A Report on the Inspection of the Care - Regulation and Quality ...

Section Five
Analysis of the Pathways of the Ten Young People
Best Interests
The HSC trusts have a legal and ethical duty to provide young people who are
looked after with the continuity of care and support that any good parent
would provide. In all aspects affecting a young person's life trusts have a duty
to act in their best interests in the decision making processes. In addition to
the protection of young people, trusts have responsibility, as corporate parent,
to meet the duty of quality in respect of services provided to young people.
This means that trusts are accountable for the provision of robust governance
arrangements to ensure high quality health and social services including those
services which accommodate children and young people.
Each year secure accommodation is populated almost entirely by young
people who are in residential care and have highly complex needs. Meeting
these needs is a resource intensive activity and poses significant challenges
to care providers. This inspection report highlights that, in terms of their best
interests, challenges remain with the quality of service provision to this group.
At the point of admission to residential care all 10 young people's cases
indicated the preferred care option was to remain in the community or
residential care or move into foster care. Yet over time, nine of these young
people were presented to the restriction of liberty panel as in need of secure
accommodation. The tenth young person was managed at home and
subsequently admitted to the juvenile justice centre where he subsequently
experienced multiple admissions. Acknowledging the complex behaviours of
this group, it is envisaged that young people could receive a service that is
increasingly more able to manage such behaviours and prevents them from
reaching the threshold for secure care in the first place.
Once admitted to residential care there were examples of good quality
assessment work in some children's homes. One trust in particular has
developed a multi-disciplinary format that provides good quality in depth
assessment of need. However, over the 10 pathways it was not always the
case that this led to effective care planning and outcomes for the young
people. For example, one young person had multiple admissions to the same
children's home despite her risk assessment stating that the placement had
increased the frequency and severity of self-harming and absconding
behaviours. The case records for the majority of the young people indicated
that they did not respond well to a group living environment yet were placed in
residential children's homes. This resulted in an escalation in their ongoing at
risk behaviours which may have been avoided in an alternative setting.
Therefore, each trust may wish to consider the interconnectedness of their
assessment outcomes and care planning decision making in terms of
achieving better outcomes for highly vulnerable young people.
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