Agenda item

(1)          Dr Ahmad-Bhatti was welcomed to the meeting and she commenced by referring members to the comprehensive biography of her role in the papers.  Her position included being a Consultant paediatrician in community child health at East Kent Hospitals University NHS Foundation Trust and the designated doctor for LAC in East Kent (EK), based in Ashford. In particular she manages epilepsy, assessment of neurodevelopmental disorders, suspected sexual abuse, complex needs due to physical and intellectual disability and teaching and training junior paediatric doctors.

(2)          A formal job description was currently being prepared in line with statutory guidance and intercollegiate competency frame work

Q - What is your interaction with the young people of Kent?

(3)          Oversee the LAC and Adoption service delivery in East Kent and Quality assure Statutory Initial Health Assessments undertaken by the EKHUFT Community Paediatricians - to identify health issues and deliver workable plans.

(4)          Direct clinical care to the LAC and YP on the clinical case load.

Q: Please outline the needs of Kent’s LAC?

(5)          In 2009/10 analysis of 187 cases identified a variety of needs including development delay, learning difficulties (ranging from mild to severe), problems with hearing, vision, obesity, speech and language problems, self-harming, smoking, teenage pregnancy and mental health. ADHD and autism also impacted on the stability of placements. A further analysis was planned to identify the current situation and trends.

Q: Are health assessments carried out before entering the care system to aid correct matching of Foster parents?

(6)          There is no absolute requirement to do so unless a medical is requested due to concerns about neglect or abuse. These assessments can be used to identify suitable placement to meet the individual child’s needs. However children with complex medical needs are usually well known to the Health services and the information from the involved professionals can be used to aid correct/appropriate matching of Foster parents or out of county placements.

(7)          Q: Does  KCC inform the service if any out of County placements are made?

(8)          Not always.

Q: Has there been an increase in numbers of foetal alcohol syndrome?

(9)           More awareness and training has led to increased diagnosis, although there are still problems as this remains relatively underdiagnosed especially Foetal alcohol spectrum disorder.  Working in the EK Team for the last 17 years has given the opportunity to provide continuity of care to the very vulnerable and needy families and now we have also seen the second generation of families who are already known to the Social care system. There is high unemployment and poor parenting skills with mental health issues in the parents of these LAC and the problems in the second generation are more intense, which are partly genetic and partly environmental i.e family dynamics, exposure to chaotic family life, Domestic violence, neglect, parental substance and alcohol misuse. There are more   single parent families and mums often have mental and emotional health issues.

Q: Are there any figures available that show the percentage of LAC whose parents actually were or are in care?

(10)       There are no official local figures to show the number of current LAC and YP whose mother or father or both were looked after. This is an observation from the clinical experience and the information from IHA reports.

Q: Once problems are identified, eg, mental health, what is the next step?

(11)       Depends on the urgency. For urgent cases where there are significant concerns, the examining Paediatrician can contact the duty team and can refer directly after discussing the case. For less urgent cases, SW is given the responsibility in the Health action plan to make the referral to local CAMHS.  Now a new LAC CAMHS service has been set up, which provides support to the Child /YP and carers but do not provide diagnostic service for Developmental disorders. However they help in fast tracking these cases to mainstream CAMH’s.

Q: Are there any differences between the problems in East and West Kent?

(12)       No. Children can be placed in either area and both share the same problems. There is a Kent wide Health and Safe Guarding group where issues raised both from the East and West Kent are considered and this group feeds in to LCSB.

Q: What is the impact of alcohol on pregnancy?

(13)       Evidence and research has confirmed that alcohol is a toxin/poison and even a small amount during the critical period of pregnancy is toxic.  Mother’s emotional and mental health, together with problems related to alcohol and substance misuse, all impact on the developing brain.  Environmental factors including family dynamics have an effect on developing foetus as well. Research has shown that babies born to alcoholic mothers are at higher risk of developing developmental and mental health issues as well as learning and behaviour difficulties. Identified areas of difficulty include brain, eyes, and heart, growth, concentration and attachment issues. Clinical practice has shown that most pregnancies were unplanned and the mother’s definition of a unit of alcohol was not the same as you would expect.

Q: What is the impact of smoking on pregnancy?

(14)       The foetus may develop respiratory/bronchial problems, have an increased risk of developing asthma or hyper sensitivity and be of greater risk of becoming a smoker themselves in later life.

Q: How can binge drinking be addressed?

(13) There is no simple solutions-a vicious circle developed in families where alcoholic parents were not good role models, neglected children grew up thinking this was the norm. Increasing awareness was essential.

Q: To what extent are the health needs of these children effectively met?

(14): We cannot change the genetic influences and familial risks but we can modify and improve environmental risk factors. When we identify the needs, all agencies/ staff involved with the LAC/YP try their best to meet these identified needs but the constant restructuring of Organisations and lack of continuity did little to promote stability.

Q:  How effective was the interaction between different agencies, communication and the sharing of information?

(15)     To achieve the best outcomes, Statutory guidance promotes collaborative working between all the agencies involved with the LAC and YP which can only be achieved with better information sharing, robust Goverence arrangements and integrated Pathways. This has resource implications. KCC and partner agencies including the Health providers are working towards developing integrated pathways. There is a Child in Care coordinator that provides single point of contact for all the referrals for initial and review health assessments and adoption medicals. Now a Kent wide LAC provider/Care leaving group has been established to oversee various services provided for LAC and care leavers and developing integrated pathways. To manage the problems like Child sexual exploitation and gang bullying, there is an absolute need of working together and Health and safeguarding group provides a platform where all the relevant agencies share the information and work collaboratively to promote the safeguarding.

Q: How can elected members help, be more effective?

(16)     Elected members are the corporate parents. They need to know the profile of their children, their diverse needs, their strengths and the areas where they are struggling. They need to ensure that all the relevant agencies involved with LAC and YP are fulfilling the role on their behalf and are providing a high quality child centred service and where the barriers are met, use their power to overcome these barriers.

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Q: Despite being Corporate Parent members are one stage removed-how can individual members be aware of a child’s status and help?

(17)     Regular feedback is crucial, young people do have direct access to the Panel and it is imperative their views are taken seriously. IRO also maintain a close link with the LAC and YP, their feedback is also a valuable resource that can be used to reach out or kept informed of the LAC /YP ‘s status.

Q: Is feedback received by the Corporate Parenting Group?

(18)     Previously there was no arrangement in place for regular feedback to KCPG from the Panel, but more recently one of the Panel members have started joining KCPG meeting, which is very helpful, as this feedback needs to be a two-way process.

(19)     There were no other questions and the Chairman sincerely thanked Dr Ahmad-Bhatti for attending the Select Committee and furnishing the members with such informative and honest information.