Safety recommendation
HSSIB recommends that NHS England provides guidance regarding communication of essential safety and risk mitigation information when patients transition from inpatient children and young people’s mental health services due to reaching transition age. This is to safeguard vulnerable people and may include how to share information with families and carers, health and social care providers, and third sector organisations.
Response:
NHS England is working with all NHS and major Independent Providers to deliver the Mental Health, Learning Disability and Autism Inpatient Culture of Care Improvement Programme. This includes support in removing away from risk stratification towards personalised safety planning alongside the role of information sharing and involvement of families, carers and relevant agencies in safety planning. Separately, NHS England has been working to draft - Staying Safe from Suicide: Best Practice Guidance for Safety Assessment, Formulation and Management. This guidance augments NICE Guidance NG225 which recommends a move away from risk prediction and stratification to a psychosocial assessment and formulation-based approach, and will be published shortly.
Safeguarding is already part of the NHS commissioning guidance, the standard NHS contract and expectations are set out in the NHS England Safeguarding Accountability and Assurance Framework (SAAF). The requirement that each person requires a unique safeguarding approach is already contained in the SAAF. The contract and SAAF are reviewed annually to reflect any evolving statute and will support the review and update of service specifications and commissioning guidance. There is a National NHS England Clinical Lead for Safeguarding Adults and Transition.
Regarding training to support any needs-based rather than age-based transition, the intercollegiate documents for Safeguarding Adults, ‘Adult Safeguarding: Roles and Competencies for Health Care Staff’ (2024), supports the delivery of safeguarding education and training across child and adult safeguarding but does not include any specific guidance for safeguarding young adults in a child focused setting. The current intercollegiate document for safeguarding children includes the needs for all professionals to understand the needs and legal position of young people, particularly 16-18 year olds, and the transition between children’s and adult legal frameworks and service provision. The guidance is currently being revised by the Royal College of Paediatrics and Child Health.
NHS Safeguarding will update the NHS Safeguarding Accountability and Assurance Framework (SAAF) to include the need to consider best practice in safeguarding across the transition between young people and young adult services, and that where services are provided across the young people and young adult age ranges, that both child and adult safeguarding competencies are achieved and maintained. This will be approved and assured via National Safeguarding Steering Group (NSSG).
NHS Safeguarding will ask the Royal College of Paediatrics and Child Health to consider the findings of this document in their review of the intercollegiate document (‘Safeguarding children and young people and looked after children and young people: Competencies for Healthcare Staff’ - RCN, 2019).
Actions planned to deliver safety recommendation:
- Deliver the culture of care improvement programme, with a specific focus on personalised safety planning as an alternative to risk stratification, by end 2025/26. Organisational lead: NHS England. Resources in place to deliver actions: Funding secured.
- Update the NHS Safeguarding Accountability and Assurance Framework (SAAF), by end 2025/26. Organisational lead: NHS England. Resources in place to deliver actions: Nil.
Response received on 7 March 2025.