An update on health commissioning arrangements, service delivery and performance for children looked after including: Initial Health Assessment Performance, Review Health Assessment Performance and Children Looked After emotional wellbeing and mental health services.
Officers introduced the report informing on the performance of the initial health assessments for all young people in care who were seen by a care professional or a LAC (Looked After Child) Medical.
Questions from EMPIRE included how the NHS kept a track on the mental health of the young children, how long the information was stored for and the confidentiality of data. Officers informed the Panel that there was ongoing work around monitoring health needs and reviewing individual data. A spreadsheet was used to capture data for officers to have a better picture of what was being recorded. Officers confirmed that the information stored was for up to ten years due to the request of information that may be required within the decade to provide answers to the individual or involved services. With regards to confidentiality, officers advised that consent was often granted before staff completed a medical, the staff would explain the routine process and who would be in the know of their medical information to the young person before they are to sign any form. It was said that usually the social worker, the school nurse and the GP were kept aware of the health of their young person, though if the young person did not want their medical notes to be shared this was to be acknowledged.
The Chief Executive Officer (CEO) was interested to understand what the reasons were for young people declining health medicals and issues around health assessments, why there was a dip in completing health assessments and what the service was doing. Officers informed that they were working very closely with Children’s Services for better communication between the systems for referrals to be received on time. Officers informed the Panel that there was difficulty in completing health assessments if the referral was not received within the timescales.
A delay to the receipt of a referral would often include incorrect information of the young person’s foster carer to book appointments. Officers added that there was a high rate of children who do not attend scheduled appointments, which meant having to reschedule.
Officers highlighted that the health team was aware of the difficulty in timescales and were reviewing standards to improve the service. The health service was further reviewing their assessments and were at a point where they were sharing information twelve weeks in advance. The service had put a lot of intensity into one area as other areas were often missed, and needed to understand why it was not happening from a themed perspective.
The CEO, on reviewing an action plan, asked as part of the action plan whether there were key actions to dealing with the backlog and work for the ones backlogged, and further asked whether there were capacity issues. Officers addressed the queries by stating that they were putting in plans and through their data were looking at how far behind they were, and the approach to work on clearing the backlog without creating another backlog. The service were also providing appropriate provision for better assessments. Conversations between services had improved and GPs were given more time to complete their assessments. Officers confirmed that there were no capacity issues within the service, and with the review health assessments, the service had capacity within the nursing team, which was positive.
Co-optee Members complimented four LAC assessment reviews and initial assessments they attended, which were spot on and within the three weeks’ timescale. The only concern shared was that contact information is often not updated and foster carers receive calls for children not in their care. Officers commented that the doctors who see the young person do not often spend a lot of time with the young person and would generally need more than one hour to complete their assessment. Two hours was generally given to an unaccompanied child, which was deemed appropriate. Doctors were also able to access a lot of information, however cross borough records were more difficult to access. Part of the improvement plan was for communication to be better between boroughs for sharing data.
The Panel heard that the service had a requirement for GPs to spend more time with the young person and training had been put in place for unaccompanied asylum seeking children’s information to make referrals as appropriate. There was also a triage in process for the most appropriate GP or paediatrician to pick up on the referrals and put in place adequate time.
The Panel discussed their disappointment in reasons why assessments were delayed or not completed within the timescales, and there were still some uncertainty as to what the delays were. Members also noted that twenty-three missed children according to the report was very upsetting, and noted a communication problem between the foster carers and health should be looked into further. In detail, officers said that the twenty-three missed children related to the young children who were not brought in to have their assessment completed. Officers further commented that the young people who were being cared for should be encouraged to attend appointments. For the purpose of the report the wording was changed to “did not attend”.
The Panel would like to see the service review the way health services complete assessments to avoid missing vital information in young people. The Chair added that it was important that this was monitored across the board as it was very important for a child or an unaccompanied asylum seeking child coming into the system to see the process in a seamless way without any blockage. Though this was a very good report there was a request for wider detail.
ACTION: Health Paper to return to the next CPP meeting to review shortfalls, and why it is happening. Regarding the 23 missed children and overview of the process in wider detail.