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

ACTIONS SPEAK LOUDER
CONCLUSIONS
Pathways for referrals from initial assessments to interventions, whether these
are within or outside the YOT, were not clear enough. Additionally, work with cases
requiring a dual diagnosis was not sufficiently consistent. Health interventions with
victims and the use of aspects of healthcare within restorative justice were
underdeveloped.
The extent of health interventions was limited in a number of YOT areas, because
there were gaps in provision. This included lengthy vacancies for health workers and
insufficient commitment from primary care trusts (PCTs). This has led to health
needs not being fully, or properly assessed, and/or being referred on.
Although the quantity of health provision has improved since the time of our first
review, too many PCTs are still not meeting their statutory duty to provide at least
one health worker to a YOT. Universal health services have again improved, but we
are still seeing examples of needs not being met within child and adolescent mental
health services – particularly for the older age range. This can be critical where
essential support is needed to bridge the transition to adult services.
Inspections found problems in communication between community settings and
secure environments for custodial cases. Health provision in the community
following a release from custody can also be problematic. The situation is much
improved, however, where good liaison and communication takes place between the
local YOT and the establishment, both at the beginning of a sentence and prior to
release. If a child or young person is engaged with a community-based health
worker before release, there is a much stronger likelihood that good links will
continue afterwards. One generally positive aspect relating to custody is the
introduction and use of resettlement and aftercare project workers, who are
providing good, ongoing support to those who misuse substances.
We found that health services were represented more than before at management
board meetings, although there were some continuing problems with their levels
of attendance and contribution. Substance misuse services, however, are much less
well represented at that level. Consistent, functional and up-to-date service level
agreements and protocols were only found at the best YOTs, so this area requires
an increased focus by PCTs. We were particularly concerned with the lack of
information-sharing protocols between YOTs and health services, which allows the
misunderstandings and confusion to continue.
Resources provided by health services to the YOTs remained inadequate in nearly
half of the YOTs evaluated for this review and the national average for this financial
contribution has fallen. This is worrying since we also found, as detailed above, that
health needs are not consistently being identified and met. Gaps in provision are
clearly affecting the ability of YOTs to deliver appropriate interventions.
34