Date Published: 12 February 2009

Watchdogs say NHS must do more to help heal young offenders

The Healthcare Commission and Her Majesty's Inspectorate of Probation (HMI Probation) today (Thursday) joined forces to call for better healthcare for young offenders and those thought to be at risk of offending.

They published a joint report looking at healthcare services delivered by local Youth Offending Teams (YOTs) in the community and when young people move into and out of custody.

The Commission and HMI Probation said insufficient progress has been made since a similar review of YOTs was conducted in 2006.

They said YOTs did not always properly assess the healthcare needs of young people and so they did not always get the support and treatment they required. This is despite the fact that young offenders have disproportionately high physical, emotional and mental health needs compared to the general population.

In addition, healthcare workers and different parts of the criminal justice system did not always share vital information. This meant that courts did not always consider relevant issues such as learning disabilities or mental health problems during sentencing, suggesting that some young people are sentenced without having their heath needs addressed.

Anna Walker, Healthcare Commission Chief Executive, said:

"We know that young offenders are more likely to have physical, emotional or mental health needs than the average population. In many cases, this can be an important factor in offending behaviour.

If we are truly serious about breaking the cycle of crime and preventing young offenders from becoming adult offenders, we must make sure that health needs are addressed. Healthcare is not an added extra, but an essential part of the support these young people need. It is clear that in too many cases, the NHS is letting these young people down.

Primary care trusts must look urgently at how they work with YOTs, to improve the way health needs are assessed and to ensure appropriate and timely healthcare is delivered. The Chief Executive of the Care Quality Commission, Cynthia Bower, and I have written to the chairs of PCT boards to ask them to satisfy themselves that their PCT is meeting its obligations to young and adult offenders. In March, as part of the 2008/09 annual health check, they will need to declare how they are doing this and we will carry out follow-up checks if necessary."

Andrew Bridges, Her Majesty's Chief Inspector of Probation, said:

"This report is important because health is one of the many important aspects of youth offending work that can make a difference in preventing reoffending."

Youth offending teams (YOTs) are established in every local authority in England and Wales. They are multi-agency groups that bring together experts in education, health and social care, as well as the police and probation services.

YOTs are responsible for assessing the needs of young people who offend, or who are deemed at risk of offending, and ensuring they receive the necessary support to reduce offending behaviour.

The Healthcare Commission works with HMI Probation to assess how effectively the healthcare aspects of YOTs in England function. Between April 2007 and September 2008, they visited 50 out of 139 YOTs in England, interviewing key workers and case managers and reviewing the case notes of more than 450 young people involved in prevention, community order and custodial action.

Of the all the cases reviewed, almost a quarter of young people were assessed as having some form of disability. Of those, half had a learning disability, a fifth had a physical disability and the remainder had a disability linked to their mental health or emotional state.

Findings from the report include:

* Health assessments of young offenders or those likely to offend, frequently did not contain all relevant health information and young people often did not receive the healthcare they needed. For example, there was evidence of healthcare interventions for young people on community orders for only 36% of those with physical health needs, 37% with emotional and mental health needs and 58% of those misusing substances.
* The health needs of a young person can affect how they are sentenced. Of 130 cases examined where the young person has gone through court, an appropriate health assessment was included in 68%. But, inspectors considered less than half of these to be balanced, verified and factually accurate.
* 70% of young people in custody with substance misuse problems had appropriate planned support, suggesting that 30% did not.
* It is a statutory requirement for PCTs to have a health representative on local YOT management boards. Of the YOTs inspected, only two did not meet this requirement, however 16% of health representatives did not always attend board meetings and 12% did not contribute sufficiently.
* Ten per cent of the YOTs inspected did not provide sufficient and appropriate healthcare to young people following release from custody. Staff in community and custodial settings did not always exchange vital information about health.
* Primary care trusts did not provide adequate resources in almost half of the YOTs inspected. Nationally, the funding contribution from PCTs to YOTs fell from 5.8% of the total YOT budget in 2006, to 3.4% in 2008.


Source: The Healthcare Commission (England, UK).

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