Overview

A partnership agreement for the children and young people secure estate in England has been in place to support the commissioning and delivery of healthcare in secure settings for children since NHS England became the statutory agency responsible for health commissioning in 2013.

This agreement provides our core objectives and priorities for 2023-2025, and sets out our commitment to fully integrated working with shared accountability for delivery. The Partnership has progressed to support a whole pathway approach for children with complex needs, helping to prevent children entering welfare and/or youth justice detention. A mixture of arms-length bodies and government departments are incorporated, all with a key role to play in ensuring high-quality, outcomes-based health services for challenging, and vulnerable children and young people with complex needs. Just as the responsibilities of these organisations vary, with each playing a unique role in the health and justice system, so too will our contributions to meeting the objectives. These objectives are, therefore, shared at a system level, rather than each organisation making a direct contribution to each objective. Together, they underpin our shared vision.

Our cohort: children with complex needs

Children can be deprived of their liberty in England under one of three legal frameworks:

• Section 25 of the Children Act (1989) placing them in a secure children’s home.
• Under the Youth Justice System on remand or serving a sentence in a secure children’s home (SCH), secure training centre (STC) or young offender institution (YOI).
• The Mental Health Act (1983, as amended 2007) placing them in hospital.

This cohort of children often have complex needs in multiple domains and are sometimes described as “high risk, high harm, high vulnerability”. They may:

• Have a higher likelihood of having been subjected to Adverse Childhood Experiences (ACEs)
• Have a higher likelihood of having been subjected to trauma or severe neglect.
• Have challenges in developing secure attachments.
• Have experienced high levels of social disadvantage.
• Have multi-layered, unmet and complex needs.
• Not be accessing services in a timely manner in the first place, despite high levels of need.

Placement in the children and young people secure estate is temporary, and part of a broader pathway of care. The Framework for Integrated Care (Community) considers the needs of those who are at risk of entering the welfare, youth justice or mental health inpatient estate. It focuses on services working together in a more integrated way and intervening early to best meet and deliver the needs of children with the most complex needs.

Our Cohort

Youth Justice

Children given a custodial sentence are more likely to be assessed as having multiple needs and concerns compared to children who receive a community sentence.

Many of these children also have an offending history, with 37% of children in custody in 2019 having had 7 or more prior cautions or convictions. Numbers of children in youth justice settings have dramatically decreased (from an average of 2881 in 2009 to 859 in 2019) but the estate is holding a larger proportion of children for longer (a 15% increase of 12 month + sentences), and for more serious offences (children in custody for violence against the person offences rose by 7% during this period).

• Mental health: A third (33%) of children in custody were recorded as having mental health concerns, with a higher proportion for girls (41% compared to 33% of boys).
• Education: Over 60% were not engaged in education prior to entering custody.
• Special needs: A third (32%) were recorded as having a learning disability or difficulty (compared to 18% in the general population)
• Looked After Child: 45% were recorded as currently being or having previously been a looked after child.

Welfare

In a study of children referred to Secure Children’s Homes completed in 2020, all young people for whom the requisite data existed were a ‘child in need’ at some time in the three years before referral to secure accommodation. These children were both high risk and vulnerable. About half had been victims of sexual exploitation, at risk of self-harm, or had a diagnosed or suspected mental health condition.

The same study shows high levels of background trauma that will influence behaviour.

What are we committing to deliver

Our partnership is underpinned by three core objectives:

1. To improve health and address inequalities, by making children and young people secure settings to become environments that enable good health and well-being and improve overall outcomes.
2. To improve future life outcomes by focusing on the elements which promote change in children, thus addressing the reasons for them coming into contact with the welfare and/or justice system and detention
3. To support a robust care pathway that enables continuity, better meeting the needs of children at risk of detention, supporting children when placed in the children and young people secure estate as a temporary placement and back into the community, or to other secure settings.

Principles of partnership

Principle 1

We have a shared vision to improve outcomes for children in contact or at risk of contact with the children and young people secure estate, supporting the children and young people secure estate settings to become environments that enable good health and wellbeing.

