Craig.russo

Craig Russo outlines the Core Needs School Pilot, a needs-led, school-based early intervention model for young people with neurodevelopmental needs. He describes how embedding clinicians in schools enables rapid, functional assessment and support without waiting for diagnosis, improving outcomes while significantly reducing costs and demand on specialist services. It demonstrates impact and support expansion, highlighting strong value for money, improved access and alignment with national SEND reform principles. The Core Needs provides a clear, practical example of how a needs‑led model can be operationalised at scale within mainstream education, moving beyond theory into delivery. It demonstrates how embedding clinical expertise directly into schools transforms access, shifting support closer to children and young people and enabling real-time assessment, observation and intervention in their everyday environment. This approach not only improves timeliness but strengthens relationships between health, education and families, creating a more joined-up system that is easier to navigate. A key learning point is the power of intervening early with functional, strengths-based support rather than relying on diagnostic thresholds. The model shows that many young people can be effectively supported through a single, well-structured intervention, supported by a period of watchful waiting and clear step-up pathways when required. This has important implications for demand management, demonstrating a credible route to reducing pressure on specialist services while maintaining safe and appropriate escalation. The pilot also highlights the importance of building capability within schools. By working alongside SENCOs and staff, clinicians are not only supporting individual children but leaving a lasting legacy of increased confidence, skills and consistency within the wider workforce. This creates a multiplier effect, where impact extends beyond the initial intervention and contributes to longer-term system resilience. From an operational perspective, the pilot identifies critical enablers of success, including strong multi-agency partnership working, clear referral processes, dedicated workforce capacity and a structured delivery model. It also makes clear the risks of not investing, particularly around increasing demand, widening inequity of access and continued reliance on costly statutory pathways. For decision-makers, the key action is to consider how this model can be embedded as part of the core local offer, rather than as a time-limited pilot. The evidence presented supports scaling through a phased approach, ensuring quality and consistency are maintained while expanding reach. It also prompts a wider reflection on how services can redesign pathways to prioritise early intervention, improve flow and ensure that resources are directed where they have the greatest impact. Overall, this pilot offers a compelling, evidence-informed case for system change, showing not just what should be done differently, but how it can be delivered in practice in a way that is sustainable, equitable and centred on the needs of children and young people. More blogs on the hub from Craig Russo: Partnership working between A&E, the police and custody healthcare

Craig Russo is an Operational Manager at Leeds Community Healthcare NHS Trust. In this blog, he tells us about a recent project he delivered in partnership with Accident and Emergency (A&E) services, the police and custody healthcare. Craig talks about the safety concerns that led them to take action and the positive impact they have seen so far.  This project responded to concerns that had been repeatedly highlighted through incident reports, feedback from staff and patients, and formal investigations conducted by myself. The concerns focused around: Patient safety and quality of care with regards to discharges from A&E into police custody. Patients being brought into a police custody healthcare setting who required the specialist care of A&E. Patients in police custody being discharged from A&E without appropriate care given to them, which put them at high risk of deterioration or safety implications. NHS services and the police bringing in patients to a police custody healthcare setting, who had been arrested and were requiring urgent care. Underlying issues Training and communication barriers Firstly, the A&E staff had very little training on detainee patients, who in their own right often present as being very complex. Long-term difficulties in communication between A&E, Humberside Police and Custody NHS services also existed and this didn’t help with knowledge sharing. Discharge policies not fit for purpose Patients were often discharged without a thorough assessment, care plans, records or handovers. The policies, protocols, pathways and records were not fit for purpose. This caused major risks to patients' safety and care, and we had a number of patients who were discharged requiring urgent care and being returned to A&E. This put a strain on all services, increased costs, and damaged the patient journey. Poor risk assessment It had been highlighted that some police officers were not doing a holistic, thorough assessment of the patient when arresting them. Often, they were bringing them to police custody NHS services, which are not designed to conduct urgent care, instead of taking them to A&E for appropriate treatment. Delaying their care was often life-threatening. Working in partnership for patient safety Previously there had been lots of challenges. We had all been using different systems, no clear pathways, there was very poor communication and reduced accountability. Partnership working did not exist. We looked at creating a partnership between Hull Trust, Lincolnshire and Goole Trust, Leeds Community Healthcare, and Humberside Police that could directly influence and improve patient care and standards. We wanted to share knowledge and expertise between all organisations and reduce the number of serious incidents. We wanted to do something that had never been done before. Patient care and safety was the focus but there were other areas we wanted to improve including: care pathways documentation costs staff time the patient journey training. Impact This project is unique and innovative, covering both the NHS and criminal justice system. It is such a specialist area of medical care that no one had thought to review and improve it. We’ve achieved so much by working in partnership. Key outputs: Introduction of a discharge safety checklist designed to support safety in police custody care - improving accountability, standards, and providing a handover to the police and NHS staff (see document attached to the bottom of this blog). Bespoke training rolled out to Hull NHS Trust A&E, to upskill and teach staff about police custody and patients in custody. New pathways integrated into the care of patients. Key outcomes: Improved communication between three trusts and the police. Reduced number of incidents of poor patient care or safety (serious incident reports and investigations). Improved patient journey. Increased knowledge of patients in custody among NHS staff. Reduced wrong area referrals. Improvement in the wellbeing of patients. Reduced wastage of staff time. Reduced costs. The bespoke training is also now part of the corporate induction, delivered by Leeds Community Healthcare staff. Feedback from patients and staff has been very positive. It is now the ‘gold standard’ for Humberside Police force and adopted by A&E’s in multiple areas. "The training has been really well received in A&E it has upskilled staff and increased their knowledge of this specialist area" (healthcare professional). Final reflections There has been a massive reduction in serious incidents reports and investigations. Staff now receive training that focuses specifically on patients in custody. Patients are treated with dignity and have become more cooperative. This project has been an outstanding success and has been put forward for parliamentary awards, and others. It has been recognised by professionals, trusts and the police as being extraordinary and innovative work which has improved safety, productivity, learning and reduced costs. This approach is going to be implemented in South Yorkshire and West Yorkshire Police custody. York NHS trust has also expressed interest in learning from our project and implementing similar. It has been an amazing project, underpinned by partnership working. If you would like to find out more about the project, you can get in touch with Craig at [email protected] Do you have a project to share? Have you been involved in a project that has improved patient safety? Could you share your insights and learning to help others do the same? You can comment below (sign up first, for free), or get in touch with the editorial team at [email protected] Discharge of Patient from the Emergency Department into.docx