Agenda item

This report combines NHS Brent CCG and the Provider Health reports for Looked After Children (LAC). The health provider is London North West University Healthcare NHS Trust (LNWUHT).  The report outlines the delivery of health services to LAC by the London Borough of Brent, in line with National Statutory Guidance, and reviews performance indicators, clinical work undertaken by the LAC health team, service improvements and plans for further development.

Dr Arlene Boroda (Designated Doctor for Safeguarding Children, Brent CCG) delivered a presentation to the committee summarising the Brent LAC Health Annual Report 2017-18.  The Annual Report outlined the delivery of health services to LAC by the London Borough of Brent and combined NHS Brent CCG and Provider health reports; it included performance indicators, clinical work undertaken by the LAC health team, service improvements and plans for further development.

During the presentation, Dr Boroda drew the committee’s attention to the statutory monitoring requirements, noting that the majority of health assessments for LAC were completed within the statutory timeframe. Any that were not undertaken within timescales were analysed to ascertain the reasons for delay and whether  improvements to arrangements were needed. Members further heard about Brent’s audit tool, used to assess the quality of health assessments, and which would be used across the eight North West London CCGs. The audit explored issues of thoroughness, identification of health needs, consent, voice of the child, record keeping, developmental and educational needs, risk factors, and substance abuse, among others. Highlighting areas for improvement, Dr Boroda noted that these included the recording of who was in the room during health checks, the  tracking of immunisations, dental and vision checks, and supporting transitions between children’s and adults’ services.

In the subsequent discussion, the committee questioned how the statutory requirements were met for those young people who did not want to engage with LAC health services. Assurance was sought regarding the quality of the working relationship with London North West University Healthcare NHS Trust (LNWUHT). Clarification was sought regarding the numbers of Unaccompanied Asylum Seeking Children (UASC) in Brent. The committee queried what actions would be undertaken to deliver against the conclusions identified from the analysis of UASC health assessments. Questions were raised regarding non-NHS service providers and how the council and CCG engaged these groups to ensure that the care and quality provided was sufficient. Further details were also sought regarding vulnerable LAC in prisons and the barriers to understanding whether their disabilities and learning needs were being addressed. Committee members raised further questions regarding mental health support when transitioning between children’s and adults services.

The Chair invited questions and contributions from the CIA representatives who sought an update on activity relating to a matter on which they had been previously consulted regarding mental health support

Responding to the queries raised, Dr Boroda explained that if a child or young person appeared unwilling to engage, an offer could be made to hold the assessment over the phone initially or in a place where the young person felt safe and comfortable. The team would also work to identify and utilise any existing channels of engagement with the individual established by other services. It was emphasised that for safeguarding and LAC services, communication and connectivity with the LNWUHT worked well.

Onder Beter (Head of LAC and Permanency) clarified that there had been an overall decline in the numbers of UASC from 2016/17. Dr Boroda provided an overview of the activity to address the identified needs of the UASC cohort which included training by the CCG across the local health economy, particularly for GPs, with whom all USAC had to be registered. The committee heard that the needs of UASC were being continually highlighted. Screenings for infectious diseases were offered routinely for UASC, as were emotional health and wellbeing screenings, with referrals made to other services as appropriate. It was noted that a significant number of UASC arrive without immunisation records. Training was given to Foster Cares and other care providers on supporting health needs, including immunisations and how to recognise a sick child.

Addressing questions regarding non-NHS service providers, Dr Boroda advised that this was an area which required further attention but a lot of work was being done to raise awareness of safeguarding considerations amongst commissioners. The committee heard that health care services for prisons and offender units were directly commissioned by the NHS. Brent was currently in dialogue with the NHS regarding arrangements around quality assurance. It was emphasised that some of the health care services at these facilities were outstanding; however, this was a cohort of very vulnerable young people and therefore the matter would continue to be pursued with the NHS. In response to a query regarding capturing the voice of the child, Gail Tolley (Strategic Director, Children and Young People) advised that each young person would have a Youth Offending Service (YOS) worker and a Social Worker.

Dr Boroda advised that supporting transitions was a priority and a specific post had been commissioned to support Children and Young People transitioning between children’s and adults services. It was explained that the CIA had been consulted with respect to a scoping exercise on the emotional health and needs of children and young people. It had been found that there was overlap in the services and support available but that often there was a lack of connectivity between these services. It was agreed that arrangements would be made to formally feedback to the CIA on the findings and work arising from the scoping exercise.

The Chair thanked Dr Boroda for her contribution to the meeting.