Actions speak louder: A second review of healthcare in ... - HMCPSI

INTRODUCTION
ACTIONS SPEAK LOUDER
Health services and youth offending
It may be useful, at this point, to demonstrate how health services can be involved
in the pathway of children and young people who are believed by different agencies
to be likely to offend. Health workers in schools or early years facilities can, for
example, identify initial issues and intervene to support families before possible
escalation. Children’s services can also identify early needs for intervention and
employ a lead health professional through the use of the CAF process (Common
Assessment Framework). Early intervention will generally be with primary health
services in the community, but sometimes there is access to specialist health
workers within YOTs. Health services and YOT health workers are likely to be directly
involved, where this is seen to be appropriate, once children and young people are
involved with anti-social behaviour, or when they begin to offend.
An assessment of health needs and possible interventions can again take place
when a child or young person is charged and then remanded on bail or in custody.
Court reports, prior to sentence, should also contain relevant health information to
assist magistrates in sentencing. A community order or a custodial sentence may
also involve external health services (substance misuse, psychological or psychiatric
services, for example) and YOT health workers in order to meet health needs,
particularly where these are clearly linked to offending behaviour. The YOT health
practitioner, indeed, should be the key link worker for transitions between the
community and custody, or other secure environments, and also central to the
release process in appropriate circumstances.
There have been a limited number of explicit expectations or standards on
healthcare services in relation to youth offending services and this has contributed
to developments being made inconsistently. The Crime and Disorder Act 1998 placed
a duty on the former health authorities to cooperate in the establishment of YOTs.
It set the expectation that this cooperation would be fulfilled through authorities
participating in the steering group, and contributing to the funding and the provision
of at least one health worker. Subsequent inter-departmental guidance (Ref. 2)
clarified a number of aspects, including the role of healthcare staff and how
information should be shared. A great degree of flexibility, however, remains in
relation to the development of individual frameworks delivering health interventions.
The responsibilities outlined have now, effectively, been transferred from health
authorities to PCTs. Indeed, a number of inspections highlighted the negative effect that
successive health reorganisations had on continued and consistent involvement with
YOTs. The complexity of commissioning arrangements and changes in responsibility
was sharply highlighted in inspections, where some health representatives on YOTs’
management boards had no clear idea of the expectations on them in relation to those
children and young people who are involved with YOTs. Similarly, the increasing focus on
youth offending in, for example, the Improving Health, Supporting Justice consultation
and strategy, and the Youth Crime Action Plan was not generally well understood.
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