Agenda item

(1)          The Chairman welcomed Nancy Sayer to the meeting and invited her to introduce herself and to briefly outline her role before answering questions from Member.

(2)          Nancy explained that as the designated Nurse for Looked after Children (LAC) for Kent and Medway she covered all 8 CCG (Clinical Commissioning Group) areas. She was a shared resource hosted by Swale CCG.  Her role was to provide expert advice on clinical matters regarding LAC, both Kent & Medway’s own LAC and those placed in Kent by other local authorities.  It was her responsibility to support the CCGs in   meet their statutory responsibilities to LAC.

Q – How do you encounter LAC and if you identify issues how is the next stage?

(3)          Nancy explained that the health service was split between providers and commissioner (CCG’s).  I work with both the commissioning groups and providers to ensure that they put in place what is required to provide a good level of service to LAC’s.  I am a bridge between the commissioners and providers. At the moment we are looking at the capacity of services to provide hands on work for LAC and if necessary look at what needs to be done to commission additional services for this group.

Q – Please provide an outline of the health needs of children and young people in care in Kent.

(4)          Nancy stated that two thirds of children entering care had one or more physical ailments. Other’s may not have had for example standard vaccinations early in life or had speech/language issues assessed and addressed.  All of these young people come with emotional needs by virtue of being in the care system. 

(5)       Nancy referred to a health needs analysis that had been carried out last October which showed that health professionals did not keep enough data on LAC and therefore it was not currently possible to accurately assess the health needs of our population of LAC.   For example the data on dental and optical needs of these children was not readily available.  In relation to the speech and language development and ASD needs it was important to make sure that there was capacity in the system to ensure that LAC are dealt with quickly.

(6)          Nancy stated that she needed to get a data tool in place so that when a child became a LAC and a health assessment was carried out within 28 days  to gather and record the information.  However currently this information tends to be handwritten and typed in free text rather than entered into a database.  Therefore information on LAC health was kept but not in a form that enabled it to be analysed.

(7)          Nancy confirmed that the evidence on LAC had not been available for the Health and Wellbeing Board’s Joint Strategic Needs Assessment.  A database was needed to enable this information to be produced easily, Medway had such a system and it was hoped that a version of this could be used in Kent.  Discussions were being carried out with Medway Maritime NHS Foundation Trust’s IT service to see if  they would be willing to sell this database to Kent and if so would they be willing to support an expanded Kent database.  Once the database was established it would take a year before data was available to analyse.

Q – In order for the LAC to have treatment such as a vaccination or an eye test is the birth parents permission required?

(8)          Nancy explained that this depended on the legal framework around the child e.g. the legal agreement between the social  services and the birth parent.  Foster carers have certain deligated consents e.g. for vaccinations and eye tests.

(9)          Nancy stated that there were still a minority of birth parents who held onto control and maybe reluctant to have, for example MMR vaccinations.  If a child came in to care via a care order then parental responsibility was shared between the Council/Social Services and the birth parent, with the Council making the decisions on the child’s care while keeping the birth parents informed. 

Q – If the seven Kent and Medway CCG are working together why have there been difficulties in service provision?

(10)       Nancy explained that each of the CCG areas had specific issues relating to LAC.  The CQC (Quality Care Commission) had carried out a review of services for LAC in west Kent it was clear that there was a need to bring the seven CCG’s together.

(11)       Nancy referred to the Kent Joint Adoption and LAC Group which was chaired by Hazel Carpenter (Accountable Officer for South East Coastal CCG). This group provided an opportunity for a senior officer from each of the CCG’s, officers from KCC and herself to discuss issues relating to LAC in order to ensure that improved decisions were taken in a timely way.  In relation to non-Kent LAC and care leavers the group looked at pathways for the child through the system without delays and barriers.   

Q – What information is available about the health of foster carer’s health, for example obesity in order to make sure that they could have targeted advice about achieving a good diet and how this should be handled?

(12)       Nancy explained that foster carers had to have a health assessment and a report from their GP which was sent to the designated Doctor for LAC who would look at this report and provide health advice to the foster carers.  There was a lot of debate regarding obesity and whether it was right to prevent people from being foster carers if they were overweight. Nancy expressed a personal view that if you have issues around the health of yourself and your family then it is difficult to put a LAC in that setting but then if the foster carers are able to provide a good level of care for the LAC then there is a balance to be stuck.  There is no government guidance on this issue but the British Association of Adoption and Fostering had produced some guidance

Q –Does the same apply to foster carers and smoking?

