Every Child Matters - Continued

The action team considered restructuring existing agencies into an integrated children's services agency; while seeing value in this, they reject the idea of further centrally imposed structural change. But they call for basic cultural changes in the way agencies work, led jointly by a senior Council member ("Chair of Children's Services") and a senior figure from the NHS in each area.

The process of planning children's services must be a joint one not only of different agencies but children, parents and relevant voluntary organisations must be involved as full participants. Together, they should "assess need, develop a local vision, agree funding, deliver services, develop services, monitor and evaluate." Such plans will also have to relate to community care planning and drugs action teams at local level.

There was particular concern that "no staff are currently specifically trained to work with families". Because of this lack, some action was seen as "vaguely supportive in intent but failing to achieve real improvements in the lives of vulnerable children"; it should therefore be a priority to identify and support staff equipped to provide a "much more robust and change-orientated approach to working with families".

The key here is to avoid many of those most vulnerable (eg "those who have a disorganised lifestyle or who are without a regular domicile") falling through the service net, through GP de-registration, school exclusion or homelessness. Active methods of making and keeping contact with all families, as well as sharing of information, are needed to ensure that health and education services are maintained for the children of such families.

The action team found a more positive view of pre-5 services, which "tended to operate as a service to the family, rather than only to the child, something that was perceived to alter when the child began primary school, and the family often felt no longer supported (or even felt excluded)".

"One stop shop" single entry points to local services, community schools and healthy living centres are welcomed as providing important opportunities for inclusive access to services, but none of these yet bring together all of the major elements of services to children. "Unless schools and health centres were co-located (an option about which there are many reservations) it will remain impossible to have a single entry to every service provided from a single site."

There should be explicit recognition of the present practice in which the NHS takes the co-ordinating role for children before they enter formal education services, and education fulfils that role once children are at school. "At every stage, every child should have a named individual who can function as the main point of information/reference for the child, and who can co-ordinate arrangements for considering whether other, more specialist, services are required for the small proportion of children who will need these."

The action team also make a strong case for developing a single, multi-discipline format for needs assessment, covering the range of agencies. Children and parents are, they feel, comfortable with the sharing of such information across agencies if it avoids repetition, secures joined-up service delivery and is done with "care, respect and consent".

Where there is an identified need for a consistent long-term contact with the child/family, or for more intensive or complex intervention, a care co-ordinator should be identified (who might be a social worker, guidance teacher, educational psychologist, child and adolescent psychiatrist, paediatrician or other professional).

It is hoped that the development of a "multi-disciplinary, multi-agency model of staged/
tiered intervention" will avoid the accident of the entry point to services determining the service provided and enable a more effective response.