Agenda item
Responding to Health Needs of Looked After Children
To receive a presentation from the Clinical Commissioning Group (CCG) regarding responding to health needs of Looked After Children (LAC).
Minutes:
The Committee received a presentation from Brigid Offley-Shore (Designated Nurse for LAC, Brent) and Dr Arlene Boroda (Designated Doctor for LAC, Brent) about the ways in which the Brent Clinical Commissioning Group (CCG) had responded to the health needs of Looked After Children (LAC). During the presentation, the following key points were highlighted:
- Improved administration processes had facilitated more timely referrals from social workers to health colleagues. New processes had been put in place for out of Borough placements.
- There had been an increase in referrals for initial and review health assessments which the CCG were responding well to.
- Working Groups had been established to look at support for LAC with Long Term Conditions and the CCG were working with Adult Social Services in relation to transitions for those over 16 years old with Long Term Conditions.
- A health resource booklet had been created with input from stakeholders and young people, which would be included in future pathway plans and was available as a paper copy and digital resource.
- An audit had been undertaken of initial health assessments looking at the questionnaires given to parents, carers and young people following initial health assessments over the period 2019 to 2020. The findings showed service users were very satisfied with the service, with the only areas for improvement being the environment of the clinic rooms and choice of appointment times. Those findings had been taken on board over the past year.
- A second audit had been undertaken by Dr Boroda looking at arrangements for UASCs being referred to the Infectious Diseases Team at Northwick Park Hospital, which had resulted in a referral template being created for initial health assessments for UASCs. This template was now available from the Royal College of Paediatric Health and was fully agreed as a standard template across the 8 North West London CCGs. The audit had looked at a sample of initial health assessments covering the period of 2018-2019, who had been referred, what the standards of assessment were, and what was found from the assessments. The findings had been very clear that many UASCs coming into the country did not have vaccination records and this would, as a result, be reported as ‘unknown if fully immunised’.
- A follow-up visit following a CQC Ofsted inspection of Special Educational Needs and Disability (SEND) inspection undertaken in May 2017 had concluded that the local area leaders had worked effectively together to tackle the weaknesses identified at the initial assessment.
- LAC health assessments continued to be delivered during the pandemic but as time went on some review health assessments and out of Borough health assessments were conducted over the telephone and virtually as opposed to physical face-to-face assessments. During the pandemic, infection risk assessments for children and young people who required face-to-face health assessments were undertaken and LAC were prioritised. Infection control measures were also introduced with the use of PPE for face-to-face assessments.
- Dr Boroda shared some case studies that demonstrated how the CCG had continued with the service and demonstrated the new ways of working with one example of a face-to-face health assessment and one example of a telephone assessment with an interpreter. During the physical assessment example Dr Boroda had conducted a face-to-face initial health assessment for a baby who had recently been placed with a Foster Carer, in full PPE, and was able to help the Foster Carer register the baby with a GP online. During the telephone assessment Dr Boroda ensured she was as prepared as possible going into the health assessment and made sure to speak to the manager of the placement and social worker to gather as much information as possible for the telephone assessment to help it run smoothly. It appeared that the default position for many services going forward would be using remote platforms which feedback suggested was very user friendly.
Following the presentation the Committee queried whether virtual or telephone health assessments where physical / face-to-face assessments were not possible had the potential to miss signs that a physical assessment would not. The Committee were reminded that the health assessments being discussed were for children who had come into care and were now in a safe place in care. Dr Boroda explained that for most initial health assessments children and young people were seen face-to-face, in person. If a child had alleged or there was concern of abuse they would be seen either in A&E, a primary care setting or by a community paediatrician and put in a safe place if needed. She added that clinicians were curious and if there was a concern the child would be seen and linked with other services, and across North West London there was a directive that if there was a concern the child would need to be seen face-to-face as soon as possible. She advised it was important to work around the team and what was the safest for the child, carers and health professionals to ensure infection control. Dr Boroda highlighted that, given the COVID-19 guidelines, a decision was necessary and where, for example, teens were placed very far away a virtual assessment would be the interim arrangement for the next steps. Dr Boroda had been redeployed to ensure the staffing was in place to deliver as best a service as possible under the guidelines. The Local Authority had been grateful for the support from Dr Boroda and her team.
Considering the new ways of working as a result of the pandemic, the Committee queried whether there would be subsequent to face-to-face, in person assessments when restrictions were lifted or whether the CCG were satisfied with the assessments done virtually. Dr Boroda advised that for review health assessments done by nursing staff, if there were other health needs of the child they would receive clinical care in addition to support from the Looked After Children’s Service and would continue to access their paediatric services. Many services for children stopped face-to-face appointments unless it was a clinical emergency, but a directive had gone out to say face-to-face was a priority for the initial health assessments of Looked After Children. For children out of Borough who had telephone assessments, the CCG would follow up with the local service to do what was necessary, but Dr Boroda noted that a lot of services had now changed to virtual consultations, including primary care, therefore face-to-face now meant via remote platforms rather than in the same room in some circumstances.
The Committee queried whether Mental Health was being assessed with as much importance as physical health during initial health assessments. Dr Boroda advised that the initial health assessments were rigorous and clinicians were mindful of COVID-19, the lack of school and new stresses. The clinicians ensured they had a lot of time to review background information before seeing the child so that questions were not repeated and that they were sensitive, appropriate and accessible for the child. Links with necessary services would take place also. Dr Boroda advised that they had received wonderful support, for example social workers attending assessments, following up, and leaving no stone left unturned to support the emotional wellbeing of the child. She reflected that as some services were stopped as a result of the pandemic they had more time and less pressure meaning more availability which had been beneficial. They had been seeing children in a peaceful environment. Brigid Offley-Shore added that for any Looked After Child there was priority for the treatment required and she had received that assurance at a meeting the previous week. She highlighted that the number of referrals to a clinical psychologist had doubled. She reminded the Committee that Kooth was available online for young people not able to speak to somebody face-to-face.
In relation to the merger of the 8 CCGs in North West London into 1 CCG the Committee queried how confident the representatives were that their service provision would not experience any disruptions. Dr Boroda advised she could give assurance that they would try their best to minimise disruption and replicate the service they were currently delivering from 1 April 2021. She highlighted that a big benefit in Brent was the continuity of committed staff with organisational knowledge and memory. The arrangements for the merger had been transitioning over time and they had strongly resisted any dilution of the safeguarding and LAC Designates in the CCGs, and she noted that Brent was more resourced than other Boroughs for designated staffing. She had advocated for this resource in order to have a good service and things worked well between the CCG and LAC health provider service and primary care. Local teams were staying as they were. The health provider service would change to a new trust and Dr Boroda advised that it was not within her gift to comment or influence but hoped it would bring positives and more joined up working. She felt that in the bigger context, following the pandemic, the way health services were designed and delivered was changing and they needed to ensure they were part of the design and delivery that embraced the change and new ways of working. The Chair requested that an update on this be presented the following year.
The health booklets had been rolled out and would be reviewed in six months’ time. Young people had given input on the booklets including the size of print, colours and pictures. Onder Beter (Head of Looked After Children and Permanency, Brent Council) advised that there was a very good communications strategy in place for the booklets to reach young people. The young people involved had been very helpful and honest with their feedback meaning the booklet had been revised significantly and was a really good example of co-production.
RESOLVED:
i) To note the presentation received from the CCG.
ii) To receive an update on the impact on the service after the 8 NWL CCGs merged into one.