(13)       Nancy explained that a LAC under 5 would not be placed with a foster carer who smoked and with older children the foster carer must only smoke outside.   She stated that when she worked as a nurse in Medway she had issues with one or two foster carers who smoked and she tried to help them understand the importance of giving up smoking.

Q- What statutory responsibility do you have for LAC placed in Kent by other local authorities?

(14)       Nancy explained that this was limited. These LAC had a right to a healthcare service and there was a limited service to provide a health assessment for these children. The local authority placing the child remained the corporate parent and the CCG for the area from which they came were responsible for them.  Nancy confirmed that it was possible to cross charge for providing health assessment for these children.   She stated that the London Borough of Greenwich sent nurses into Kent to carry out health assessments, as Kent did not carry out these assessments she did not know what the state of health of these children was nor their needs other than any referral from a GP.  This lack of information about the health of LAC placed in Kent did not help with the commissioning of services for LAC generally.

Q – we have heard from another witness that LAC placed in Kent did not have access to the specific LAC CAMH service provided for Kent LAC, and that records showed that only 20 non Kent LAC had received a service from the mainstream CAMH service do you think that this is number is under-reported or that these LAC’s are not receiving CAMH treatment that they may need?

(15)       Nancy stated that she believed it to be the latter.  LAC place in Kent would have similar health and wellbeing needs but received a different level of CAMHs service, there was therefore a risk that problems were being stored up for both these young people and for those around them.   Some LAC were place in Kent because the placement in their home area had broken down these young people may have a higher risk of behavioural or health needs and therefore have higher health needs.   They may either go without receiving the service that they need or go back to their own local authority area for this service we do not have any information on this.

Q – Do you have a statutory right to go onto approved Children’s homes and if not would you like to have this right?

(16)       Nancy stated that she did not have this right and would like to have the right to go into Children’s Homes if it was suspected that they were not providing the appropriate level of health care.  There was nothing stopping her from asking if she could go into a Children’s Home but she had no right to do so.  She stated that it is difficult sometimes when placing Kent LAC in that there was not enough choice in placements if they had behavioural difficulties and they may be placed in a setting that was not the best fit for their needs.

(17)       Nancy agreed that foster carers did an amazing job and it was important to make sure that they had the skills that they need to support the child that was placed with them. 

Q – Do you have any suggestion as to how we can improve the information flow with placing authorities, such as Greenwich, who carry out their own health assessments so that you can have an accurate picture of the health needs of these LAC?

(18)       Nancy confirmed that this was a difficult issue, it would be possible to ask colleagues in Greenwich  send all the Healthcare plans for their LAC placed in Kent but then what would be done with them as she was struggling to provide a robust service for Kent’s own LAC.   She stated that when the Kent database was in place it may be possible to add information on LAC placed in Kent who were not our responsibility and so gather health information to inform the future commissioning of health services

Q – Would be helpful for schools to know what the needs of this non-Kent LAC were?

(19)       Nancy stated that schools were often in a better position with regard to being aware of these children and their needs, they should all have a personal education plan which would go with them to their new school.  Often the first time that health colleagues were aware of these children was if they had to visit hospital maybe via A & E.  What should happen is that the CCG for the area that the child in place in should be informed by the placing authority but I am not sure that this happens 100% of the time.  One issue is that there is no national email address to send this information to so you need to know which individual in the CCG to send it to and care needs to be taken as this is sensitive data.

(20)       Nancy mentioned that in Kent there was the additional challenge of the increasing numbers of unaccompanied asylum seeking children which could impact on public health issues such as TB.

Q – All Elected Members are Corporate Parents, what can we do individually or collectively to make improve the lives of LAC?

(21)       Nancy explained that when she worked in Medway she sat on the Parenting Board.  In the year that she had been in her current role in Kent she had not been asked to provide any information to the Corporate Parenting Board on the health of Kent’s LAC.  If I was a Corporate Parent I would want to know what the health issues of these children were and if there were public health issues e.g. measles what could be done to make sure that LAC were immunised.  I would have thought that this type of information would be vital to you in your role as Corporate Parents but I have never been asked to supply any such information.

(22)       Nancy stated that she did not understand the relationship of the Corporate Parenting Group with the Corporate Parenting Panel and how Members, as Corporate Parents, pick up information coming from the Group, which is an officer group.  Although the minutes from the officer group go the Members Corporate Parenting Panel, Members miss out on important discussions that take place in the Group. 

(23)       Nancy expressed the view that the Corporate Parenting Panel and the Corporate Parenting Group should be merged to insure that there is no gap in the information coming to Members to support their role as Corporate Parents.

(24)       The Chairman thanked Nancy for attending the meeting and for providing very helpful responses to Members questions.