Children's and Young Peoples Secure Estate - Needs of Children and Young People

1. Children's and Young Peoples Secure Estate - Needs of Children and Young People Kate Davies OBE Head of Public Health, Armed Forces and their Families and Health & Justice, NHS England 18 November 2013

2. Who are NHS England? • NHS England exists to save and improve lives: to make people better when they are ill. We are committed to design and deliver care around the needs and choices of each individual patient • We want to make the NHS the best customer service in the world and ensure that every person who comes in to contact with the NHS is treated fairly and equally, whether a patient or a member of staff. It is vital that we allocate valuable public resources to secure the best possible outcomes for patients now and in future generations and uphold the NHS Constitution

3. How we operate: Responsibilities We allocate £60bn to clinical commissioners, supporting, developing and assuring the commissioning system We directly commission £26bn of health services, including primary care, some public health services and specialised health services We plan for civil emergencies and make sure the NHS is resilient We work in partnership for quality We lead strategy, research and innovation for outcomes and growth We empower clinical and professional leadership at every level of the NHS We promote a world class customer service through better information, transparency and participation We develop commissioning support to make it the best it can be

4. Secretary of States Mandate - Health and Justice • Whether working with local councils, schools, housing associations, job centres, universities, prisons, the police or criminal justice agencies such as Police and Crime Commissioners and Community Safety Partnerships, NHS England's objective is to make partnership a success particularly against Governments priorities • Contributing to reducing violence, in particular by improving the way the NHS shares information about violence assaults with partners and supports victims of crime • Developing better healthcare services for offenders and people in the Criminal Justice system which are integrated between custody and the community, including through the development of Liaison and Diversions services

5. Offender Health Commissioning • Develop commissioning policy to meet national standards & local ambition • Agree national performance frameworks with partners • Develop service level agreements with partners • Embed the new commissioning landscape and ensure stakeholders and partners are fully involved in commissioning • Manage national contingencies and risks

6. Commissioning Features (England) Commissioning of public health, and social care services, for the general population including substance misuse services Commissioning public health and care services for offenders managed in the community or released from custody e.g. Drug and alcohol treatment services for offenders not in prison or places of detention Commissioning majority of healthcare services for the general population, including secondary care Commissioning majority of health services for offenders managed in the community or released from custody e.g. Children & young people on court orders and released from secure estate, adult offenders managed by Probation CCG’s (211) LA’s (152) 4 Regions; 10 AT NHS England Commissioning of primary care for general population Commissioning of health services for people in ‘prison and other places of detention’ Specialist care Armed forces and their families health Elements of PH health and wellbeing boards (152) Key strategic and planning role in bringing together local authorities, the local NHS and communities (with other key partners) to produce Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWSs) to underpin local commissioning plans and service planning

7. Healthy Child’s Programme The Healthy Child Programme 0-5 years can be split into 3 service delivery areas: • Universal Element of Health Child Programme 0-5 years • Early intervention and prevention programme offered universally • Offers screening, immunisations and development reviews • Information to support children and parenting • Health Visitors (HV) including the Health Visitor Implementation Plan • Priority on training, recruitment and retention of HV • Professional development • Improved commissioning of the service over 4 year period to 2015 (increase of 4,200 HV during this time)

8. Family Nurse Partnership (FNP) Programme (16,000 places by 2015) • Programme to support young mothers in their first pregnancy • Improves outcomes in pregnancy • Child Health and development • Parental self-efficiency Deliver by working in partnership with several different bodies including NHS England, Clinical Commissioning Groups and Local Authorities to commission excellent services for children.

9. Public Health Functions Commissioned by NHS England • Immunisation Programmes • Screening Programmes • Sexual Assault Referral Centres • Child Health Information Systems • Public Health of offenders and detained settings • Children’s Public Health Services 0 to 5 years

10. Commissioning responsibilities for Health & Justice • NHS England is responsible for planning, securing and monitoring an agreed set of services for: • Prisons • Young Offender Institutions (YOIs) • Immigration Removal Centres • Secure Training Centres • Secure Children’s Homes • Police Custody Suites • Court Liaison and Diversion Services • Sexual Assault Services • Public Health Section 7A - Sexual Assault Services • The Public Health of persons in prisons, secure and detainee settings

11. The population Adult Offenders and children and young people in secure settings typically have poorer health and health outcomes than the average population. For instance: • 81% of adult prisoners said they had used illicit drugs at some point prior to entering prison, including almost two-thirds (64%) within the month before entering prison • 17% of prisoners had been treated or counselled for an emotional or mental health problem in the year before custody • Female prisoners are more than three times as likely to self-harm as male prisoners • Children and young people in contact with the youth justice system have high levels of vulnerability: over one quarter have been looked after children at some point • The proportion of children and young people in custody who have experienced serious child maltreatment is at least twice that in the population as a whole • Children and young people in the youth justice system are at least 3 times as likely to have mental health problems than their non-offending counterparts

12. Children's & Young Peoples Secure Estate • The Children & Young People’s Secure estate is the collective term for the three types of establishment in which 10 to 17 year olds sentenced or remanded to custody can be placed, and children detained on welfare grounds: • Secure children’s homes (SCHs) • Secure training centres (STCs) • Young offender institutions (YOIs). • YOIs and STCs hold young people who are: on remand; serving detention and training orders (DTOs); or serving longer periods of detention under section 90 of the Powers of Criminal Courts (Sentencing) Act 2000 (i.e. are detained during Her Majesty’s pleasure) or under section 91 of that Act (for certain serious offences mainly those punishable by 14 years imprisonment or more in the case of an adult).

