CORPORATE PARENTING GROUP
Wednesday 22 March 2006 at 2.00 pm / Agenda item
4
REPORT ON THE HEALTH OF LOOKED AFTER CHILDREN
Report of the Director of Children, Schools & Families
Author: Maureen Phillips, Head of Service Looked after Children
Lynda Alleyne, Designated Nurse for Looked after Children
Tel: 01992 556340 and 01707 386870 respectively
Executive Member: Jane Pitman
1. Purpose of the Report
· To summarise the statutory requirements and Hertfordshire County Council performance in relation to the health of Looked after Children
· To inform members of the work to date of the Looked After Children & Care Leavers Health Team
· To inform members of work planned in 2006/07
2. Summary
This report summarises Hertfordshire’s position in relation to implementation of the statutory guidance on promoting the health of looked after children. A key government priority, the health of looked after children is subject to national performance indicators and inspection. Whilst there is a dedicated health team to promote the health of looked after children, Hertfordshire’s performance in 2004/05 was of concern and strenuous efforts in 2005/06 have produced improvements. However, further improvement will be guided by two key multi-agency steering groups operating at strategic level to address capacity and policy matters and at operational level to oversee implementation of policy and the work of the health team.
3. Conclusion
Concern about Hertfordshire’s performance in relation to the health assessments for looked after children completed within timescales has been subject to close scrutiny and remedial action in 2005/06 with some positive results. Further improvements are anticipated with the launch of new procedures in 2006/07 and the consolidation of the work of the Health of Looked after Children and Care Leavers Team, newly re-formed in 2005. However, improvements must be made within existing capacity both within Health and within Hertfordshire County Council, requiring creative solutions driven at senior level through a newly formed steering group providing oversight of all aspects of this statutory duty.
1. Background
1.1 Improving the health of looked after children has been a key aspect of the government’s drive to improve children’s services since 1998. More recently, performance indicators and key judgements relating to the health of looked after children have been enshrined within ‘Every Child Matters’ outcomes framework of the Annual Performance Assessment by which the local authority’s overall performance is judged. The Joint Area Review, due to take place in Hertfordshire in 2007/08 will also assess the extent to which the local authority and partner agencies are working together to achieve good health outcomes for looked after children.
1.2 Hertfordshire County Council and the eight Hertfordshire Primary Care Trusts jointly appointed the first specialist nurse for looked after children in 1999. Subsequently, in 2002 a second specialist nurse was appointed specifically for care leavers. This second post was funded from Quality Protects local authority grant.
1.3 Statutory guidance issued in December 2002 revised the statutory regulation for health assessments for looked after children and established the requirement to appoint a designated nurse and designated doctor for each local authority area to work strategically in order to “assist PCTs in their responsibilities as commissioner of services to improve health of looked after children”. The existing nursing appointments in Hertfordshire did not fulfil this statutory role and in January 2005 the original post of specialist nurse was re-configured to create the role of designated nurse for the whole of Hertfordshire. Additional funding from the four West Hertfordshire PCTs at the same time created an additional specialist nurse post to operate in the West of the county. The Health of Looked after Children Team therefore consists of a designated nurse and two specialist nurses, together with administrative support. The designated doctor role remains to be established.
2. The Statutory Framework
2.1 The statutory framework is contained within the government guidance, ‘Promoting the Health of Looked after Children’, published in November 2002, together with associated statutory regulations relating to notifications & health assessments.
2.2 The regulations require the responsible authority to notify a range of persons and authorities in writing of a child coming into and out of care and any change of placements. The relevant Primary Care Trust must be informed of the child’s arrival in their area, as the location of the GP with whom the child is registered determines the PCT responsible for that child’s health needs.
2.3 PCT’s are required to have systems in place to ensure that looked after children are registered with a local GP and dentist and that records are fast tracked from one GP to another. Provision should be made to ensure that children moving into the area wait no longer than a child already in that area who has an equivalent need and also that when a child moves area, he or she is not disadvantaged by being placed at the bottom of a new waiting list.
2.4 A statutory health assessment is required when a child becomes looked after, six-monthly thereafter up to the age of 5 years and annually for children aged 5 years and above. The first assessment must be completed by a doctor and subsequent assessments can be completed by a nurse unless special circumstances require a doctor.
2.5 The completion of statutory health assessments within timescales is subject to a nationally reported performance indicator. Hertfordshire County Council reported 61% conducted within timescales in 2004/05 which was unacceptably low and of concern. To understand and address the contributory factors, an audit of the cohort on which we reported at 31st March 2005 was conducted in August 2005. This important data gives an understanding of both practice issues within CSF and capacity issues within health which contributed to the difficulties. Although data is not yet finalised for the 2005/06 Annual Performance Assessment, provisionally the figure shows an improvement to 71% and we aim to improve this further to above 80% in 2006/07. In order to do so, a new procedure has been written and published in relation to statutory notifications and health assessments. A comprehensive launch is planned for early 2006/07 across CSF and Health.
2.6 It remains of concern that Health has not yet been able to find capacity to create the role of designated doctor. This continues to be subject of discussion at senior level and although commitment has been given in principle, the current financial situation and reorganisation in Health are proving to be obstacles to achieving this appointment.
2.7 Creating sufficient capacity within Health to undertake health assessment has been a consistent theme for a number of years. Whilst school nurses and health visitors have undertaken review health assessments in North and East Herts for some years, this is not the case in West where capacity has not been available to introduce this practice. However, there has been an undertaking to create capacity in West for an additional 70 health assessments, details of which we expect to be confirmed shortly and this should address the difficulties. In all cases, the solution to the problem in Health must be to do things differently in order to create capacity as there is no opportunity for additional resource currently. Re-configuring how teams work in a period of significant change is proving to be a challenge.
