Health bill could weaken child protection procedures, PCTs claim in their risk assessment analysis
The government's NHS reform bill could increase the dangers facing vulnerable children, according to a survey of the risk assessments produced by primary care trusts in response to the legislation.
The analysis of the risk assessments drawn up by the 54 PCTs, the organisations which manage and pay for patient care in England, found children in danger of being physically abused could suffer because of problems and weaknesses caused by the restructuring.
They claim child protection procedures are threatened by issues such as fragmentation between new organisations that are being created in the shakeup, making it hard for staff to swap information about sensitive or complicated cases where there is suspicion of neglect or abuse by relatives or carers.
Safeguarding processes have been tightened up after the death in London in August 2007 of 17-month-old Peter Connelly who sustained injuries at the hands of his mother, her boyfriend and their lodger, that were missed by social workers and NHS staff.
But the risk analysis produced by a group of five PCTs in south-east London and the Bexley care trust in late January said: "There is a risk that children's safeguarding arrangements may not be satisfactory, caused by insufficient rigour of processes and capacity during the transition, leading to individuals potentially being placed in an unsafe environment or receiving uncontrolled care ."
It classified the danger as a "possible" risk which, if it occurred, would have "catastrophic" consequences. The "transition" it refers to is the period until the new organisational structure of the NHS in England starts in April 2013.
Similarly, Milton Keynes and Northamptonshire PCT's risk analysis, also agreed in January, outlined "significant harm or fatalities of children and vulnerable adults" as one of the "underlying significant/high operational risks" facing it as a result of the shakeup.
The problems identified by such reports echo a letter to the Lancet medical journal signed by 154 paediatricians calling on government to drop the health bill because they fear the fragmentation and pressure on health workers would have "an extremely damaging effect on the healthcare of children and their families".
PCTs blame the shakeup directly for other hazards facing the NHS. Sandwell PCT, for example, fears it could be "so busy looking at internal structures, clustering [and] separation that it fails on improving care quality for patients, service redesign and making the difference needed for Sandwell people", while North Yorkshire and York PCT fears a "decrease in staff morale, attendance, [and an] increase in sickness levels due to badly-managed organisational change."
The health and social care bill, which ministers hope will have passed parliament within weeks, will set up complex new structures in England's NHS in April 2013. GP-led clinical commissioning groups (CCGs) will replace PCTs as the bodies which commission and pay for treatments, with PCTs and strategic health authorities being scrapped.
The risk analyses are public documents which are produced by PCTs to help their boards smooth the transition to the new system. They also identify the upheaval involved in the reforms as being a "distraction" from the demanding job of providing good quality healthcare, and leading to poor staff morale, key personnel leaving and public health programmes suffering. Some fear they will not be able to deliver their share of the NHS's £20bn savings drive, respond fully to a major incident or ensure that CCGs are properly established by next April.
These new disclosures come as the health secretary, Andrew Lansley, prepares for a two-day hearing starting on Monday at the Information Rights Tribunal into his refusal to publish the Department of Health's own NHS transition risk register setting out its view of the risks involved in the shakeup. Labour and many medical leaders have called for it to be released so that peers can use its contents to properly assess the bill.
Andy Burnham, Labour's shadow health secretary, accused the government of gambling with children's health. "The government is insulting parliament by asking MPs and peers to approve far-reaching changes to our country's best-loved institution without providing information on all the risks of doing so at this time of unprecedented financial pressure," said Burnham. "Local NHS risk assessments already provide plentiful evidence for this bill to be stopped in its tracks with immediate effect. The scale of the risks ministers are taking with patient and children's safety is breath-taking. They should be stopped before they cause real harm."
Many of the PCTs' risk assessments identify the potential failure of safeguarding procedures for children, and often vulnerable adults too.
Any such failings may mean that the NHS organisations concerned were in breach of their legal duties to protect at-risk children. The north-west London group of PCTs' analysis links the ability to safeguard the vulnerable directly to the plethora of new bodies and also Lansley's drive to reduce the NHS's stock of managers by 45%. It cites "Failure to comply with safeguarding policies (children)" and "lack of information sharing as a result of reconfiguration under management cost reduction" as risks which could lead to "Failure to prevent harm to children. Services for children and young people may become fragmented and/or diluted, which will impact on the safeguarding functions to protect children."
An equivalent exercise in Birmingham and Solihull last month raised the prospect of the local NHS being unable to maintain the "resilience" of its "health visiting workforce resulting in potential inability to deliver on early prevention, leading to potential risk in safeguarding children". It also said; "Transition to the new system architecture may lead to a fragmentation of children's services".
The leader of Britain's children's doctors voiced concern. "All risk registers will consider the worst case scenario but it's troubling that fragmentation of services has been highlighted as such a serious risk amongst these PCTs", said Professor Terence Stephenson, president of the Royal College of Paediatrics and Child Health.
"Everyone knows how important it is to join up health care and social care and it remains one the most challenging priorities for professionals working with children. It's crucial that any impact of the reforms on safeguarding for children is anticipated and robust guidance sets out clearly how agencies will work together during this time of turbulence", added Stephenson.
Jan Norman, director of nursing for the Milton Keynes and Northamptonshire PCT, said they had considered a "combination" of factors before identifying children being harmed or even killed as a risk and cited three potential problems.
"Clearly in any reorganisation there's a tendency for people to be distracted because suddenly there's uncertainty about jobs, the future's unclear, the organisational form is unclear, so people may take their eye off the ball," she said.
"Obviously in transition to new organisations that haven't had responsibility previously for prevention of harm we have to be realistic about the fact that people in that transition may take time to get up to speed about how they best discharge those responsibilities. And of course there are risks in that change we'll lose key personnel: people with expertise and professionalism, or simply people closely involve in that agency and have the organisational history and broad links", Norman added.
A Department of Health spokesman said: "Robust measures are in place to continue to protect children as management arrangements are changed."
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