13. Young Offender Institutions (YOIs) • YOIs are run by the Prison Service, and can accommodate 15 – 21 year olds. The Youth Justice Board (YJB) commissions and purchases the places for under 8s (i.e. 15 – 17 year olds), who are held in units that are separate from those for 18 – 21 year olds. • YOIs have lower ratios of staff to young people than STCs and secure children's homes, and generally accommodate larger numbers of young people. • Consequently, they are less able to address the individual needs of young people, and are generally considered to be inappropriate accommodation for more vulnerable young people. • Hindley YOI ( mixed site from April 2014) • Wetherby YOI (CYP only) • Werrington YOI (CYP only) • Feltham YOI (mixed site) • Cookham Wood YOI (CYP only)

14. Secure Training Centres (STCs) • Secure Training Centres (STCs) are purpose-built centres for young people up to the age of 17. They are run by private operators under Youth Justice Board for England and Wales (YJB) contracts, which set out detailed operational requirements. There are four STCs in England: • Oakhill in Milton Keynes • Hassockfield in County Durham • Rainsbrook in Rugby • Medway in Kent • In size and staff-to-young people ratio, they are in the middle between secure children’s homes and YOIs.

15. Secure Children’s Homes (SCHs) Secure children’s homes are run by Local Authority Social Services Departments or by voluntary organisations. They are the policy, but not operational responsibility of the Department of Education. Of the three types of establishments, SCHs have the highest ratio of staff to young people, and are generally smaller, ranging in size from 6 to 42 beds. They are usually used to accommodate younger children (those aged 12 to 14), young women up to the age of 16, and 15 to 16-year-old young men who are assessed as needing extra care. In addition to providing places to the YJB, secure children’s homes also provide places for looked-after children who need to be secured for their own welfare (known as ‘welfare placements’). Some secure children’s homes currently provide only welfare places; the others provide a mixture of welfare and YJB beds.

16. Needs of CYP in custody • Children in secure settings are some of the most vulnerable, often suffering poor physical and mental health. Evidence presented in the report shows young people in secure settings: • Are more likely to be victims of crime, have a parent in prison, have been exposed to bullying and be a young parent. • Are twice as likely as the general population to have experienced serious maltreatment, with many having been in contact with children’s social care or have been looked after. • Have three times the prevalence of mental health disorders compared to the general population, with depression and anxiety being the most common disorders.

17. In addition: Over a quarter of young men and a third of young women in secure settings have a long standing physical complaint including respiratory problems, dental health problems, blood-borne viruses, sexually transmitted infections and epilepsy. An estimated 50% have learning disabilities A high proportion of young people in secure settings have a history of substance misuse. Before they entered custody 83% were regular smokers, over 60% drank alcohol daily or weekly and over 80% used an illegal drug at least once a month.

18. Work NHS England is doing Healthcare Standards for Children & Young People in Secure Settings (CYPSS) Drawn up by a group of Royal Medical Colleges led by the Royal College of Paediatrics and Child Health and backed by the Children’s Commissioners of all four UK nations, the Healthcare Standards for Children and Young People in Secure Settings (CYPSS) are designed to help plan, deliver and quality assure the provision of children and young people’s health services in secure settings

19. There are 69 standards in total, which include the need for every child and young person to: • Undergo an initial health screening and risk assessment before the first night and ideally within two hours of their arrival. • Have a comprehensive healthcare plan including physical health, mental health, neurodisabilities and substance misuse within 10 days of their arrival in the secure setting. • Have all health assessments reviewed annually and mental health assessments reviewed within 3 months of admission to ascertain if needs have changed. • Have a named lead healthcare professional.

20. Comprehensive Health Assessment Tool (CHAT) The Comprehensive Health Assessment Tool (CHAT), an evidence based reception screen and comprehensive health assessment tool, verified for use with under 18s , which has been developed to replace a screening system not designed to assess children’s health needs. The tool is currently being rolled out across the CYPSE. The Community version of the tool has been piloted and is currently being validated. There are five parts to CHAT. Part 1 is an initial assessment of immediate risk in relation to physical health, mental health, substance misuse and safety. Part 2 is a comprehensive assessment of physical health. Part 3 is a comprehensive assessment of substance misuse. Part 4 is a comprehensive assessment of mental health. Part 5 focusses on neurodevelopmental disorders (learning disability, autistic spectrum disorders and speech

21. Questions?