We had a seminar today on child abuse, covering its history, types of abuse, legislation in place to prevent it, etc. In particular we looked at the cases of Victoria Climbié and Baby P. In both of these cases there were multiple factors resulting in the abuse and death of these children, but a key factor in both was lack of integration of services/communication between them.
It was rather prophetic, therefore that the faculty of public health released an assessment of the risk of the NHS bill
, highlighting the failures this bill will have, such as the following scenario
A seven year old girl has autism and attention deficit hyperactivity disorder. She lives with her single mother and three siblings in a high rise flat in a deprived area. Her mother is depressed and struggling to cope.
The school are concerned because she regularly has bruises on her arms and arrives hungry and late. The bruising may result from reasonable restraint by her mother and her hunger may be indicative of her challenging behaviour as autistic children can be difficult to feed.
She needs an urgent combined health and social care assessment to determine whether she is being abused and/or neglected. She requires an appropriate school that can cope with her complex needs, and regular review by community paediatricians, a child development team and child and adolescent mental health professionals working together to coordinate services around the child. A high level of cooperation is essential to ensure the child’s safety.
The notion of choice has no relevance to this family. It is unlikely that this girl’s mother will be able to adequately articulate her needs and have the skill and resources to navigate a complex environment of healthcare, social care and education services.
Some of the services this family need, such as parenting skills for her mother, may be regarded as low priority by the CCG. Services for this family will fall under the responsibility of the CCG, the NHS Commissioning Board, the local authority public health department, the local authority children’s social care and with the new Police Commissioner. Ensuring that fragmented health services can fully integrate with social care and education services will be a significant challenge.
These problems are common enough in a system which is meant to be consistent, when various agencies are trying to purchase contracts, it will be many time worse. Indeed, as the document says:
In a competitive market there is no incentive for providers to collaborate to provide integrated pathways of care. Indeed, such collaboration may be seen as anti-competitive and incur substantial financial penalties
At the risk of sounding meladramatic, I honestly believe this legislation will kill children.