights of the Child (UNCRC)
On the 3 June 2016, the United Nations Committee on the Rights of the Child issued a series of Concluding Observations to the UK and devolved governments which set out ways in which they can better meet their obligations in respect of implementing the UNCRC. The UN Committee made a number of Recommendations in respect of Health and Health Services, Mental Health, Adolescent Health andNutrition (pp14-17). The Committee was particularly concerned at the inequality in access to health services and inequity of health outcomes in respect of vulnerable and marginalised groups.
We would suggest that the Committee give due regard to these Concluding Observations when initiating all enquiries which encompass the physical, mental and public health and well-being of all children and young people in Wales.
1) Integration of Health and Social Care Services
Part 9 of the Social Services and Well Being (Wales) Act 2014 sets out the duties placed on local authorities to make arrangements to promote cooperation with relevant partners to improve the outcomes for people (including children and young people) with care and support needs. Cooperation, integration and partnership are key cornerstones of the Act, alongside ensuring that recipients of services have a voice and control. The previous Welsh Government also provided revenue funding to improve care coordination between social services, health, housing, education and the third and independent sector.
Children in Wales would welcome the Committee looking at the progress made to date on the integration of health and social care services, and links with community based services, and to assess the impact of Welsh Government policies and legislation to date.
For disabled children and young people, we would suggest that the following issues are considered as part of this inquiry:-
1.1 Definition of a Health and Social Care Need
Members of Children in Wales from both the health and social care sector who work with disabled children and young people tell us that there are ongoing discussions between professionals around what constitutes a health need or a social care need and therefore who should provide and resource support. This sometimes means that disabled children and their families do not receive support until this matter is resolved which is of some concern.
1.2 Transition to adulthood for disabled young people
An omission from The Social Services and Well-being (Wales) Act 2014 is the absence of provisions which detail local authority responsibilities to both disabled children and their carers when a young person is in transition to adulthood. The Act does not appear to repeal the duty to consider the transition needs of children with Special Educational Needs Statements under the Education Act 1996. This means that the duties under the Disabled Persons (Services, Consultation and Representation) Act 1986 sections 5 and 6 remain – namely the duty when the child is 14, that the relevant social services officer be contacted with a view to a social care assessment of the young person’s needs being undertaken – so that services are in place when educational provision ceases.
The Act is for ‘people’ and therefore the local authority is responsible for disabled people from ‘cradle to grave’. The reality is that different departments and social services teams, who have different budgets and local criteria, will often be responsible for disabled children from those responsible for disabled adults. We have some concern that Transition problems will continue to occur as frequently as they did under the previous legislation.
Recommendation
Children in Wales therefore recommends that the committee consider the above two issue as part of an overall inquiry around the impact of Welsh Government policies and legislation on integration of health and social care services.
1.3 Children and Young People’s Continuing Care
Continuing care packages provide long term care and support to children and young people who are disabled or otherwise in need of support. The packages can include care provided by both health and social services professionals. Managers of local authority disabled children’s team in Wales have informed Children in Wales that although many of the children they work with have complex health care needs which the social workers believe would meet the eligibility criteria for continuing care funding, very few are assessed by health as meeting the required criteria when the decision support tool is completed. This in effect means that many children and their families are at the centre of a dispute over who pays for the required support and may not be receiving the care to which they are entitled.
Recommendation
Children in Wales recommends that the Children and Young People’s Continuing Care Guidance is reviewed with a particular focus on whether the decision support tool needs to be replaced with a summary of need as has been proposed by The All Wales Children’s Community Nurse Forum Subgroup for children and young people’s continuing care. (Further information can be provided on request)
2) Neonatal services
The Committee’s previous inquiry noted clear improvements in some areas whilst concluding that further progress was still required in a number of important areas, including addressing the shortfall in medical and nursing staff and the effective distribution and utilisation of cots. Children in Wales would support a follow up review of the previous recommendations.
3) Sport and public health
Children in Wales would welcome the Committee examining the potential health benefits of sport and the role of NHS Wales in promoting sport and physical activity generally to tackle obesity. The Consultation document makes reference to the rise in the level of adult obesity evidenced by the Wales Health Survey 2015. The Committee will be aware that the previous Children and Young People Committee published their report following an inquiry into childhood obesity in Wales. We would suggest that progress in taking forward the Recommendations from this report is also included as part of any inquiry.
The Committee could also include reference to the growing calls, and support amongst some previous Assembly members, for a ‘Sugar tax’ with the potential for the Welsh Government to introduce a levy on sugary drinks. Only last month, children and young people called for there to be a sugar tax on fizzy drinks as a means of helping to prevent tooth decay and some diseases, such as diabetes.
We would also support the Committee examining the relationship between health and access to sports facilities, which would include participation in sport activities, including by children, young people and groups with protected characteristics. The previous Communities and Local Governmnet Committee undertook an inquiry into participation levels in sport which took evidence from health professionals and made a series of recommendations, some of which should be reviewed through a further inquiry.
Rising levels of obesity can have a big impact on the health of children and young people with their parents needing additional support to manage healthy lifestyles. This would include advice around healthy eating and exercise. One initiative which provides this is the Welsh Government Families First programme which highlights a range of support services under the healthy lifestyles package that could benefit all children and young people in Wales. Unfortunately this and other programmes that work with obese children and young people are not widely known.
Other issues
4) Child Health
Children in Wales would support a specific inquiry focused on child health, with an emphasis on preventative action and giving children the best start in life; addressing harmful behaviours, reducing instances of mental health problems and promoting healthy behaviours. With the status of the National Service Framework for Children, Young People and Maternity Services in Wales remaining unclear ( to our knowledge the All Wales Posture and Mobility Partnership Board is the only body that provides regular reports on how the wheelchair service is performing against the key actions) a new focus on child health is required.
The Royal College for Paediatrics and Child Health Wales (RCPCH) have published a report entitled “Child health matters: A vision for 2016 in Wales - rcpch”
This identified five ways in which children’s health outcomes can be improved. These are:-
1 Preventing children and young people from becoming unwell, acting early and intervening at the right time
2 Tackling child health inequalities
3 Reducing the number of child deaths
4 Involving children and young people in decision making
5 Delivering effective healthcare for children and young people
Recommendation
Children in Wales supports the RCPCH report and recommends that:-
1) The status of the National Service Framework for Children Health and Maternity Services in Wales is clarified
2) A renewed focus is given to child health and a rights based, outcome focused health delivery plan for children and young people is developed
Participation and engagement in health services
The UN Committee on the Rights of the Child made a recommendation that ‘children are not only heard but also listened to and their views given due weight by all professionals working with children’. As part of any inquiry which the NAfW Committee chooses to conduct, it is imperative that the issue of participation and engagement of all children and young people on all decision making matters which concern them is considered and included.