Mental health inpatient settings: Supporting safe care during transition from inpatient children and young people’s mental health services to adult mental health services

NHS England support this recommendation and will incorporate it in the ongoing review of inpatient children and young people’s service specifications but this will require additional funding to be secured in a future spending review first. Actions planned to deliver the safety recommendation: Update inpatient children and young people’s service specification and commissioning guidance, by: to be confirmed as dependent on additional resources. Organisational lead: NHS England. Resources in place: none at this stage. Other dependencies identified: Additional government resource to implement the service specifications. Additional comments: NHS England has developed a draft service specification for children and young peoples inpatient services, and has supported the 17 NHS-led Provider Collaboratives to do a gap analysis against the revised specifications and guidance. NHS England will require additional resource to implement new service specifications, which is subject to government spending review decisions. Response received on 7 March 2025.

NHS England supports this recommendation and recognises the importance of a consistent approach to healthcare delivery that aligns services to mitigate gaps. Existing guidance and national policy steers do recognise this, however, as noted in the report, its application in practice is variable and dependent on the relationship between multiple partners. NHS England will reiterate this in future guidance and policy. The report recognises pockets of good practice which NHS England will share and support other systems to learn from. Further, the nationally-commissioned Culture of Care Improvement Programme includes a specific focus on personalised safety planning as an alternative to risk stratification. This will put the unique needs of patients and their families front and centre in decision making about support needs and transition/discharge arrangements. Actions planned to deliver safety recommendation: Use consistent language regarding children and young people in guidance and policy. Additional comments: NHS England will ensure consistency in language when reviewing and updating existing /new guidance and policy. Deliver the culture of care improvement programme, with a specific focus on personalised safety planning as an alternative to risk stratification, by end of 2025/26. Organisational lead: NHS England. Resources in place to deliver actions: Funding secured. Response received on 7 March 2025.

Our ICS assessments are currently paused. We are planning to undertake further development and testing of our ICS assessment approach during 2025, subject to resources being made available to support that work. We remain committed to exploring if and how our assessments might include an assessment of transition from inpatient children and young people’s mental health services to adult mental health services. This will include reflecting any objectives and priorities for ICS assessments that may be set by the Secretary of State in the future. Action planned to deliver safety recommendation: Development and testing of ICS approach, by end 2025. Other dependencies identified: Final approach requires agreement by Secretary of State. Response received on 5 March 2025.

An effective response to this recommendation requires cross-government working and covers areas which are the responsibility of other departments. Therefore, the Department of Health and Social Care will explore cross-government approaches to the transition from young people to adulthood as part of implementing actions from the priority government work on the missions and our 10 year health plan. We will seek to include transitions as part of the outputs from three of the Government’s five cross-government Missions: Building an NHS Fit for the Future, Breaking Down Barriers to Opportunity, and Safer Streets. Action planned to deliver safety recommendation: Consideration of transition to adulthood as part of our actions from the cross-government missions and 10 year health plan, by Summer 2025. Resources in place to deliver actions: Officials in DHSC Children and Young People Mental Health Team. Other dependencies identified: Outputs from cross-government missions and 10 year health plan. Response received on 24 March 2025.

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. ------------------------------------------ May 2026: HSSIB has been notified by the NHS England that all actions have been completed.