2.8 In order to support implementation of the statutory guidance and ongoing monitoring of performance, the Strategic Health of Looked after Children and Care Leavers Group was established, chaired by the Deputy Chief Executive of St Albans and Harpenden PCT. This group has senior management representation from CSF and PCTs with a county wide remit. Terms of reference and memberships can be found at appendix 1. The group is currently addressing the capacity issues and will be held accountable within the Joint Area Review for ensuring that the statutory guidance is implemented.
2.9 The strategic group delegates oversight of operational matters to the Health of Looked after Children & Care Leavers Operational Group, chaired by the Designated Nurse and having representation at middle management level from CSF and Health. This group had its first meeting in October 2005 and meets quarterly. A primary task of the group will be to oversee the implementation of the new notification and health assessment procedures for both CSF & Health staff. Terms of reference and membership can be found at appendix 2.
3. The Work of the Looked after Children and Care Leavers Health Team
3.1 The two original specialist nurses left in 2004 for career development opportunities. Three new appointments were made to the Health Team in 2005, the first two being Lynda Alleyne to the post of designated nurse and Christine Jackson to the post of specialist nurse for West, both commencing appointment in January 2005. Maggie Davis took up post as specialist nurse for care leavers in September 2005. This relatively new team has therefore needed to spend time establishing essential relationships across CSF and within Health also developing ways of working together across the whole county to improve outcomes for over 950 Hertfordshire looked after children
3.2 The Team is presently hosted by Welwyn Hatfield PCT although the three nurses and two Administrators are based on two sites – Welwyn Garden City where the designated nurse and specialist nurse for care leavers are based and St Albans where the specialist nurse for West is based. This is not ideal and it is hoped that the current restructuring within the NHS will provide an opportunity for the whole team to be co-located.
3.3 The team works in partnership with CSF social work teams, fostering, adoption and children’s homes staff and health professionals to promote the health of looked after children. In addition to monitoring the overall health needs of all looked after children, the team provides advice in relation to specific chldren develops policy and practice to cover all aspects of health care and promotes healthy lifestyles through training, advice and guidance. The team is not responsible directly for conducting the statutory health assessments which are undertaken by community paediatricians, general practitioners, health visitors or school nurses, depending on the circumstances of the child.
3.4 The primary task of the designated nurse has been to establish a mechanism for Health to receive and record all statutory notifications of children looked after moving into or out of a PCT area, whether they be Hertfordshire County Council children or other local authority children placed in their area. This mechanism is essential for Health to monitor notifications, ensuring that the needs of this vulnerable group of children are met and that they are not disadvantaged as result of moving between PCT areas. However, although there has been good cooperation between Hertfordshire County Council management information staff and the Practitioner Services Unit in Health, this work has proved complex and time consuming. There is still a considerable amount more to be done to ensure that all data is accurate, although the basic system is now in place and is linked to a database held in the Health of Looked after Children Team.
3.5 To date, the team has provided training to:-
· Residential Children’s Home staff
· School Nurses & Health Visitors
· Foster carers on adolescent health issues
· Welwyn Hatfield PCT community staff (GP’s and reception staff included) on a wide range of issues for looked after children and statutory health assessments
· Young people, both individually and in groups on general health and sexual health matters
3.6 The specialist nurse for looked after children based in St. Albans has established good working relationships with staff and young people in the residential children’s homes in her area. She has instigated innovative practices, for example :-
· a dental nurse visiting the homes to promote good dental health, delivered in a fun way;
· obtained funds for an art competition for young people in Datchworth Turn Children’s Residential Home;
· attended health visitor groups in the West, raising awareness of LAC issues and preparing staff for undertaking review health assessments for looked after children;
· linking with foster carers concerning individual looked after children health & emotional issues.
3.7 An activity day (September 1st 2005) was organised to boost self-esteem and confidence of foster children. In partnership with the Youth Service and fostering team a full day of water-based activities at Young Mariners Base in Cheshunt was enjoyed by 45 foster carers, their children and their foster children. The objective of the event was to promote positive family interaction by encouraging children to work with their foster carers as a team. Feedback from the carers and the young people was positive, with emphasis from the adults on how proud they were of all the young people and how good it was to see them working together. Discussions are ongoing to make this a regular annual event and also set up a day for the children’s homes.
3.8 The specialist nurse for care leavers works closely with the NCH Care Leaving Service, establishing a clear mechanism for referral in order to prioritise and structure her work. She has also established links with the Children’s Asylum & Refugee Team and has developed a system to support and refer any child coming into the country who may need BCG cover.
3.9 A pilot for the specialist counselling service for Care Leavers to support emotional health issues was set up in September 2003 using CAMHS grant slippage and will end March 31st 2006. This initiative employed one therapist working to a ‘Human Givens’ model. Although there is some evidence to suggest this service has been welcomed by young people, it is not sustainable and evaluation not sufficiently convincing to continue the sessions. It is hoped that lessons from this model will be taken forward in improving access to alternative counselling services and mainstream CAMHS.
4. The Way Forward
4.1 The Health of Looked after Children and Care Leaving Team has developed a work programme for 2006/07 to address the priority areas for development. In addition, the Strategic and Operational Groups will continue to meet quarterly to oversee this work and the implementation of the guidance.