Read Standard 7: Healthcare, medical examinations and support for children and young people

Standard statement

NHS boards ensure person-centred and trauma-informed care is delivered in the best interests of the child or young person.

Rationale

Children and young people who have experienced sexual abuse may have additional requirements. Services should consider these and provide as appropriate. This standard sets out the additional considerations that services should take into account when implementing Standards 1-3. These standards are to be implemented in conjunction with Bairns’ Hoose standards, which include standards on health and wellbeing, interview processes, medical examinations and therapeutic recovery services.

Care and support for children and young people is underpinned by the UNCRC (Incorporation) (Scotland) Act 2024, and aligns with the key policy programmes of Keeping the Promise, Getting it right for every child (GIRFEC) and the National guidance for child protection in Scotland. This includes upholding a child’s rights to care, protection, education and recovery.

NHS boards and statutory partners should demonstrate implementation of key legislation, policy and guidance, including the national clinical pathway, child protection guidance and Bairns’ Hoose standards.^{18, 27,29,42} NHS boards are a key delivery partner for Bairns’ Hoose. Bairns’ Hoose is an approach to care, protection and child-friendly justice that requires leadership and effective collaboration between agencies.

Staff should have the specialist skills and knowledge to deliver care and services for children and young people.⁴² This includes identification of vulnerabilities and social and cultural factors.

Children and young people should be cared for in a child friendly or age-appropriate, trauma-informed healthcare setting. Activities and equipment should reflect the broad range of children and young people who may use the service including access to age-appropriate toys, games, outdoor spaces and the internet.^{18, 25,29}

NHS boards should ensure that children and young people have the right support for their age, stage and understanding. This includes coordinated tailored therapeutic support for children, their family or trusted representatives to support services.¹⁸

Children and young people, and their care partners or representatives, should be central to the planning, design, delivery and evaluation of services.¹⁸

Children and young people should have access to comprehensive services in response to disclosures of child sexual abuse. A comprehensive health and wellbeing assessment should be undertaken by appropriately trained staff. The decision to carry out a medical examination and the decision about the type of examination should be made by a paediatrician or appropriate healthcare professional as part of the inter-agency referral discussion (IRD) process.¹⁸^,27,29 This will take account of the best interests of the child or young person and the decision should be fully documented.

The timing of the medical examination should be person centred and trauma informed and put the best interests of the child or young person at the centre of all decisions. The timing should align with national timelines outlined in the quality indicators. Where there is delay or exceptions in meeting the indicators, these should be fully documented, recorded in the national proformas and shared with appropriate partners. The child or young person and their representatives should always be kept informed of any delays to the examination.

For young people aged 16 and 17, professional judgement should be used to decide whether the adult clinical pathway or the pathway for children and young people is most appropriate.

Information should be shared with the child or young person’s GP summarising the outcome of any examination and ongoing care needs, in accordance with relevant information governance protocols. Children and young people, and their care partner or representatives where appropriate, should be supported to understand what information may be shared.

Criteria

7.1

Children and young people are:

listened to and taken seriously
fully supported to make decisions about their healthcare and wellbeing
supported to understand and uphold their rights
supported to understand what information may be shared about them
able to access appropriate psychological or therapeutic services to support their mental health and wellbeing.

7.2

Children and young people are given care, information and support which is:

trauma informed
accessible
rights based and appropriate to their stage of emotional development, chronological age and specific needs.

7.3

Family or trusted representatives are:

informed of children and young people’s rights
able to access appropriate psychological or therapeutic services to support their own mental health and wellbeing as appropriate
provided with information and signposted to third sector organisations for advice as appropriate.

7.4

NHS boards work in partnership to deliver services that are in line with national child protection guidance,²⁹ the national clinical pathway and any related guidance.

7.5

NHS boards can demonstrate how the best interests of the child or young person have been considered in assessment and decision making.

7.6

NHS boards have established referral pathways into therapeutic recovery and advocacy support, for example a Bairns’ Hoose where this is available.

7.7

Staff have the knowledge, skills and competencies to work to deliver person-centred and trauma informed care in the best interests of the child or young person.

7.8

For children and young people, the decision to undertake a medical examination and the type of examination is:

taken by a paediatrician or other appropriate healthcare professional²⁹
informed by an IRD or other appropriate multiagency discussion
fully documented and consent recorded
in line with national pathways and protocols.

7.9

For children and young people, examinations are:

planned in the best interest of the child or young person
undertaken in line with national timeframes²⁰
undertaken in an age-appropriate healthcare setting
carried out by a paediatrician, sexual offences examiner or other appropriate healthcare professionals.

7.10

Children and young people are given meaningful opportunities to participate in the evaluation of services and organisations can demonstrate where this feedback has resulted in change. Approaches to capturing feedback are age-appropriate.

What does this standard mean for...

What does the standard mean for children and young people receiving care and support?

Staff will understand what your rights are and do everything they can to uphold them.
Decisions about you are made with your input and in your best interests.
You will be included in what is happening and given as much choice as possible.
The information you get will be clear, understandable and useful. You will get it when you need it.
You will have a chance to be involved, to provide feedback and help to shape services.
You will be able to ask questions and can get help to understand the information you get if you need it.
Your family will be supported.

What does the standard mean for staff?

Staff, in line with roles, responsibilities and workplace setting:

put the best interests of children and young people at the centre of their work, including respecting privacy and confidentiality, where possible
are knowledgeable and trained in the relevant legislation, the national children and young people clinical pathway and Bairns’ Hoose standards
understand how to recognise safeguarding concerns and can provide immediate advice and subsequent assessment
involve children and young people in decision making and support them to make choices about their care where possible
understand social and cultural experiences that may impact on the child or young person
can refer to the relevant professional or service to provide immediate advice and subsequent assessment, if necessary.

What does the standard mean for the NHS board?

NHS boards:

uphold the rights of children and young people
ensure that examinations are planned and undertaken based on the best interests of the child
ensure that legislation, care pathways, guidance and standards relating to children and young people are adhered to
ensure that staff working with children and young people are trained and knowledgeable in providing person-centred care that is trauma informed
ensure that staff are provided with opportunities to participate in training and professional development relating to work with children and young people
promote collaborative working with Bairns’ Hoose partnerships and other agencies who come into contact with children and young people
respond to safeguarding concerns about a child or young person and follow necessary procedures and protocols
work in partnership with agencies to ensure that all children have pathways to therapeutic support and recovery.

Examples of what meeting this standard might look like

Reporting through relevant national datasets.
Audit of decisions and timing relating to medical examinations in line with national quality indicators.
Learning and improvement plans to demonstrate implementation with national guidance and standards, for example child protection or Bairns’ Hoose standards.
Evidence of partnership and multiagency working including within Bairns’ Hoose partnerships, education services, mental health services, health visitors and the third sector.
Evidence of alignment of national policies relating to service delivery for children and young people.
Information provided in alternative formats and languages including videos and online material developed in partnership with children, young people and their care partner or representative.
Use of Children’s Rights and Wellbeing Impact Assessments and other impact assessments to inform service design and delivery for children and young people.
Evidence of working with young people and their care partner or representatives in the design, planning and delivery of services.