Updated Healthcare Standards for Secure Settings centres children’s voices

The standards, first published in 2013 and previously updated in 2019, help healthcare professionals, commissioners, service planners and providers and regulators, to improve the quality and consistency of healthcare available to children in secure settings.

The 2023 refresh was led by Health and Justice NHS England, alongside an expert reference group of clinical and non-clinical professionals including commissioners, providers and national bodies, including the Royal College of Speech and Language Therapists. The standards were refreshed to consider changes to regulation, legislation, and professional guidance.

Changes to the standards

The refreshed guidance:

• introduces a new standard to ensure that healthcare staff work collaboratively with the child to support them to communicate their views, wishes, and feelings, in line with their level of understanding and competency, to make informed decisions that are in the best interests of the child.
• adds a new standard which states that reasonable adjustments will be made in the provision of health services for those with an identified need.
• advises that children should be informed in an age and developmentally appropriate way about the setting’s constant care and supervision practices.

The refreshed guidance also:

• amends the overarching principles by specifically stating services are delivered to meet speech, language and communication needs. Existing standards have also been updated including the standard on feedback mechanisms which has been strengthened to assure that these are robust for children/parents/carers/next of kin and take into account how to adapt and accommodate populations’ needs including speech, language and communication needs.
• Updates the standard on staff training to ensure that staff are sensitive to the significance of children’s behaviour and how it can be an important way in which they communicate underlying distress.

Furthermore, the staff training standard specify that training on speech, language and communication needs is made available for staff across the secure setting where required.

Our view

The RCSLT welcomes the publication of the standards, which is an important step forward in ensuring that all children receive the care they need to improve their health outcomes.

At any given time in England, there are approximately 1,000 children and young people living in secure settings. Children in secure settings are more likely than their peers to have additional healthcare needs such as speech, language and communication needs, mental health difficulties and a range of physical health conditions, all of which are often previously unidentified and unmet.

Speech, language and communication needs are prevalent across the justice system, with over 60% of children affected. Children would benefit from tailored and personalised responses, and we are pleased that the standards advise on reasonable adjustments to speech, language and communication needs. We are also pleased that the standards advise that materials and activities are tailored to meet the needs of children with communication or learning needs.

Access to speech and language therapists across young offender institution, secure children’s homes, secure training centres and their equivalents is key, and the standards reiterate the importance of access to healthcare professionals including speech and language therapy.

Staff understanding and training underpins this, and it is positive to see the standards advise that training in speech, language and communication needs is made available for all staff across the secure setting.