Agenda item
Responding to Health Needs of Looked After Children
To receive a presentation from CCG representatives on the ways health services respond to the health needs of Looked After Children.
Minutes:
The Committee received a presentation from Dr Arlene Boroda (Designated Doctor for Safeguarding Children, and Children Looked After – Brent, NWL CCG) and Esther Powers (Designated Nurse for Looked After Children – Brent and Hounslow, NWL CCG) which provided an update on the response to the health needs of looked after children during 2021. The following points were highlighted during the presentation:
· Statutory duties had continued during Covid-19, including Initial Health Assessments, which were conducted face to face, and Review Health Assessments, which had been conducted either face to face or virtually depending on the clinical need and preferences of the person. Infection control measures had been in place.
· All Unaccompanied Asylum Seeking Children (UASC) needing screening for infectious disease had been seen or referred.
· Partnership work had continued, and health was very well represented at relevant panels, such as the Entry to Care Panel.
· The Health Provider Team was well resourced in terms of staffing. The transfer of community services had been seamless, and Central London Community Healthcare NHS Trust (CLCH) had invested in an additional LAC Nurse to cover out of borough cases. A new specialist mental health LAC nurse had also been appointed by Central and North West London Healthcare NHS Trust (CNWL) to support out of borough placements.
· In relation to care leavers specifically, a health resource booklet had been co-produced with young people and incorporated into Pathway Plans.
· A care leavers’ health audit had been completed in 2021 with a sample of 15 care leavers. 33% of the sample had been UASC with no vaccination records. Of the overall audit sample, registration with a dentist and optician, and regular dental and vision checks, were not at 100%, but when compared to other populations they were at similar percentages, and the numbers were not a cause for concern.
· In relation to what had gone well during the reporting period, the following areas were listed: there had been positive progress in the management of timeliness for BAAFs; The Looked After Children (LAC) health admin continued to offer quarterly bitesize training sessions for social workers; a wider professional network was participating in strategy meetings and risk management discussions and; the out of borough CAMHS co-ordinator was providing flexible resource for LAC and care leavers requiring referrals for therapeutic intervention.
· The health service continued to work on areas for improvement, such as waiting times for CAMHS which remained a priority, out of borough care leavers receiving their care leaver’s health summary consistently, and timeliness of referrals for initial and review health assessments.
· A new pathway had been designed by NHSE for dental access for LAC due to the difficulty in accessing dental care for young people across Brent.
· In relation to the overall health arrangements in Brent, from 1 April 2021 Brent CCG had been subsumed into the NWL CCG covering all 8 NWL boroughs. The CCG was a part of the quality directorate, and across NWL CCG there was a want to standardise the offer across the 8 boroughs to ensure best practice.
· Dr Boroda provided a case study of how the health service was supporting UASCs. She advised that the CCG were committed to meeting the health needs of UASCs placed in Brent and asked how they were feeling, what their journey had been like, and invited them to use the services on offer. The health service ensured the use of translators where necessary, and offered culturally competent practice.
In considering the presentation, the Committee raised the following points:
The Committee queried the reasons for the difficulties in accessing dental care for looked after children. Esther Powers advised that during the pandemic dental care was difficult to access for everybody, and, even though looked after children were considered priority in Brent to be seen, it had been difficult to get them to be seen face to face for routine care. Dr Arlene Boroda added that NHSE had issued directives around infection control because dental procedures involved access to the oral cavity, which was high risk in relation to the transmission of Covid-19. Many aerosol generated procedures could carry the virus and pose risk to the patient and professional. She highlighted that NWL Designated Safeguarding professionals had raised the alarm that the dental figures would be poor and asked what the government was doing about it, and services were commissioned on the back of that. The safeguarding community continued to argue the cause for services for the population so there were no closed doors for Brent’s young people. She added that medical emergencies did continue and community dentists and A&E remained open for those in pain that needed to be addressed.
The Committee asked whether there were any opportunities for funding to be streamed through to LAC health services. Dr Arlene Boroda believed that, if statutory functions were needed, commissioners would have those conversations and do their best to meet the need. She was not aware of any funding restrictions impacting services. One workstream that should be monitored was the increased number of Unaccompanied Asylum Seeking Children (UASC) and she was sure that conversation would be held at the appropriate level.
In relation to how CAMHS waiting lists could be addressed for looked after children, Dr Arlene Boroda advised there was no one size fits all approach. There was an opportunity to work together as a partnership and there were conversations with children and young people and foster carers which she felt was key. She highlighted that emotional wellbeing and mental health was very complex, and over the past 2 years emotional wellbeing and mental health for young people had been impacted by multiple variables not limited to Covid-19. She felt working together to find and trial solutions to see what worked was important. Dr Boroda felt optimistic that the strategic leaders in Brent would work together in the means they had to focus on this issue.
Gail Tolley (Strategic Director Children and Young People, Brent Council) expressed thanks to Dr Boroda for the presentation and the work she and her team did, which was cited as best practice in London and nationally. Dr Boroda added that the team worked very well as a partnership and had good foster carers and social care professionals.
RESOLVED:
i) To note the report.