As part of a collective effort across the children's sector, RCPCH helped to secure a commitment in the Health and Care Act (2022) that requires every Integrated Care Board (ICB) in England to have an executive lead for children and young people on their board.
The Act specifies that ICBs must appoint board-level executive leads with responsibility and oversight of the following areas:
- Children and young people (aged 0 - 25)
- Children and young people with special educational needs and disabilities (SEND)
- Safeguarding (all-age) including looked after children
- Learning disabilities and autism (all age)
- Down syndrome (all age)
ICBs are also required to appoint a lead for mental health (all age), but there is no requirement for this to be a board level position.
These leadership requirements were created with the intention to secure visible and effective board-level leadership and to ensure ICBs effectively meet the needs of children and young people and other vulnerable groups above.
NHS England have now developed statutory guidance which sets out the expectations and responsibilities for these roles in more detail.
These responsibilities include:
- Championing co-production with children, young people and families
- Ensuring appropriate resource allocation for children and young people's services.
- Leading relationships with key partners across health, local authorities, social care, education, justice and VCSE
- Ensuring the ICB's joint forward plan sets out how they will meet the needs of children and young people
- Making sure statutory duties related to safeguarding and SEND receive appropriate focus.
The expectation is that ICBs should assign these roles to board members with suitable experience and sufficient capacity to meet the responsibilities required within their wider portfolio. There is no legislative requirement for each of these executive lead roles to be performed by different people and we are aware that the CYP executive lead role, SEND executive lead role and sometimes also the Learning disability/Autism executive lead role are often all held by the Chief Nurse. However, the guidance is clear that it would not be wise for too many roles to be performed by the same person, and that having sufficient capacity and experience to undertake this role effectively is crucial.
We welcome NHS England providing clarification regarding the expectations and responsibilities of these roles. Integrated Care Boards have a huge opportunity to achieve better health outcomes for children and young people by improving integration and investing in services. It is therefore crucial that children are represented on these boards by executive leads who understand the needs of this population and have the capacity to carry out the responsibilities laid out in the guidance. It is also important that there are effective governance arrangements to allow communication to and from paediatric networks, services and children, young people and families to ensure their voice informs decision-making and strategic planning.
Partnership working is key to improving integration of children's services and improving health outcomes so we are pleased that a responsibility of the executive lead role is leading relationships with partners across the system including local authorities, social care, education, justice and VCSE.
Several of the executive lead roles are across all ages e.g. safeguarding, learning disability and autism, Down syndrome and mental health. Where this is the case it is vital that sufficient focus is given to the unique requirements of children and young people.
England has some of the worst child health outcomes in Europe with child health inequalities widening and waiting times for consultant led and community services at a record high and increasing. It is therefore more important than ever that children and young people's needs are represented and prioritised at ICB level to support service recovery and address health inequalities so that children receive the care they need at the right time and have equal opportunities to be healthy, happy and well.