Published: 05/02/2004, Volume II4, No. 5891 Page 12 13

Pathfinder trusts are finding a route to integrating and building new services around children. MaryLouise Harding examines their work

If a child is attending school it is likely that they are learning. At the very least that child is receiving a daily meal (although the nutritional value of the meal are another story), interacting with peers, has a basic standard of health, and is in contact with professionals who monitor pupil welfare indicators.

So if the basic health, well-being and attainment of a population of children can be measured by school attendance figures, it is surely in the interest of all agencies with responsibility to improve child health, well-being and attainment to take joint responsibility for tackling truancy.

Well, it is according to Sheffield pathfinder children's and young people's trust, one of 35 currently attempting to find a clear route through the children's services jungle, which has made school attendance figures a performance indicator for all partners, including the four primary care trusts within its geographical local authority boundaries.

This is one small but radical ingredient of Sheffield's response to Lord Laming's report into the Victoria Climbié tragedy and the subsequent green paper Every Child Matters.

The Pathfinders are not piloting a centrally prescribed model.

Rather they are looking at ways of building services centred on children, young people and their families that recognise that the health, safety, enjoyment and achievement, contribution and economic well-being of every child matters.A report from the joint Department for Education and Skills and Department of Health children's trust team on moving towards a common assessment framework for children is expected in March, with a view to it being introduced by pathfinders by September.

There are a number of models being explored across the pathfinders, based in part on building on existing arrangements and strengths.

They range from focusing on joining up services for children and young people with disabilities or special needs as a starting point (Bolton, Darlington Ealing are examples), to building on child and mental health service partnerships (Hampshire, for instance) to focusing on developing a whole range of services through extended schools or children's centres (such as Cambridgeshire and Redbridge).

Decisions on where to jump off into development of integrated services have been influenced by the spread of organisations and their nature in an area. For example, Hampshire has seven PCTs with which to negotiate partnership working, so is looking into how its CAMHS services can be extended across the county council area.

Large areas with multiple PCTs have particular challenges to face, not only in the very nature of bringing together a greater set of people and achieve agreements, but also in approaching pooled budget arrangements under section 31 of the 1998 Health Act.

'How do you design financial accountability lines for PCTs if they are measured on gains for a community but their money has gone into a pot serving a much wider population?' asks Hampshire children's services partnership and performance manager Natalie Trentham.

Pathfinders are also testing out different structures: some are joint commissioning; some with and some without pooled budgets; some are prioritising single-assessment tracking and referral work; and some are focusing on the needs of an integrated workforce.

Joint competency training for the children's workforce - from school nurses to social workers - has been identified as one of the top three challenges by pathfinders, as well as appropriate leadership training for managers driving trust models forward.

The Trafford pathfinder stands out among the 35 as it is focused on delivery first. It set up a notfor-profit company that is initially concentrating on providing the area's Connexions services, but is working on expanding to become a single contractor for all children's health and welfare services, commissioned by a soon-to-belaunched joint children's commissioning board.

The company - which has just appointed Trafford metropolitan borough council's children's director as its chief executive and has representatives from health, education and young people and carers on its board - is in negotiations with NHS staff and managers to secure arrangements for staff to work for the company, while retaining their contractual arrangements with the relevant PCT or hospital trust, at least for the first year.

Project Director Heather Fisher says school nurses are a prime example: 'School nurses employed by Trafford Healthcare trust are keen to work with company so We are looking at where the responsibilities of the company and the current employer will lie: things like trying to determine how they will work within the team, where they will be located, how working time is organised.'

Ms Fisher adds that through all this wrangling over process and structure, the national evaluation and subsequent guidance on trusts will focus on the essential point that everything that is being done is intended to improve services for children.

'We have heard quite a lot about what makes partnership work, but what we really need is what works to keep a child-centred focus and improves quality at the sharp end.'