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

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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
CONCLUSIONS ACTIONS SPEAK LOUDER Although health services are beginning to look more at outcomes from their work within YOTs, and their increased representation on management boards is contributing to this improvement, the lack of widespread evaluation means that the usefulness of health interventions in contributing to reducing offending behaviour cannot be measured. The findings in a small number of initial inspections of YOTs led to re-inspections. Our recommendations about health have led to specific improvements in almost all cases. However, one YOT, where health provision deteriorated, had to be pursued more rigorously through local Healthcare Commission operational teams and the relevant strategic health authority (SHA). An explicit health action plan was requested, and provided, and progress is being followed up. It is also notable that evidence suggests that SHAs are not universally aware of their responsibilities in relation to the health provision within YOTs. 35
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Actions speak louder: A second review of healthcare in ... - HMCPSI

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