Agenda item

To provide information to the Council’s Corporate Parenting Committee in relation to health services and outcomes for Looked After Children in Brent.

Esther Power (Designated Nurse – Children in Care - Brent & Hounslow – NHS NWL) and Kate Head (Designated doctor for Children Looked After - Harrow, Hillingdon and Brent – NHS NWL) provided a presentation on the health needs of Looked After Children (LAC) across NWL. The following key points were highlighted:

• There had been a close focus on inequalities for children and young people over the past 2 years, and the health service had signed up to the Care Leaver’s Covenant, which looked to reduce barriers for LAC and care leavers into getting employment and training in the NHS.
• In terms of health inequalities, it was highlighted that LAC were 4 times more likely to have a mental health need, behavioural and emotional difficulties, substance misuse, or experience teenage pregnancy.
• It was highlighted that many children became looked after as a result of abuse and neglect and as such, although they had many of the same health issues as their peers, the extend of those health issues was often greater because of their past experiences.
• There were 348 LAC in Brent which was higher than other NWL boroughs had who provided that data.
• In terms of the health needs identified during initial and review health assessments, the top themes were around CAMHS, dentistry and immunisations. There was a large range of health issues reported at 431 health needs across 127 individual health assessments, meaning many had more than one identified health need.
• 77% of children and young people reported an emotional health need, and some children may have reported an emotional health need but were not necessarily accessing CAMHS or counselling.
• 38% of children and young people over 10 years old reported sleep issues, which was high.
• In relation to growth and development, the percentage of children and young people with incomplete immunisations was 33.85%. As immunisations were a premise for good health all children would be expected to have complete immunisations. This data may have been skewed by the high number Unaccompanied Asylum-Seeking Children (UASC) in the borough, as often they attended health reviews with incomplete health records.
• In terms of UASC health specifically, some health needs identified were around sleep, dentistry, counselling, and infectious disease screening. 50 UASCs reported a mental health need, 22 reported gastro issues and 31 reported skin infections. It was highlighted that, compared to the data from the rest of the population, there were some outliers in health needs identified for UASC relating to their unique experiences. UASC also had lower incidences of therapeutic input relative to reported emotional health and wellbeing needs.
• Suggested interventions to tackle health inequalities, high rates of incomplete immunisations and high rates of dental issues were being discussed by the Integrated Care Board (ICB). It was highlighted that if significant health needs were being identified, then the there was a need to work jointly as corporate parents to ensure young people had access to services. As an ongoing piece of work the health service was looking to review the health needs of the LAC and care leaver population, and some areas of NWL had appointed a Transition Care Leaver Nurse to work with young people over 16 years old.

The Chair thanked colleagues for the presentation and invited comments and questions from those present, with the following raised:

The Committee asked about the additional support on offer for LAC and care leavers experiencing mental health issues or emotional wellbeing issues. They were advised that the health service had seen an increased number of young people attending A & E departments in distress, and so CAMHS were looking at where the most suitable placements were for young people to be discharged and what support could be put in place. There was now a Children and Young People Mental Health Working Group scoping all services across the ICB and how they could be improved, informed by engagement with children and young people.

The Committee asked for further information about the Specialist Services for UASC. They were advised that the Unity Clinic covered health assessments, emotional wellbeing screenings, and infectious disease screenings in one appointment. The health service wanted the infectious disease screening to be more joined up across NWL as some areas of NWL required multiple referrals which held up the process. It was highlighted that in Brent this was quite well-managed compared to other boroughs, so the ICB was looking to make this more equitable for all UASC across NWL. The Council was currently in discussions with the health service to consider the joint commissioning of a service for UASC emotional wellbeing.

The Committee asked what the difficulties were in maintaining frequency of health assessments and supporting the health needs of LAC. They heard that the reason it was difficult to manage was due to the frequency of LAC moving around and language barriers. Due to the need to use independent fostering agencies and make placements out of borough, many LAC were not placed in the local area and it was difficult from a health perspective to have oversight of that and be aware of health services in other areas. Getting to know young people was very important in ensuring there was consistency in health, so building relationships where UASC felt they could trust healthcare professionals was important and key in identifying exploitation. Esther Power was involved in Strategy discussions all the way through to health assessments ensuring that trust and consistency of professional. Another aspect of supporting LAC and care leavers with their health needs was around empowering young people to manage their own health and supporting young people to advocate for themselves. The service was also looking to attend as many forums as possible to hear directly form young people what they needed from their health services and what was affecting them.

The Chair felt there had been some interesting ideas raised to pilot future programmes and was pleased to have colleagues from health attending the Committee on an annual basis. The Committee hoped to integrate health more into the Committee in future to have more of a collaborative approach going forward.

RESOLVED:

i)              To note the contents of the presentation.