Agenda item

Joy Edwards, designated nurse for looked after children and care leavers, Dr Jenny Taylor, virtual mental health lead for looked after children Southwark, Jenny Izod (Southwark NHS) and Rachel Massey (community consultant) were present at the meeting.

 

Summary of Powerpoint presentations

 

Joy Edwards – presented

 

·  Changing NHS landscape, implementation of ICB (integrated care board) /ICS (integrated care systems) continues

 

·  Unknown impact both short and long – term of the current economic crisis

 

·  Whilst services return to normal delivery post COVID-19, impact of long COVID-19 was unknown and had a potential to impact on service delivery across  the health economy in the future

 

·  There was an increase in demand on current commissioned services, increasing the need of all vulnerable families across the health economy. This includes both primary and secondary health care i.e. occupational therapy, community paediatrics, speech and language, social emotional mental health (SEMH), autistic spectrum disorder (ASD)

 

·  Increasing evidence indicates that care leavers require further support and whilst unaccompanied asylum seeking children (UASC) numbers remain stable these young people form part of an increasing number of care leavers

 

·  The uncertainty of unaccompanied asylum seeking children (UASC) may experience as part of their asylum status may lead to increased vulnerabilities and reduced engagement with health services as they become care leavers

 

·  Southwark looked after children profile shows an increasing number of older children entering care for the first time

 

·  Data suggests that there was evidence that this population have identified  unmet health needs such as: emotional well-being disorders, missing immunisations and undiagnosed health and learning needs

 

·  Potentially delayed identified complex needs that require early intervention

 

·  Looked after children placed outside of a twenty-mile radius from Southwark may experience a variation in service delivery.

 

Looked after Children Strategic Focus 2023/2024

 

·  Continued oversight and assurance of current service specifications delivery and key performance indicators with providers

 

·  Continued collaborative partnership working with all relevant agencies to improve health outcomes for looked after children and young people

 

·  Continued support to care leavers as they progress to semi- independence/independence

 

·  Develop and progress a health quality assurance framework for children placed in Residential units in partnership with the local authority

 

·  Establishing assurance/evidence  that residential units can meet  the health needs of the children and young people who live there

 

·  Transitional safeguarding alongside adult Safeguarding to highlight our more vulnerable cohort as they move to adult services

 

·  Influence of the voice of children/carers and parents is visible and embedded in service delivery

 

·  Continued strategic influence across the health economy  to consider the identified needs of looked after children and young people within all children’s commissioned services

 

·  To challenge and act as an advocate for our children and young people to ensure that  their health needs are met in a timely manner, wherever they are living

 

·  Continue deliver current training programmes and develop training in relation to trauma informed care.

 

Positive news – summary

 

·  Embedded proactive and positive partnership working with local authority and health partners across the health economy

 

·  Continue partnership working shows a positive increase in reaching statutory requirements for health assessments

 

·  Distinct local looked after children’s health service available at point of contact

 

·  Agreement for care leavers (up to 25 years of age) to access pre-paid prescription certificates should they have to pay for prescriptions

 

·  Newly developed health pathway guidance for social care as care leavers move to semi-independence

 

·  Unaccompanied asylum seeking children (UASC) are able to access specialist health support from public health and CAMHS

·  Public health and looked after children health team actively working together to promote and increase immunisation uptake for our cohort of children.

 

Team challenges – summary

 

·  Significant IT outage of our community electronic notes system led to challenges in accessing data of the children and young people (CYP) for a number of months, impacting access to patients’ medical records

 

·  Fall in immunisation levels of our LAC cohort, aligns with national figures of all CYP, but also impacted by the IT outage as there was no access to immunisations

 

·  Care leavers health summaries sitting at 12%, this is an area of focus for the named professionals who are working closely with clinicians to understand the barriers for completing these summaries.

 

Team successes - summary

 

·  Despite significant IT and staffing challenges, 85% of children and young people were seen within 20 days of a referral to the LAC health team

 

·  A pilot project running jointly with LAC health and the paediatric infectious diseases team from Evelina - in a one stop service has started. The team hope this would improve the experience for the UASC population and streamline support and services

 

·  Funding for a UASC specific carelink therapist was approved

 

·  Following the fall in the number of fully immunised LAC children and young people, the team held two fully booked immunisation clinics and the plan would be to have a regular rolling program as part of the LAC Health offer moving forward.

 

·  The team had two additional clinics over summer months, plus the two on this rolling program to capture as many young people as possible and increase uptake. With the full support of a new immunisation coordinator in post

 

·  Improved capacity of nursing team allowing flexibility of clinics to be arranged around young people needs

 

·  The team would continue to seek the views and opinions of our LAC population. Initial ideas from phone consultations with the young people

 

·  To continue to provide effective and efficient CLA health services which improve outcomes for CLA.

 

Mental Health of Looked after Children

 

Dr Jenny Taylor – presented

 

·  SDQ - screening questionnaires, are requested annually from all carers of 4 - 16 year olds

·  Children and young people’s psychological as well as physical health needs were assessed annually at their annual healthcare assessments

·  Children and young people’s social workers and PAs regularly review their well-being with embedded mental health clinicians as part of the local authority’s group supervision process

·  These processes ensure that children and young people’s needs are identified early so that specialist input can be provided as needed

·  In line with national requirements the team currently monitor children’s mental health in Southwark with the strengths and difficulties questionnaires (SDQ) – we had a 83% completion rate (compared with 77% UK average)

·  The first UK local authority to use the more comprehensive child and the adolescent needs (CANS), assessment tool to monitor our children’s wellbeing.

 

Mental health provision:

 

Southwark’s looked after children continue to benefit from access to an array of mental health provision:

 

·  Children up to the age of 18

·  Specialist NHS CAMHS provision (Carelink)

·  Open access CAMHS provision (The Nest)

·  18 - 25 year olds

·  NHS AMHS provision

·  Open access CAMHS provision (The Nest)

·  Children/young people out of borough

·  Carelink if able to travel to site

·  Local CAMH/AMH services out-of-borough

·  Private providers

 

Note:

If the support is not provided via the above routes, the embedded local authority clinicians are able to provide direct assessments and interventions and work with birth families as well as carers and residential placements.

 

·  In terms of equity of access, our data suggests that the authority needs to ensure there is enough good access for black children and young people aged 16 and over. Both issues would be a priority for understanding and remedying over the year ahead

·  CANS implementation now underway

·  Carelink have recruited to a specialist post for UASC.

·  The trusted assessor approach to improve access to AMHS for our over 18 careleavers has now been formally agreed

·  Plans for embedded L.A. clinical staff to work with Guy’s and St Thomas’ NHS Foundation Trust (GSTT) colleagues to support an increase in capacity for autism diagnostic assessments

·  Plans to review staffing in relation to mental health provision for over 18s.

 

RESOLVED:

 

1.  That the report in relation to the delivery of health services for children looked after and care leavers (LAC) who are in the care of London borough of Southwark be noted.

 

2.  That the committee agreed to feedback any comments on the Southwark LAC Health report for consideration by the LAC Health leads across the health economy.