Agenda item

To receive information in relation to the health needs of children in care in Brent and the services provided to children in care in 2025-26.

Kim Lewis (Head of Clinical Services – Brent Children, CLCH) introduced a report providing information on the health needs of Brent looked after children and services provided to looked after children in 2025-26. In introducing the report, she highlighted the following key points:

• It was understood that, nationally, children in care often entered care in worse levels of health than their peers. As such, they benefited from support to navigate the health services that were available universally and often needed additional support from specialist nurses.
• CLCH had a caseload of 349 looked after children, which was a 5% increase on the previous year. The majority of children looked after in Brent that CLCH saw were between 5-16 years old, and the under 5 cohort was increasing whilst the under 16 cohort was reducing.
• CLCH had a very small health team with one Named Nurse post shared between two, two Looked After Children Nurses for Review Health Assessments (RHAs), 2 Consultant Community Paediatricians for Initial Health Assessments (IHAs), one Named Doctor, and a cohort of Resident Doctors from Northwick Park Hospital to support the team. Bank staff were also available to provide advice around adoption and fostering and were involved in the assessment of those who had applied to become adult foster carers and children going through the adoption process. There was a 2 day a week vacancy in the nursing service currently.
• IHAs were required to be completed within 15 days of a child coming into care. RHAs were conducted twice a year for children under 5 and once a year for children over 5. Monthly reporting on performance was sent to the West and North London Integrated Care Board (WNL ICB), including an analysis of any breaches of the deadlines.
• WNL ICB recently conducted an audit of IHA performance and as a result was looking to develop a core specification to ensure consistency across the 13 WNL boroughs with set standards.
• The three most common causes for breaches to the deadline were; challenges with referrals from the Council’s LAC team to the health team in a timely way; out of borough placements waiting for an assessment within the borough they were placed; and missed appointments.
• She had been meeting with Kelli Eboji to explore how to overcome some of the challenges in meeting the IHA and RHA deadlines. A deep dive on the breaches identified that there were multi-factorial reasons for the breaches and now that those were understood more deeply officers could start addressing them in a more cohesive way to improve performance.
• In relation to the health needs of looked after children, the number of children and young people with up-to-date immunisations was usually around 50% when they entered care which rose to 60% at review. The number of children with an up-to-date dental check was around 60% at entry to care which rose to 80% at review which was a good improvement, and the number of children with an up-to-date eye check was around 30% at IHA and 60% at RHA. The number of children registered with a GP had increased by 20%.
• 21% of young people reported having emotional wellbeing and mental health concerns with only 11% accepting a referral to CAMHS or other support.
• 80% of young people reported experiencing substance misuse, which included smoking, with only 2.4% accepting support.
• Going forward, the main focus was on improving the time breaches of assessments, particularly for out of borough placements which were out of CLCH’s control and needed a centralised solution.

The Chair thanked Kim Lewis for the introduction and invited comments and questions from those present, with the following issues raised:

The Committee raised concerns regarding the table outlining the breaches of assessment timeliness, highlighting that it appeared there had been no assessments conducted on time in February 2026. Kim Lewis explained that this was due to the very small cohort, and therefore this could refer to only one or none. She explained that this was the way the ICB required breaches to be reported, in percentage format, but agreed that presenting the actual figures could be explored for future annual reports presented to the Corporate Parenting Committee.

In response to how the ICB changes had impacted this work, Kim Lewis advised that children looked after was a key priority for the ICB currently. The ICB was looking to develop a core offer specification which she had been heavily involved with, and she confirmed there was a real commitment from the ICB to improve services, as currently the offer was very fragmented across the WNL area and the ICB wanted to ensure consistency. In terms of the funding for the Children Looked After teams, Kim Lewis confirmed that the ICB held the funds, but commissioning differed across boroughs which was why the core offer was being reviewed.

In relation to how the local authority worked with the health service to reduce breaches in assessment timeliness, Kelli Eboji (Head of LAC and Permanency, Brent Council) advised that her team had done work this year to improve the referral form on the reporting system which helped Social Workers ensure they were reporting the relevant information through pre-populated information. The local authority was also considering the admin resource allocated to this area to see if that could be adjusted. The Committee asked to receive information in the future as to the impact of the improvements, particularly the streamlined referral process.

In response to a query on how Brent data compared to other local authorities covered by CLCH, Kim Lewis confirmed that the data was similar across the local authorities that CLCH covered, with Brent sitting around the middle across the 13 WNL boroughs. She advised that CLCH sent reporting data to the ICB on a monthly basis which could be provided to Nigel Chapman (Corporate Director Children, Young People and Community Development, Brent Council) on a regular basis to give the local authority greater oversight of performance.

The Committee asked whether there was any learning from the other boroughs CLCH covered that could be replicated in Brent. Kim Lewis advised that she attended many joint meetings where the ICB brought boroughs together to understand what was working or whether there were any common difficulties. There were variances in how things were done across boroughs, with Brent’s IHA performance relatively good compared to other boroughs because Consultant Paediatricians undertaking those assessments were employed directly whereas other boroughs relied on acute colleagues undertaking those assessments on their behalf.

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