Agenda item

These reports provide information to the Corporate Parenting Committee (CPC) on the health needs of Brent Looked After Children and the service provided to these children in 2022-23 and 2023-24.

Kim Lewis (Head of Clinical Services, Brent Children - CLCH) introduced the report, which provided the annual Looked After Children (LAC) Health Reports for 2022-23 and 2023-24. In introducing the reports, she highlighted the following key points:

• The CLCH LAC health team worked closely together with the wider system to improve outcomes for children and young people. The portfolio had sat within CLCH since 2021.
• During 2022-23 the LAC health team had supported 369 children at year end, which was an 8% increase from the previous year. The Royal College Intercollegiate Framework provided guidance on nursing staff provision per LAC and this was monitored closely by CLCH to ensure compliance.
• The Committee were advised, however, that the recruitment of nurses into the service had been challenging during that reporting period. There was a high number of agency and bank staff use and mutual aid available through CLCH, as well as assistance from the other boroughs that CLCH were providers for. Those staffing issues were now resolved and a full permanent team was in place, with final recruits now being onboarded and inducted which would lead to more consistency.
• Due to the staffing challenges experienced, there had been a pause of health team attendance at some meetings so that the service could ensure core health plans for children and young people were completed, and the team was now in the process of stepping that attendance back up.
• The timeliness of health assessments for 2022-23 showed that 92% had been completed on time. Some of the challenges for completion were around waiting for appointments from hosting boroughs, re-booking of appointments where the child was not brought to the appointment, and timely information transfers between the health team and the Council LAC team. A meeting was scheduled to look into that challenge and come up with a solution to improve that process.
• Section 5.2 of the report detailed the number of LAC children registered with a GP, which was 97% for 2022-23. Final data was not yet available for 2023-24 but the health team continued to work closely to register children and young people. For those young people who did not want to register with a GP the health team signposted to alternatives.
• Section 5.11 detailed the patient experience measure results which asked ‘is this a good service’ to which 95% agreed or strongly agreed.
• The health service was undertaking a quality improvement process, working with children and young people, to create an animation about the LAC health service to showcase the support available and dispel common myths about the LAC population. The video would be aimed at children and young people themselves as well as those who may have inaccuracies in their views of LAC. Children and young people had been very involved in that project which was due to launch in January 2025.
• The reports also included a summary of service improvements and challenges, including improvements to networking with system wide partners, assigning specialist roles to individual nurses in LAC to develop specialist support within the team, future provision of training, system improvements to the interpreter’s booking system, and improved information sharing between teams.

The Chair thanked officers for the updates and then invited comments and questions from Committee members with the following raised:

The Committee highlighted section 5.5, table 6 of the report, which detailed the overall percentage of children who had received dental and optician health checks. They highlighted this seemed low and asked if the service was doing anything to increase those numbers to hit the target of 95%. Kim Lewis advised members that GPs could not undertake dental and optical checks so the health service was required to work with children and young people to encourage them to access opticians and dentists. Julia Blankson (Named Nurse for Safeguarding Children in Brent - CLCH) would have a plan for that process. Kelli Eboji (Head of LAC and Permanency, Brent Council) added that this was discussed as part of the child’s health assessment when they entered into care and their carers registered the child with opticians and dentists. That gap in performance was often due to the young person refusing appointments, as well as some cohorts moving placements and therefore changing providers often.

In relation to the low immunisation rates, the Committee was advised that GPs held records for immunisations which health providers did not have immediate access to and needed to request that information. There was a large cohort of Unaccompanied Asylum Seeking Children (UASCs) where there was no immunisations record and the health service was required to start again to ensure they were fully vaccinated. With that, there was slower take-up due to differences in understanding of immunisations and LAC cohort typically having a higher percentage of parents refusing immunisations for their child. Data collection was a difficult part of this process. Nigel Chapman (Corporate Director Children and Young People, Brent Council) added that Brent had a high number of children in care under a Section 20, which meant the Council did not have direct parental responsibility for them in the same way it would for a child with a Care Order. In most cases, the local authority tried to work with the parent to encourage the uptake of immunisations but if the parent refused then the immunisations could not be provided.

The Committee asked whether there was a high number of children in the LAC cohort with diabetes. Kelli Eboji responded that there was not a large cohort of children in care with diabetes currently, but that was always monitored as there had been a large number in the past and the cohort was regularly changing. In the past, when there were high levels of diabetes in the LAC population, there had been targeted work alongside health partners to support those children and young people.

The Committee commended the forward planning section of the report, particularly the possibility of commissioning a care leavers health service post-18. Members asked what would be required to move that proposal forward. Trish Stewart (Director of Safeguarding - CLCH) advised members that there was a review happening across the whole of NWL of LAC services, looking at writing a new service specification everyone would adhere to, which could incorporate that post-18 support. Some other London boroughs had a post-18 nurse and she could see that added value of that.

Nigel Chapman asked how the role of the Integrated Care Board (ICB) affected CLCH and whether there was a case to be made in relation to equity of funding or resource in Brent compared to other NWL boroughs. Kim Lewis advised members that, because they were guided by the Royal College Intercollegiate Framework which stipulated how teams should be staffed based on case numbers, the resource allocations were fairly standard across the piece and there was a formula for that. What differed was the details in the service specification around which populations fell within the remit of the service. For example, in Brent, if a child was placed outside of the M25 then there would be a reliance on the hosting borough to do health assessments, but some boroughs were commissioned to travel anywhere in the country to complete health assessments. This caused challenges in terms of operational capacity to do that as well as understanding the local services available in different areas of the country to signpost. Trish Stewart added that there was now an annual LAC Away Day for services across the boroughs CLCH provided for, where it was common practice to listen to each borough and hear what they were doing differently and how the ICB shared information with them. As there were differences, CLCH were looking at putting an agreement in place in terms of governance processes and reporting.

In terms of information sharing, the Committee heard that there may be ways to share certain information between CLCH and the local authority now that the Health Information Exchange was running.

RESOLVED:

i)              To note the content of the reports.