Updated standards published to enhance the health and wellbeing of vulnerable children in secure settings

At any given time in England there are approximately 1,000 children and young people living in secure settings. These settings include young offender institutions, secure children’s homes, secure training centres and their equivalents. Children in these settings are some of the most vulnerable, often suffering poor physical and mental health. 

These healthcare standards - first published in 2013, refreshed in 2019 and now again in 2023 for England - help healthcare professionals, commissioners, service providers, regulators, managers, and governors ensure that these young people receive the care they need to improve their health outcomes.

The standards refresh has been led by Health & Justice NHS England, together with an expert reference group comprised of clinical and non-clinical professionals including commissioners, providers and national bodies, including Dr Alison Steele, who was in post as Officer for Child Protection at the RCPCH throughout the refresh process. NHSE also collaborated with Peer Power, a child’s voice organisation, to obtain relevant stakeholder feedback directly from young people with lived experience in secure settings, and this has been fed into the refresh.

Key changes from the existing 2019 standards, also ratified by the RCPCH and hosted on our website, are as follows:

1. Changes to existing standards
2. Standards outlining the content of the CHAT assessments were removed (CYPSS Standard 4).
3. Standards outlining restraint and supervision procedures were updated to reflect current best practice (CYPSS Standard 6).
4. Standard 8 was renamed from ‘neurodiversity care’ to ‘neurodevelopmental care’.
5. Several standards were strengthened to include suicidal ideation as a reason for intervention. 
6. CYPSS standard 8.2.2 was divided into two standards to separate formulation and the provision of care by the integrated CYPMHS team. 
7. Several standards, for example in CYPSS Standard 13, were strengthened to assure that feedback mechanisms for children/parents/carers/next of kin are robust. 
8. The glossary was strengthened with the addition of several new entries to support the understanding and interpretation of the standards by those that use them.

Additional new standards

1. A new standard was developed within Overarching Principles highlighting the importance of listening to children and working collaboratively with them to ensure their views, wishes and feelings are heard (CYPSS Standard 1.4). 
2. Another new standard within Overarching Principles was developed to underline the importance of health promotion activities (CYPSS Standard 1.5). 
3. An additional safeguarding standard was developed to highlight the need for children to have a member of healthcare staff they have a trusted relationship with and they can go to with concerns which are appropriately reported (CYPSS Standard 2.4).
4. A new standard on entry and assessment was added to assure children have the settings’ constant care and supervision practices explained to them (4.2.4).
5. New standards relating to dental care were added within the physical health standard (CYPSS Standard 7.5.1, 7.5.3).  
6. A new standard was added outlining the support young people should receive in relation to good menstrual health and prompt access to treatment for gynaecological health issues including, but not limited to, endometriosis and PCOS. (CPYSS Standard 7.11)

RCPCH President Dr Camilla Kingdon said:

The update of these standards is a tremendously important piece of work that aims to standardise care for some of the most vulnerable children in our society. These changes outlined today reflect a clear modernisation of this policy, and the true and real need to put children and young people at the heart of these standards – and making sure they are heard and listened to at all stages of their care. 

A significant addition to these standards is to reflect need and help ensure young people are supported with menstruation and gynaecological issues in a speedy way. This is essential to the well-being and empowerment of children and adolescents. I am also deeply heartened to see a specific focus on the emphasis of trusting relationships between children and secure setting staff. We know how significant a role staff play in the lives and future development on these children. Their work with these children is invaluable. 

We are indebted to the expert reference group, royal colleges, and faculties, as well as all the children and young people who truly shared their insights and experiences – and helped bring this together.