Advocacy in Child Health

This week I’ve been reflecting on children’s advocacy challenges. Advocacy seeks to ensure everyone is able to have their say on issues that are important to them, that their rights are met and importantly, that their wishes and views are genuinely considered when decisions are being taken about their lives.

As a Children’s Nurse you’d expect me to say I’m committed to hearing the voices of children and young people in healthcare and in ensuring their rights, outlined in the United Nations Convention Rights of the Children (UNCRC), are met. The UNCRC celebrates its 30th birthday on the 20th Nov this year https://www.niccy.org/about-us/childrens-rights/uncrc-at-30/ and just as an aside I’m wondering how we can celebrate Children’s Rights across the NHS on this day?….

As health care professionals whether in homes, schools, primary care, youth justice settings, ED, on wards, anywhere, day in, day out, we’re constantly using advocacy skills, which include:

1. Really listening to the issue at hand;

2. Finding out more, identifying what matters most in the situation;

3. Identifying rights in the situation, using the UNCRC, including addressing issues such as consent, this summary from CQC on consent is helpful https://www.cqc.org.uk/sites/default/files/20180228_briefguide-capacity_consent_under_18s_v2.pdf

4. Exploring solutions;

5. Encouraging children and young people to express their views, opinions and thoughts about the issues, ultimately reaching a decision CYP have actively participated in.

Children and young people however still tell us we’re still not involving them in decisions about their healthcare as much as they want to be. Of course most babies, children and young people will, although, not always, have parents who will advocate appropriately for and ideally with them (although of course children, young people and their families can and do have differing views). Our role then as healthcare professionals is to use our skills in ensuring CYP are active, empowered participants in decision making processes whilst supporting parents too.

We need to constantly work on our refining and maturing communication skills if we’re to advocate effectively for and with individuals.The ‘CYP Me first’ model helps us as professionals to do this better, to more effectively engage with young people, there are loads of great resources on their website https://www.mefirst.org.uk/ and you can follow them on twitter @CYPMeFirst

So I wonder how can CYP using the NHS benefit from professional advocacy services? What’s their professional advocacy offer to Children and Young People across the NHS? I’ve had many conversations with respected colleagues over the years about advocacy services in health, there still seems to be an unmet need. Please correct me if you’ve got a model that we need to be sharing!

The use of professional advocacy services for those with learning disabilities or mental health needs is perhaps more commonplace than in general paediatric care. Children and Young People just as adults can benefit from neutrality in exploring issues and in making decisions.

Last week saw the publication of a Report supported by the office of the Children’s Commissioner into Advocacy Services for Children and Young People https://www.childrenscommissioner.gov.uk/wp-content/uploads/2019/06/CCO-Advocacy-for-children-June-2019.pdf

The Children’s Commissioner report highlights advocacy services in health are commissioned via a range of routes, some from local authorities and some trusts run these services internally, the report challenges the access to these services. These are the core values they’ve highlighted as important for advocacy services to work to:

The statutory advocacy support in health is focused on supporting young people to make complaints. Processes are often adult centric, increasingly though NHS complaints processes are becoming more CYP friendly. Yet there’s more to health advocacy than making complaints.

Children and young people who have special educational needs and disabilities, who are detained under the mental health act are also named as those specifically entitled to professional advocacy services but let’s not forget those with physical health needs too. Here’s the full list of situations when statutory advocacy is identified as being needed:

So as influencers in child health do we need to ask questions about what’s available locally to the CYP we serve? how are these services advertised and what training have staff had to support CYP with health related decision making issues?

Of course we also have a system advocacy role too. As Professionals we must advocate for improvements in Children and Young People’s Care and services. Even though they are 25% of the population we often end up focusing on adult related issues. Having Children and Young People in the NHS Longterm Plan puts an imperative on local systems to ensure CYP Health issues receive the focus they deserve, but we as healthcare professionals need to take our place at the STP tables and champion children and young people.

Wonderfully Children, Young People and families advocating for improvements in Children and Young People’s Care and services is another element we’re seeing more of and it’s having huge impact. It’s even better if professionals and users collaborate in advocating for improvement. Together we can be a powerful force for change. A great example of this is that NHS England supported the establishment of the NHS Youth Forum back in 2014 and they are having great impact on collectively lobbying the NHS to think more about the needs of children and young people in healthcare. This film from the Young Reporters summarises the Youth Voice Summit held back in April where young people met with senior leaders and spoke about what mattered most to them
https://www.youtube.com/watch?v=vuNfKkfctgw The @NNPCF is another example of parents advocating for improved services, particularly for disabled children so that their needs are met proactively rather than reactively, the impact they are having on the SEND agenda is phenomenal, although I know they’d say there’s much more to do!

Advocacy is going to continue be in the spotlight, especially in the UNCRC 30th year, let’s ensure practitioners supporting CYP and families have these skills and let’s champion the need for professional advocacy for all CYP across health, social care and education.

Reflections post blog

this is great short film for children on consent, thanks for sharing Lisa Ramsey! https://www.youtube.com/watch?v=h3nhM9UlJjc

Author: @kathevans2

I’m a Children’s Nurse who is passionate about improving healthcare and life with people who use services. I love getting out in the countryside or to the seaside to promote my mental health and well-being. On a journey to doing 100 marathons (slowly!) & part of team #NHS1000miles (new members always welcome!) I also love charity shopping, cooking and healthy eating too 😉 Sharing thoughts on a range of things that interest me. Comments, challenge, links to further thinking and research are most welcome. Learning and thinking together is always more fun!

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