Agenda item

This will include an update on the Children in Care service, the strategic outcomes for next year, as well as the strategic work of the team.

The Chair complimented the service area on the report. Dr Sender then ran through the Annual Review. Discussion turned to the metrics. Dr Sender outlined the KPIs set out in the annual report, however he explained to the Committee that they did not illustrate well what the services experienced. He outlined five key metrics. - The number of children and young people with an Initial Health Assessment (IHA) within 20 working days was at 73%. Dr Sender commented that this was not where the team wanted the figures to be. He stated that there was Page 4 significant joint working with the service about identifying issues. He commented that the figures had been improving over the years, but that there was still work to do. - The number of children and young people who have their Review Health Assessment (RHA) is at 97%. He stated that the remaining 3% reflected those who did not want the RHA. - He stated that the number of dental care assessments reflected the scarcity of dental services available to children and young people. However, there were more initiatives ensuring that Children in Care were prioritised in central and north London, so he expected that the figures will improve. - Dr Sender then commented on the percentage of children and young people who are up to date with vaccinations. He stated that there was a need to interrogate these figures and understand why it was underperforming. They were currently undertaking an audit of vaccination coverage – which would look at individual children over 3-6 months. - The number of Strengths and Difficulties Questionnaires (SDQ) completed was then mentioned. Dr Sender commented that there was a need to understand why the figure wasn’t higher. Mental health and early intervention was now a focus for the team, as Children in Care are usually faced with significant challenges. He explained that the SDQ was a screening tool however it only screened for some conditions. He thought a better screening process would be helpful, as well as a stronger focus for early interventions when entering care for younger children, and a responsive service for older children in crisis. Dr Sender commented that he wanted to look at data collection tools in the year ahead, and how well Children in Care were doing from a wellbeing perspective. He stated that the team wanted to provide early intervention and good services but that the data collected did not tell or measure what concerns children coming into care the most. This approach would give insight and understanding and ultimately improve the performance of the key metrics. Discussion returned to immunisations. The Chair agreed with the team about the complexity of issues facing them but highlighted they were gatekeepers. If a child needed to be immunised, then Children’s Services should determine this as Corporate Parents. She highlighted she was concerned about the high number of those in care without immunisation. Dr Sender replied that there were some issues regarding consent and the differing levels of care. He stated that looking at individual cases would give him more insight. The Principal Social Worker stated that even though children could be placed under a Care Order, the team had to make an application to the high courts to get permission to vaccinate. She added that there were many parents in Haringey that were suspicious of immunisations. The Designated Nurse stated that the statistics included the flu vaccine –this was now part of the routine schedule and was given in schools. This had affected the Page 5 figures. She highlighted that many foster carers lived out of the borough. Social Workers needed to consent to vaccinations for school immunisers. Dr Sender stated the team worked hard to get data from GPs. However, some records were not updated or accurate. The team was working with vaccination teams and Public Health to rectify this. Another question was raised about whether a child could be vaccinated twice. This was answered affirmatively. Dr Sender explained that there was a fragmentation of datasets, and databases weren’t linked effectively. He stated that Public Health England was aware of this. A question was raised about the nature of early intervention, whether it was fit for purpose and the nature of the package of services available to children. The Designated Doctor replied that there was work to be done to understand the providers that were involved and how they worked together. There had been engagement with the Anna Freud Centre and nationally across teams, however there was no uniformity of standards or design across the boroughs. This, he stated would be down to the Integrated Care Board (ICB) Mental Health Trust and other mental health providers. However, he emphasised that there was a need to look at these issues as a matter of urgency. Another question was asked regarding the level of commitment from the partners to treat this with urgency. The Director of Children’s Services stated that the mental health system was fragmented. There were no clear pathways. Providers dealt with different age ranges and conditions. However, there was a drive to work together to achieve clarity. She stated the ICB were working on one pathway for everyone. She stressed that it had not been agreed yet, however there had been steps forward in recognising that there was a problem. She highlighted that there had been repeated changes to governance in Health Services. However, there was also some positive aspects of the services, and she wanted to showcase these more. The Chair thanked the Designated Doctor and Nurses for an insightful report that raised multiple issues, and made fully understood the breadth of their role. She raised a question about young people in detention and aired her concern that they did not require a statutory health second assessment. She indicated that due to the number of EHCPs alone, there may be significant hidden health needs in the Youth Justice cohort, and she asked how the team could work with Youth Justice to ensure that these were being picked up. The Designated Nurse clarified that if the young person was part of the Looked After cohort in Haringey before they enter an offending institution - the team would be responsible for their health care. However, if a young person or child went into care whilst inside the institution - the youth offending teams would have their own units to look after health. Another question was raised as to how many Looked After Children and Young People were in the Youth Justice System. The Chair responded that the performance data indicated it was 74 – however it was clarified that this was the whole cohort and Page 6 not the percentage of youth offenders. This number was much lower. The Director of Children’s Services wanted to assure the Committee that young people in institutions were having their health cared for, either by Haringey or in the Youth Offending teams. She suggested that a report could be brought before the Committee if needed. ACTION