A Joint Inspection Of Services For Children And Young People At Risk Of Harm In Highland

18th December 2022

The Chief Executives of Highland Council and NHS Highland, the Commander for Police Scotland, Highlands and Islands, and the Chair of the Child Protection Committee, welcome the Care Inspectorate's findings.

Collectively, they wish to highlight the key strengths in relation to the partnerships prompt and effective responses when children were at risk of harm.

The Care Inspectorate also found that the partnerships response remained a strength throughout the pandemic.

The Care Inspectorate noted that the partnerships were robustly sharing information and working together in making decisions that ultimately ensured that children at risk of harm were safe.

The inspectors also identified a number of key areas for improvement, which are fully accepted to ensure continuous improvement of services across Highland.

The improvement journey commenced prior to inspection. The findings of the inspection will enable the partnership to continue its journey relentlessly focusing on the best possible outcomes for children and families across the Highlands.

Excerpts from the report
The joint inspection of services for children and young people at risk of harm in the Highland community planning partnership area took place between 25 April 2022 and 26 September 2022. It covered the range of partners in the area that have a role in meeting the needs of children and young people at risk of harm and their families.

• We listened to the views and experiences of 52 children and young people through face-to-face meetings, telephone or video calls and survey responses.

• We listened to the views of 120 parents and carers through face-to-face meetings, telephone or video calls and survey responses.

• We reviewed practice by reading a sample of records held by a range of services for 60 children and young people at risk of harm.

• We reviewed a wide range of documents and a position statement provided by the partnership.

• We carried out a staff survey and received 727 responses from staff working in a range of services.

• We met with approximately 175 staff who work directly with children, young people and families. This included focus groups and networks of support.

• We met with members of senior leadership teams, committees and boards that oversee work with children and young people at risk of harm and their
families.

Areas for improvement
3. Immediate responses to concerns, and key processes, were more effective for younger children than they were for older young people.
4. Despite clear governance and reporting frameworks being in place, senior leaders were not effectively communicating their vision, values and aims to frontline staff who, in turn, felt their concerns about service delivery were not being heard.
5. The lack of early intervention and mental health and wellbeing resources was having a significant impact on children and young people at risk of harm, as well as on the capacity of frontline staff to meet their needs.
6. The partnership's ability to demonstrate the difference services were collectively making to the lives of children and young people was restricted because it was not systematically analysing and evaluating its data and not maximising opportunities to collate qualitative data.

The numbers of children and young people at risk of exploitation were a concern for staff in Highland. The children's reporter
confirmed they had seen an increasing number of referrals for children and young people involved in, or at risk of, exploitation.

There was also only a small number of paediatricians qualified and trained to undertake child sexual abuse medical examinations, which also only took place at Raigmore Hospital in Inverness. Children and young people from outwith Inverness had to travel to Raigmore for these examinations. These factors meant that not all
children or young people received the service they needed at the time they needed it, with the potential for further traumatisation, which staff acknowledged.

Children's hearing panel members did not feel that all plans helped them to make effective decisions for children and young people. They recognised that there were some helpful assessments and plans submitted to children's panels, however, they also acknowledged that not all assessments were tailored to each individual child or young person and this made the reading and analysis of these challenging.

There were also challenges in meeting the needs of children and young people at risk of harm. Services to support early intervention or prevention of risks escalating were limited. There were children's services worker posts in every team in Highland in order to support parents and families at the earliest point of referral. However, these were not available to families in every area due to recruitment issues. Where they were in post, they did not have the capacity to work with all the families referred to them for support.

Primary mental health workers, who were part of child and adolescent mental health services (CAMHS), were attached to every school, however, their service was stretched, with some areas reporting vacancies at 50% and workers were not able to see every young person referred to the service. CAMHS had a three-year
waiting list and, although it prioritised referrals as they came in, staff were aware that there were significant numbers of children and young people who were not receiving a service over that period. There was also a waiting list for neurodevelopmental assessments. The neurodevelopmental assessment service (NDAS) was a joint
service between Highland Council and NHS Highland. The purpose of the NDAS assessment was to have a single process to enable assessment and diagnosis of a wide range of neurodevelopmental disorders in children and young people. The NDAS service had undertaken a review in October 2021 in which families were very
critical of waiting list times and lack of support available while on the waiting list. Approximately 250 children and young people were waiting two or three years, and sometimes up to four years, for an assessment.

There had been a significant turnover of social work staff in recent years, and agency staff had been put in place to address this.

Highland council, which employed school nurses and health visitors under the lead agency model, had fewer whole time equivalents than other health board areas. Frontline staff felt this was a challenge, giving examples of practice which was stretched. They felt that they could not build relationships with children, young people and their families because of this.

The full report can be read here
Pdf 39 pages