Demonstrable measures:

• Governance is fully supported by senior personnel in all our partnerships, so there is a focus on leadership of the system as a whole. Work programmes are linked, and there is a commitment to developing a set of shared commissioning intentions. We will align commissioning timetables where possible, to facilitate the co-commissioning of services.
• We commit to working towards aligned specifications to enable improved integrated working.
• We will jointly resource where required to support service design development and to support the commissioning process, for example, through the evaluation and mobilisation of new contracts. We will jointly work together on the spending review process where bids for specific projects or programmes are dependent on each other for successful delivery.
• We will jointly respond to learning arising from urgent notifications, on a case-by-case basis.
• We will ensure that where there is a change in the number of or needs of children in the estate, so these are discussed and implemented jointly, with appropriate risk assessment and due regard to the processes and needs of partner organisations and/or co-commissioners.
• We will jointly consider strategy to enable a competent workforce by recruiting the right people, investing, supporting and developing them to improve retention.
• We will commit to embedding genuine co-production with children, and their families and carers, to develop services and systems that are accessible and acceptable to them.

Principle 2

We commit to meeting the needs of children in the children and young people secure estate, through the continued implementation of the Framework for Integrated Care (SECURE STAIRS).

Demonstrable measures:

• We will continue to support the transformation, sustainability and fidelity of the Framework for Integrated Care (SECURE STAIRS). We will work in collaboration with individual settings to agree appropriate foundations and clear plans for sustainability.
• We will ensure that future reforms proposed by partners to this agreement are designed with the Framework for Integrated Care (SECURE STAIRS) in mind, as the foundation of the future children and young people secure estate.
• We will contribute to the sustainability of the Framework for Integrated Care (SECURE STAIRS), evidenced through the continued support of key elements of staff training, data monitoring and evaluation, responding to serious and significant incidents, facilitating professional collaboration and information sharing, with consideration for the transition from the secure estate back into the community or onward to the adult estate.

Principle 3

We commit to continually improving quality: the aim should always be for outcome-focused, evidence-based health services and guidance, linked to Health and Wellbeing Needs Assessments (where in reference to the children and young people secure estate), and robust population-based data.

Demonstrable measures:

• We will collaborate to assess the needs of the cohort for any services commissioned for the children and young people secure estate, so that we can commission services that are fully evidence-based, and that help to reduce inequalities. This includes when any new services are commissioned.
• We will work together to review the quality of Health and Wellbeing Needs assessments being undertaken in the children and young people secure estate, to ensure that they are a holistic assessment of need that encompasses all necessary elements and are completed with a clear understanding of the way in which the Framework for Integrated Care (SECURE STAIRS) should function.
• We will work together to review the evidence and produce evidence-based guidance.
• We will jointly respond to recommendations from inspection reports to improve the health and wellbeing of children in secure settings.
• We will jointly respond to learning arising from urgent notifications and other reviews.

Principle 4

Through continuing to implement the Framework for Integrated Care (SECURE STAIRS) and the rollout of the Framework for Integrated Care (Community), we agree to focus on issues that may be likely to reduce the factors relating to reasons for detention, including associated risk, and to support improving life chances, by focusing on factors that promote change in children.

Demonstrable measures:

• We will jointly respond to the recommendations from the Independent Evaluation of the Framework for Integrated Care (SECURE STAIRS) full report (Anna Freud National Centre for Children and Families) to ensure the Framework remains a long-term priority.
• We will jointly respond to the findings/recommendations from the Framework for Integrated Care (SECURE STAIRS) Annual Review Quality Assurance process and learning arising from the closure of the project, to support the development of the Framework.
• We will jointly work with Integrated Care Systems (ICS) to implement the Framework for Integrated Care (Community) and support them to achieve the Framework’s proposed outcomes which incorporate a full pathway approach from prevention through to transition back to the community.
• The vision of a seamless integrated service for children in custody or detained on welfare grounds, is clearly evidenced in service requirements and is supported by ongoing contractual review and performance management processes. 

Principle 5

We accept the Healthcare Standards for Children and Young People in Secure Settings (RCPCH 2019) as a benchmark for health services within detained and secure settings, including transition in and out of these settings.

Demonstrable measures:

• We will jointly support the regular audit process for the monitoring of the impact of the Standards across each setting, including establishing a requirement for providers to comply with access for the audit to take place.

Principle 6

We have an expectation that young people leaving detention will be healthier than on arrival. ‘Healthier’ is defined as having made measurable improvements to any or all aspects of a young person’s health.

