Children's Services

Things to come: pilot status beckons for children's trusts Children's trusts are taking shape in numerous areas.Forty-five partnerships between health and social care pitched for official pilot status in May, and the successful pilots are to be announced in July.

Andrew Christie, director of children's services at the London Borough of Hammersmith and Fulham, says a trust being proposed jointly by his council and Hammersmith and Fulham primary care trust has generated great enthusiasm among staff throughout health and social care.This is perhaps surprising: weariness with yet more reorganisation was expected to dampen enthusiasm for the project.

'There is nothing to stop anyone setting up a children's trust already, so this will be going ahead, come what may.

Being a pilot would just give us a higher profile.Children's trusts are about formalising close partnerships and genuinely moving away from the myriad bodies involved.

'We are already working on bringing social services and PCT children's commissioning together; We are also developing specific proposals for bringing together services for children with disabilities, and will want to integrate health, social services and education to deal with child protection and family support services.'

In another pilot bid, Salford's coterminous PCT and city council outlined how they plan first to integrate health, social care and education commissioning, and then roll the trust out to encompass local providers of disability, mental health, community nursing and other services.This would involve developing shared development plans, common assessments, cross training and an integrated advice service.

No staffing matter: manpower shortages force rethink In children's services, as in many other areas of NHS and social care provision, staff shortages in everything from paediatrics and child and adolescent psychiatry, to paediatric nursing and social care are a major driver for change.The impending European working-time directive is also forcing acute providers to rethink the way they provide services.

At Great Ormond Street Hospital, the 'waking night team'allows the hospital's medical division to be led overnight by two clinical site practitioners - nurses with at least 10 years'experience of paediatric intensive care. It has reduced the need for junior doctor input from seven registrars and three senior house officers down to three registrars and a fourth resident on call.The CSPs take charge from 9pm-7am.They filter the doctors''bleeps' from 11pm onwards, deciding which cases need a doctor's input; and doctors and nurses work collaboratively through the night.

'Our philosophy is that the available person with the most suitable skills does whatever work needs doing, 'explains senior CSP Cheryl Unthank.'The biggest limit on what the nurses can do is their inability to prescribe.'