NHS England publishes minimum standards for keyworking services

NHS England has published minimum standards for keyworking services for autistic children and young people, and for children and young people with a learning disability.

These minimum standards support integrated care boards (ICBs) as they commission keyworking services for autistic children and young people, and for children and young people with a learning disability, who are at risk of an inpatient mental health hospital admission or are currently in an inpatient setting.

Keyworker services were developed in response to recommendations in Dame Christine Lenehan’s report, These are our children, to improve community crisis support and to avoid admissions to a mental health hospital for this group of children and young people.

What are autism and learning disability keyworkers

Autism and learning disability keyworkers are a new workforce supporting children, young people and families to help avoid unnecessary admissions to mental health hospitals in every integrated care system (ICS).

Keyworkers work with children and young people with the most complex needs, and their families and carers, to ensure families are fully involved in their plans, feel listened to and informed, that plans are personalised, and that they have the support they need at the right time, in a coordinated way.

A keyworking service should be offered to children and young people who are assessed as red, amber or blue on a dynamic support register (DSR), meaning they are at potential or immediate risk of admission to a mental health hospital, or are already in one, up until their 18th birthday, or 25th birthday for those in inpatient services.

The Minimum Standards Checklist for keyworking services

There are seven minimum standards, and the first concerns the foundations for a keyworking service. This states that keyworking services should be jointly planned, developed and reviewed; that there should be a process to monitor the impact of keyworking; and that there must be co-production at every level of planning and delivery of local keyworking services.

The second standard states that the keyworking service must be supported by a clear service specification. The workforce should possess the required knowledge, experience, and skills relevant to education, health, and care roles. Moreover, they should complete nationally mandated keyworking training, with extra training provided for keyworkers supporting young people aged 18-25.

This should reflect the issues they commonly face, such as housing challenges, securing employment, accessing benefits, or accessing specialist support for problems like addiction.

Out-of-area care and keyworking services

The third minimum centres on standard operating procedures (SOPs) and processes, which should include information on step-down, discharge, and re-referral. The SOP should include how the service intends to ensure it meets the needs of children and young people who may be placed in a mental health hospital outside of the area.

Standard four addresses eligibility, referral, and the relationship with the DSR, and standard five concerns providing information about the service, including in the SEND local offer.

NHS England says that the role of the keyworking service and the keyworker should be consistently explained and advertised to all organisations and professionals within a local area/system, including through the provider collaborative and community mental health. Information should be reviewed at least annually.

Measuring impact and escalating issues of concern

Number six looks at measuring and monitoring impact, and all children, young people, and parent carers should be asked to share their experiences of keyworking, independent of their keyworker.

The final standard focuses on escalating issues of concern with appropriate, clear governance in place to manage them. There should also be clear escalation routes for any concerns identified by keyworking services, with timely senior intervention to resolve these issues.

The minimum standards have been developed from a national evaluation of keyworking. Compliance with these standards should be reviewed at least annually, and where actions are required, these should be reviewed regularly.

All elements of the Keyworking Programme and the minimum standards have been co-developed and co-produced with a steering group and relevant subgroups, including young people, parent carers, and ICB leaders.

Alison Bloomer

Alison Bloomer is Editor of Learning Disability Today.

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