Demonstrable measures:

• We will jointly monitor the quality of health care provision using all data available and sharing data where possible.

Principle 7

We have a concerted focus on safeguarding, including Serious Untoward Incidents (SUIs), and/or any Safeguarding and Public Protection Incidents (SPPIS).

Demonstrable measures:

• There is a clear process for shared learning from deaths in custody, serious incidents and near misses and evidence of change resulting from that shared process.
• There is learning from near misses / SSPIs and Serious Case Reviews, which is fed back and discussed with the Partnership. The Partnership considers data arising from audits of the Healthcare Standards for Children and Young People in Secure Settings.

Principle 8

We work together to improve the quality of data and intelligence collection and enable better data-sharing between partners, either through manual methods (eg, the Child Health Summary) or exploring ICT integration.  This includes improving the sharing of information before and after time spent in the secure estate, to support continuity of care, and to aid the development of effective health and wellbeing outcome measures.

Demonstrable measures:

• We will agree protocols for the sharing of information.
• There is timely sharing of routine information between partners both at secure setting level and at a national level.
• We will jointly interrogate key data to inform policy and operations.
• We will engage with one another in the development and roll-out of new technologies to ensure new innovations are made available in the children and young people secure estate.

Principle 9

We support the further development of public health services in the children and young people secure estate such as the improvement of support and treatment in relation to substance misuse, the improvement of preventative, diagnostic and screening programmes for non-communicable diseases (NCDs), improvement of the proactive detection, surveillance and management of infectious diseases and the joint capability to detect and respond to outbreaks and incidents.

Demonstrable measures:

• The children in the children and young people secure estate will have access to evidence-based screening and immunisation services appropriate to their needs and in line with national quality and delivery standards.
• Cases and outbreaks of notifiable infectious diseases should be promptly notified to UKHSA’s Health Protection Teams who will undertake a public health risk assessment and lead any outbreak control team supported by partners. Partners will collaborate with UKHSA to produce evidence-based guidance to support prevention, management and control of infectious diseases and other health threats in the children and young people secure estate.

How we will deliver

• Three core objectives – principles with underlying demonstrable measures
• Activities with timelines and measures of success – jointly agreed workplan
• Measured through join governance – future priorities.

Our governance for this work

We are jointly committed to and accountable for delivering shared objectives. Each partner organisation has separate respective statutory responsibilities and independence, but to achieve the best possible outcome we commit to collaborate and cooperate to deliver on our principles of partnership. Appropriate governance structures support the delivery of this. Each partner to this agreement is responsible for ensuring decisions on spending and delivery are signed off through their distinct organisational governance structures, and that information is disseminated through the proper channels. The Secure Care Strategic Forum, feeding into the Vulnerable Children and Families Strategy Board, has responsibility for the oversight and on-going management of this agreement and delivery of integrated workplan objectives.

Vulnerable Children and Families Strategy Board

• Key forum to bring the partners together at senior level, working to improve outcomes for vulnerable children and young people, by joining-up oversight on strategy and agreeing and co-ordinating cross-cutting responses to issues facing vulnerable children and young people

Strategic Secure Care Forum

• Includes oversight of the effectiveness of partnership working for the National Partnership Agreement and its integrated workplan objectives

Governance is provided through Secure Setting Integrated Partnership Meetings. These boards should be underpinned by a Local Joint Working Agreement, based on this National Partnership Agreement, to set out how partnership work is taken forward at a local level to support delivery. These Boards will feed into central Governance Boards.

Accountability for directly commissioned health services will remain with NHS England after introducing statutory arrangements for Integrated Care Systems. Governance structures are likely to change during this agreement. 

Signatories

• Indra Morris, Director For Families (Department for Education
• Matthew Style, Director General (Department of Health and Social Care)
• Dr Jenny Harries, Chief Executive (UK Health Security Agency)
• Claire Fielder, Director, Youth Justice and Offender Policy (Ministry of Justice)
• Amy Rees, Director General Chief Executive (HM Prison & Probation Service)
• Kate Davies, Director Health and Justice, Armed Forces, and Sexual Assault Referral Centres (SARCSs) (NHS England).

Publication reference: PR2070_i