Agenda item

To provide information to the Corporate Parenting Committee in relation to the health needs of children in care in Brent and the services provided to these children in 2024-25.

Kim Lewis (Head of Clinical Services – Brent Children, CLCH) introduced the report, which provided information relating to the health needs of Brent Looked After Children and the services provided in 2024-25. In providing some context, she highlighted that, nationally, Looked After Children entered care with a worse level of health than their peers and often needed support above and beyond their peers. She then provided the following information:

• In Brent, the LAC Health Team had a caseload of 328 as of 31 March 2025, compared to 268 the previous year. The caseload fluctuated throughout the year.
• The LAC Health Team was currently fully and correctly staffed in accordance with the intercollegiate guidelines for ratios, and was made up of a Named Nurse, 3 Children Looked After Nurses, 2 Consultant Paediatricians conducting Initial Health Assessments (IHAs), one of which was the Named Doctor for Looked After Children, and a cohort of Junior Doctors on a 6-month rotation. There were also some medical advisors in place for adoption and fostering.
• The report included an analysis of monthly performance on timely completion of IHAs and Review Health Assessments (RHAs), including explanations for breaches.
• The Integrated Care Board (ICB) had recently flagged concerns with IHA performance across all 8 NWL boroughs and was undertaking a programme to address that, which health and social care teams were involved in. The most common causes of breaches were where children were placed out of borough and waiting for assessment in the borough they were placed in, ongoing challenges with referrals, and children and young people who were not brought to their appointment or chose not to attend. The Brent Health and Social Care Teams and Designates from the ICB were exploring the referral challenges and how they could be addressed.
• The team had worked to streamline referral forms to make the process quicker and easier which had received positive feedback.
• She highlighted the need for centralised solutions to improve the breaches to statutory timeframes for children placed out of borough, where Brent’s health and social care team had limited control.
• A new NWL ICB core offer specification to standardise the commissioning of children looked after across all 8 boroughs was expected, which would change how systems operated to ensure all 8 NWL boroughs were providing the same service to children regardless of where they lived.
• In 2023-24 there had been an improvement in the number of children whose immunisations were up to date, who were registered with a GP and who had received a recent dental check. The data for 2024-25 was not yet available.
• The number of children who had seen an optician for their RHA had improved.
• Data had not yet been received for mental health support and substance misuse, and the previous year there had been large gaps in the number who reported issues and those actually receiving support, highlighting the large number of young people waiting for support in those areas.
• The Central London Community Healthcare health team had established a Quality Council Project with young people in care to develop an animation discussing the experience of being in care and how they would like health professionals to speak to them. The animation included myth busting about children looked after and was due to launch soon, and had been shortlisted for 2 awards.

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

Cecilia Gabriel (Service Manager – LAC and Permanency, Brent Council) offered thanks for the work done to improve the RHA process and new form which she advised had made a big difference for social workers in Brent.

The Committee highlighted the difficulties people faced in asking for interventions for mental health and asked what support was available to allow young people to disclose that information and receive support. Kim Lewis highlighted the Strengths and Difficulties Questionnaires which examined a child’s mental wellbeing along four broad categories to plan therapeutic support referrals, which was a national tool used by health visiting staff and social workers. There was a national requirement to complete an SDQ every 12 months. She advised that the key to these was ensuring the team had built good relationships with young people so they felt comfortable asking for that support, as well as consistency of staff. In terms of the emotional wellbeing support available to young people, Kelli Eboji (Head of LAC and Permanency, Brent Council) highlighted a number of other providers outside of CAMHS known as tier 2 support such as WEST, Elev8 and VIA New Beginnings. There was also a new wellbeing service being launched specifically for former UASCs.

The Committee asked whether the figure in 5.9 of the report, stating that 90% of looked after children were reported with substance misuse, was correct. Officers agreed to check that figure but believed it to be correct, highlighting that alcohol, smoking and vaping would be included in that figure as well as cannabis use. In checking that figure, the Committee asked to be provided with the national average for adults.

The Committee asked where the complexities in meeting statutory obligations for health assessments arose. Kim Lewis explained that social workers completed the set referral form to request a health assessment. If the child was placed out of borough, the team made the referral to that local borough, however, it was noted that other boroughs tended to prioritise their own children which caused delays. For those in NWL, the CLCH team then dealt with the referral. Once the assessment was complete, they would write a report which was quality assessed by the LAC Health Team. Where children were placed out of borough, the quality of those reports were not always the required standard, and this resulted in back and forth with the other borough to get the report into an acceptable standard. She highlighted that this was happening across the whole country and felt it needed national focus.

Noting the table in the report providing monthly performance of IHAs, the Committee highlighted a drop in July and October, and asked if there had been any reflection and insight into why that was. Officers explained that the numbers did fluctuate depending on where young people were placed. In October, 3 children were in borough and 9 were out of borough, where there were more delays. There had also recently been some young people in hospital where those assessments could not be carried out. She assured the Committee that the reasons for exceptions were provided in the report to the ICB and highlighted that the small caseloads did affect the figures.

The Committee noted that section 5.4 of the report described the number of HPV immunisations delivered for girls only and highlighted that the policy in schools was now to immunise both girls and boys. Kelli Eboji confirmed that the immunisation was offered to both boys and girls, and agreed that there was further work needed in the coming year regarding vaccinations. There was a need to work with public health and health teams to improve vaccination rates and increase the messaging around eligibility.

It was noted that, whilst the report noted a slight increase of 5% in immunisations, since the report had been published the finalised figures showed a decrease in immunisation rates between the reporting year and the previous year. Cecilia Gabriel suggested that could be due to the smaller cohort of children being supported to be placed long-term, larger sibling groups where parents had not consented to immunisations, and UASCs who arrived with no immunisations or evidence of immunisation status. Officers felt that messaging and education was needed in that area, and a UASC project with public health had begun to develop some of that educational messaging, including using foster carer platforms such as newsletters and training.

The Committee asked how the service was ensuring that young people leaving care fully understood how to access their health histories. Kelli Eboji advised that the report detailed the positive work on health histories and summaries. She emphasised that the health team worked hard to ensure every young person leaving care had a health summary. Independent Reviewing Officers (IROs) brought that information to their reviews as part of the care leaver pathway plan, and social workers were now prompted to make sure a young person had received their health history, and check they had any questions or needed any support.

As no further issues were raised, the Committee resolved to note the report.