Interview: The wider remit of health - Liz Fradd, children's programme lead, Commission for Health Improvement

When the commission was set up in April 2000, no one could have predicted the impact it would have on child protection. Its initial remit was to monitor the quality of NHS healthcare in England and Wales and to investigate when things go wrong.

Liz Fradd, director of nursing and lead for the children's programme at the commission, says: "It was never intended to focus down on particular client groups or services, unless something went badly wrong or there was a National Service Framework."

The children's programme began after the Climbie inquiry report, when the commission was asked to undertake an audit of all healthcare services in England relating to child protection. Police and social services also had to do their own audits.

Fradd says: "It was an enormous undertaking, with 624 health organisations, compared to 120 in social services and 42 in the police."

With 50,000 hits on the commission's web site, Fradd believes the health report has had "the most extraordinary impact on the NHS".

A child protection self-assessment tool for healthcare professionals followed the audits (News, 17 March). It is intended for use by individuals and teams to identify what they are doing well in the area of child protection and how they can improve.

The next stage in the programme has been joint inspection, which will become the responsibility of the Commission for Healthcare Audit and Inspection from 1 April.

In 2002, the commission joined with seven other inspection agencies to look at how well eight local authorities safeguarded children. This work influenced the green paper by highlighting the importance of sharing information, the status of area child protection committees and the proposed duty to safeguard children, which she says is "a huge landmark in children's services".

The commission is now doing a similar piece of safeguarding work with nine inspection agencies, which will report in 2005 through its replacement.

It will focus on the most vulnerable youngsters including asylum seekers, children with disabilities and children in travelling families.

The children's programme has expanded into its wider inspection agenda and has increased awareness of child protection issues in the NHS.

NHS performance indicators for 2003/4 have a greater focus on child protection and child health. "It is a very positive thing," says Fradd. "It means organisations will have particular things in place that will protect children and something they have to check against on an annual basis."

Most of the commission's work is planned to come to an end when it closes its doors on 31 March and, although Fradd will not be moving to the new commission (she has no firm plans yet), she predicts: "The focus of its children's work will be the National Service Framework."

Some of the commission's other work will continue, including inspection of youth offending teams, the single inspection framework, which is now government policy, the safeguarding work and the children's indicator.

It is expected that inspections will become more focused and individualised for each organisation.

Fradd hopes that the work will not focus only on protection. She says: "It is incredibly important but it is just one small part of children's services.

"Safeguarding children is not just about child protection. It is about ensuring that children are appropriately cared for wherever they are. It's about their best interests being safeguarded and the totality of the child being ensured. That they are given choices, and that their rights are respected."

BACKGROUND

How the commission affects children

- The Commission for Health Improvement is the independent regulator of NHS performance in England in Wales and is responsible for star ratings

- The commission's children's programme has included child protection audits in England and Wales, a self-assessment tool for healthcare professionals and introducing child protection into inspections for star ratings

- The commission ceases to exist on 31 March, when it will become the Commission for Healthcare Audit and Inspection

- The focus of the new commission's work will be the upcoming National Service Framework for Children.