Agenda and draft minutes

(1)          The Chairman welcomed the guests to the meeting and invited Andrew to introduce himself and outline his role. Andrew explained that the Director of Public Health role had transferred from Primary Care Trusts to local authorities two years ago. He stated that there were three key areas which the Director of Public Health was now responsible for. The first area was health protection; the Director of Public Health had to ensure that a system was in place to deal with public health emergencies such as communicable diseases and major incidents involving a public health threats. The Director of Public Health was part of the Scientific and Technical Advisory Cell which provided advice on health issues to Strategic Coordinating Groups during an emergency response or recovery. The second area was the provision of public health advice to Clinical Commissioning Groups (CCGs) to enable them to commission effective services based on the need and demand of their local population. Each CCG in Kent had a Public Health Consultant as part of their Governing Body. The third area was the commissioning of health improvement services which had a ring-fenced budget.  These services ranged from mandatory sexual health services, Child Measurement Programme and NHS Health Checks, through to the provision of services to support smoking cessation, promoting physical exercise and addressing obesity which were based on local priorities. He noted that the Joint Strategic Needs Assessment (JSNA) was produced by local authorities’ public health departments to identify health needs within its population; the JSNA was used to develop the Health & Wellbeing Strategy and inform commissioning of health services. He stated that each upper-tier and unitary authority, acting jointly with the Secretary of State for Health was required to appoint a Director of Public Health.

Q – Are you employed by Kent County Council?

(2)          Andrew explained that he was a Kent County Council employee but the Director of Public Health role was a joint appointment between the Council and the Secretary of State for Health.

Q – How is Kent’s Public Health department supporting Children in Care?

(3)          Andrew stated that Public Health was involved in the commissioning of services for children in care and providing data about the health needs of children in care. He referenced the data provided in the Kent Children in Care JSNA Chapter Summary Update which was produced in 2014 and continued to be a live document. A copy of the chapter was circulated to Members at the conclusion of the interview.

Q – Are there any limitations with the data?

(4)          Andrew reported that there were limitations with the data availability particularly with unaccompanied asylum-seeking children who were a subset of the children in care cohort.  He referenced the statutory guidance from the Department of Education and the Department of Health ‘Promoting the health and wellbeing of looked-after children’ which set out the responsibilities for the planning, commissioning and delivery of health services for children in care. This guidance had led to fragmentation of data. He reported  ...  view the full minutes text for item 4.

(1)          Ms Infanti was welcomed to the meeting. She had been in her position in the team for the past 3 years. Her responsibility is around managing the emotional wellbeing contract and the children in care element of the child and young people mental health service provided by Sussex Partnership Foundation Trust.  Ms Infanti works  alongside West Kent CCG which is  the lead commissioner

Q: Has there been an improvement on waiting times?

(2)          The concern around waiting times had been brought to member’s attention and was discussed at previous HOSC meetings. The waiting time has since come down to an acceptable level. Across Kent the average waiting time from referral through to assessment is now at 10 weeks. The average waiting time for treatment (from referral) is now at 16 weeks.

Q: Are you finding pressure from the number of referrals?

(3)          The number of referrals has increased dramatically in recent years, particularly emergency and Out of Hours referrals. This is not a pattern unique to Kent and has been seen nationally. Since the start of the contract the number of out of hours referrals has been high, it was anticipated that there would be around 10 per month, it has been averaging around 100. The response to these is within the contract requirements.   90% of children in care had their assessment within 6 weeks, 70% within 4 weeks and 90% had their treatment within 10 weeks.

Q: What sort of problems do these children have? How can we help?

(4)          The best way to describe this is to give examples. The first is a 14 year old boy who was in care as he had been experiencing neglect and exposure to substance misuse and domestic abuse. He was referred to the child and young people’s mental health service because of his disruptive behaviour with his foster carers and he would soil himself often. The foster carers also wanted guidance to support him while changing schools. To accommodate for his needs they worked with the network (foster carer, school, social worker, Virtual School Kent) to advise and assist how to respond to his behavioural problems. The children in care CAMHS team also did some direct with the young person. This gave very positive results, his behaviour improved and he successfully moved school and, his attachment to the foster carer improved.

(5)          The other example was that of an 8 year old child living with a foster carer, he was expressing distress with disruptive behaviour, being verbally aggressive and trying to run away. This child was supported by the children in care CAMHS working with the network, helping the foster carer change how she responded to the child’s behaviour and by the school providing play therapy.

Q: In this first example, did the boy in question move schools to go to his new placement?

Yes, he did move schools for the new placement.

Q: Are you seeing an increase of issues that come about due to cyberbullying?

(6)          An increase  ...  view the full minutes text for item 5.

(1)          The Chairman welcomed Mr Littlemore to the meeting and invited him to outline his role and to answer questions from Members.

(2)          Mr Littlemore stated that he was the Head of Housing and Community Services at Maidstone Borough Council, his remit included housing, community safety, environmental health and licensing.  He confirmed that Maidstone had transferred its housing stock in 2004.  He was the current Chair of the Kent Joint Policy and Planning Board which was a strategic partnership between health, housing and social care.  He explained that the Board was involved with the development of a protocol for the housing of young people. 

 Q - What are the key challenges across districts in addressing housing issues for children in care (16-17 years old and care leavers)?

(3)           Mr Littlemore stated that this was one area which housing officers struggled with.  Legislation stated that a person had to be 18 years old to hold a tenancy.  It was difficult for local authority and private landlords to grant a tenancy to a young person under 18 years old and in some cases these young people came from disturbed backgrounds and their maturity levels varied. 

(4)          Mr Littlemore explained that the provision for supported accommodation for young people was not uniform across Kent.  There was the Trinity Foyer in Maidstone and a similar supported provision in Swale providing a holistic service for young people but little else across Kent.

(5)          Mr Littlemore stated that there was an issue regarding the different service provided to young people by Social Services and Housing departments depending upon where they lived in Kent. He referred to a paper which had been considered by Kent Chief Executives and Kent Leaders regarding adopting the Dartford model across Kent which had found favour.

Q – What emergency housing services are available to 16/17 year olds?  Can they turn to their local housing authority?

(6)          Mr Littlemore explained that there was a difference between what should happen and what happened in practise.  He referred to the Dartford model which attempted to prevent homelessness by reconciling the young person with their family.  This required a joint Social Services and Housing approach. He emphasised that no one would want to see vulnerable young people on the street. 

Q – What can a young person do if they find themselves “on the street” at 5.00pm?

(7)          Mr Littlemore confirmed that all local authorities had a 24/7 out of hours service which would direct them to services that could provide assistance.  If the young person was 16/17 years old then the first point of call was children’s social services for an assessment to see what duty was owed to them under the Children Act.  If the young person had been in care with Social Services then they should have a pathway plan, which ideally would start planning with Housing Services 6 months before the young person came out of Social Services care.  If there was no duty to this young person under the  ...  view the full minutes text for item 6.