Ministers must clarify how health services for children in custody will be commissioned in the new-look NHS or risk continued fragmentation of provision, youth justice professionals have warned.
Their call follows the government announcement that health services for young offenders will be managed through the NHS. The proposals, unveiled by care services minister Paul Burstow last week, will see responsibility for commissioning health services for young people in secure children's homes and secure training centres transfer to the NHS.
Until now, these services had been commissioned by individual institutions through the Youth Justice Board (YJB), despite the fact that equivalent services in young offender institutions have been dealt with by the NHS since 2006. Burstow claimed the transfer would improve the health and wellbeing of young offenders and "potentially reduce rates of re-offending".
"Children and young people in secure settings often have far more unmet health and social needs than other children their age," he said. "These can include poor communication skills, mental health problems and learning difficulties. It is therefore vital that this group benefits from well-commissioned health services, particularly in mental health assessment and treatment."
But while the principle behind the transfer has induced a cautious welcome from the sector, professionals are worried about how the arrangements will work under the proposed NHS reforms.
A Department of Health (DoH) spokeswoman was unable to confirm whether health services for young offenders will be dealt with by the National Commissioning Board or GP consortia, because of the current "pause" in the Health and Social Care Bill.
Gareth Jones, vice-chair of the Association of Youth Offending Team Managers, said this uncertainty is causing anxiety.
"At least with the YJB being responsible for commissioning health within individual institutions, we know where we are," he explained. "Not all youth offending teams have health workers. One of the major concerns we have is the lack of continuity between healthcare within institutions and when young people are back on release in the community. Our immediate concern is that this might lead to another layer of complexity, certainly in the short term."
Jones warned that GP consortia were liable to overlook the very specialist needs of young offenders. "The worry we have is that services for young offenders might not be high on the list of priorities for GPs, because we know the extent of the health issues that young people in custody have," he said.
Simon Lawton-Smith, head of policy at the Mental Health Foundation, said the transfer is "promising", but admitted the jury is out on whether it will actually reduce variations in quality of care. "Changing the system is fine," he said. "But we're looking at expensive services here - around £210,000 each year for a child in a secure children's home. The NHS has to make £20bn efficiency savings, so whoever is commissioning these services in the future will clearly have many priorities on their list."
He added that the new system may not eliminate the "gap" that exists between services. "Should the government's reforms go through, these services will either be commissioned through local GP consortia, which it is generally acknowledged do not have the best handle on mental health services, or through the specialist national commissioning board.
"You could still have two different commissioners, with the GPs commissioning services before the child goes into the home and when they come out, and the national commissioning board dealing with provision inside the secure estate. Potentially, there will be a mismatch and people will fall between the gaps."
But John Drew, chief executive of the YJB, insisted that the move would mean that children and young people in secure settings receive health services that are comparable to those received in the community.
"Improved links between custodial and community services will aid the transition back into mainstream health services," he said. "The YJB will continue to work closely in partnership with the DoH to ensure that children and young people's health and wellbeing needs are met."
GOVERNMENT PROPOSALS
- The government has announced plans to transfer responsibility for commissioning health services for children and young people in secure children's homes and secure training centres to the NHS
- Until now, these services had been commissioned by individual institutions, through the Youth Justice Board
- The move means that secure children's homes and secure training centres will start to commission health services in the same way as young offender institutions
- Responsibility for commissioning health services for young offender institutions and prisons passed from the prison service to the NHS in 2006
Source: Department of Health
