Agenda item

This report provides additional clarity on the actions being undertaken to improve the performance; and also an overview of the provision of services to improve emotional wellbeing and mental health of children looked after and actions relating to these services.

The Head of Children and Maternity Integrated Commissioning - Amanda Tuke, Senior Commissioning Manager - Laura Saunders, and the Head of Commissioning and Procurement Children's, Family and Education - Pasquale Brammer introduced the report and highlighted the following:

• Statutory guidance required that initial health assessments (IHAs) were delivered within twenty working days of the child becoming looked after. Notification to the Children Looked After nursing team would be received within three working days and the IHA would be delivered within sixteen working days. If the referrals were received punctually then the statutory deadline was almost always met. Health nurses would often speed up the assessment to try and hit the twenty working day deadline.
• The data, included in the report, showed that there had been a significant improvement on timeliness of IHAs compared with previous years, however, they were still looking at strengthening the quality of the assessments.
• Ensuring the management of repayments to outside boroughs were prioritised to maintain a good reputation with commissioners.
• Young people declining health assessments was a challenge, particularly with out of borough children.

• The Health and Wellbeing of Children Looked After Strategic Board chose themes and determined what was working well and where there were areas for improvement; longer term plans were then created and introduced. The Board focused on individual cases, and monitored whether there were any trends with the statistics.
• Focus was emphasised to those young people who had not attended or had declined their health assessments to encourage them to have their assessments; it was not mandatory for the young people to have their assessments after the age of 16 and they had the right to decline.
• The percentage of children in care for the last 12 months who had updated health assessments was 91.4%, as opposed to the two previous years which was 66.5% and 79.4%.
• There was an ongoing review to improve how health pathways for unaccompanied asylum seeking children (UASC) could be completed in a timely manner and to improve inclusivity; the challenges with UASC were often bespoke.
• Approximately 100 children in care were referred to South London & Maudsley NHS Foundation Trust (SLaM) per year, and Off The Record provided support to approximately 150 looked after children, of which almost 100 children were UASC.
• There were high waiting times for young people and a high threshold for young people to meet the requirements of the available services. This was a national challenge, which was continuously improving, and it was noted that Croydon were performing to a higher standard than a lot of other areas across the country.
• From February 2020, the existing multi-agency Single Point of Contact (SPOC) service would expand to include emotional wellbeing and mental health.
• Practitioners from SLaM would be co-located at Bernard Weatherill House, along with specialists from: social care, early help, health visiting services, education, safeguarding, police, and housing services.
• A new online referral form had been developed to ensure all information sharing and user confidentiality concerns had been addressed.
• The service would be evaluated over the next six months after implementation to determine how it was working and identify future developments. This would continually improve the service and ensure there was a more flexible offer to meet the need of the young people.
• A neighbouring borough had held specific training for foster carers regarding mental health and this could be introduced to Croydon.
• SPOC would provide clearer statistics to ensure the health service could be monitored closely.

Dr Julia Simpson, CLA Designated Health Professional, introduced herself and highlighted the following:

• She had held a focus group with young people regarding initial health assessments and it was expressed that they wished to know who would be completing their assessment; what the medical professional looked like, their name and what would be discussed.
• The data collected regarding the assessments undermined what was being achieved with the young people as they would discuss friendship groups, peers and school life with them; the data collected was quantative and focused on areas such as vaccinations and dental checks.
• An analysis of IHAs was being carried out by Public Health to inform a health report focused on looked after children, which would be completed by the next Corporate Parenting Panel.
• Social workers had been trained to complete new health and safety questionnaires to identify children who should be referred to SLaM.
• There was a staff training day arranged in February 2020 which would focus on the support of UASC.

In response to queries raised by EMPIRE, in regards to health checks for looked after children and confidentiality with GPs, Dr Julia Simpson clarified the following:

·       All information collected at the GP was confidential and this would only be shared with other health providers. If the information was to be shared further, for example with foster carers, then the young person would need to give consent.

·       Young people may see a different clinical nurse at their health assessment review; however, initial health assessments were usually completed by the same nurse to ensure continuity.

·       Doctors would have appointments with any looked after child without their carer once they were verbally capable. There had been recent training to improve the narrative between the health professional and young person to ensure they were able to discuss issues regarding their placement without the foster carer being present.

·       Social workers should be involved in the process of health assessments to help the young person and ensure they have an understanding of their health needs; social workers were responsible for reviewing the health assessment in their capacity as a corporate parent. It was added that the young people should not leave an assessment without knowing their health needs and the next steps; health action plans should be shared with the young person and foster carer.

·       The young people could make initial contact via telephone and could arrange an appointment with the doctor on their own from the age of 13.

·       A record of every health assessment with the GP would be on a young person’s file; however, once a young person turned 18 then hospitals and other services would not have access to this information unless the individual chose to share it with them.

A foster carer co-optee member present noted that he had seen a vast improvement in 2019-20 with health assessments, and requested that information regarding the new referral process be sent to foster carers, including those who live outside of the borough. The Head of Commissioning for Children’s, Families and Education confirmed that a narrative would be provided to explain how to make a referral to CAMHS for carers, GPs, young people and schools.

RESOLVED – That the Panel agreed:

1)    to the targets, actions and deadlines as appropriate to improve the timeliness of initial health assessments, coverage of review health assessments and access to emotional wellbeing and mental health services,

2)    that the outcomes of the CLA health needs assessment, commissioned by the Health and Wellbeing of Children Looked After Strategic Board, would be reported to Corporate Parenting Panel as part of an annual CLA health report and added to the forward plan.

At 1839 hours the Panel adjourned for a short break

At 1846 hours the Panel resumed the meeting