Agenda item

To receive a presentation on health assessments of looked after children.

Attending: Dr Kim Holt, Haringey Designated Doctor for Children in Care and Marian Parks Specialist Nurse, Whittington Health

Dr Holt and Marian Parks presented to the Panel.  Key points noted:

·        The team aims to meet the statutory health needs of children in care.

·        The health assessment should take place within the first four weeks of a child going into care.

·        For children under 5 years of age reviews take place every 6 months.

·        There is only one permanent Doctor in the team and the team therefore depends upon help from other Doctors.

·        Some children are placed out of borough and therefore the team travels out of borough to conduct health assessment reviews.

o   This ensures continuity of care for the child.

·        Immunisation records only show ‘fully immunised for age’ when there is proof that the immunisations have taken place.

o   The number of immunised children for age is believed to be higher than the 71% shown on the presentation, however if there is no proof of immunisations then they recommend that the immunisations are started again.

·        When a child is placed in Haringey the team are able to access a child’s records, but this is not the case when they are placed out of borough.  This is a challenge.

·        The numbers who DNA (Do Not Attend) are very low as a percentage overall.

o   If a child is a couple of minutes late then the team will always call them.

o   Text reminders are not sent as there is a risk that the phone could be with another person e.g. the child’s parent when the child is in care.  This would alert the parent to where the child would be at a certain time.

·        Meningitis C is due to be offered with the school leaver booster.

·        Change to Immunisation programme coming in from now e.g. for rotavirus from September 2013 first dose must be given by 15 weeks – this represents a big challenge due to the window in which it must be given in.

·        The team feels that the standard of health assessments has increased since both initial and review assessments are done by them (rather than the review done by a GP).

·        The team have access to Framework-I and therefore update records.  They are also in contact with social workers.

·        It can take 6-8 hours in total to do one health assessment – this would include signposting to services, referrals etc.

·        They are very much dependent on the Local Authority asking them to see the children/letting them know a child is in care else they have no way of being informed.

·        Challenges include:

o   Out of borough placements and ensuring continuity.

o   Adoption workload – Dr Holt can often meet with prospective adopters 3 times to explain a child’s health, risks etc, for example if the child’s mother was a drug user during pregnancy.

o   Sexual health and teenage pregnancy – if a child is pregnant then the team talks through all of the options available to them and the steps needed for the options.     

§  Cultural sensitivity is needed in these conversations.

§  Sexual health discussions include asking whether they are sexually active.  If they are then this will be noted on the assessment form.

§  The whole of the assessment form goes to the social worker.

o   Child and Adolescent Mental Health Services (CAMHS) is an area of concern as some children are very troubled.

o   Young people on remand – are now classed as children in care (following Legal Aid, Sentencing and Punishment of Offenders Act)

In response to questions by the Panel the following points were noted:

·        The situation in Islington is different – they are organisationally different as the children’s health assessment team in located within the local authority.  There are also less children in care in Islington than Haringey, but the same amount of staff.

·        It can be up to 3 months before the team are alerted that a child is in need of a health assessment in Haringey.

·        The CiC Health Assessment team do sent reminders and prompts to the Looked After Children team but it would be more efficient if it were part of a seamless process.

·         

AGREED:

·        The Panel to write to Cllr Waters about work which is being done around integrating Children in Care Health Assessments with Looked After Children team.

·        Panel to follow up progress at a later date.