Agenda item

(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 that whilst individual Health Assessments were completed for children in care, the information from the assessment was not collated to achieve a wider strategic overview of the overall health needs for children in care. Public Health did not have a detailed understanding of the health of children in care as the data was not available; it was reliant on national data which was related back to children in care in Kent. He highlighted that some GPs carried out health assessments but Public Health had no access to GPs’ systems to extract the data. He noted that the data available included convictions, exclusions, education performance and health assessments.

 

Q – What are your key concerns about the health and wellbeing of children in care?

 

(5)          Andrew noted that due to the information infrastructure, it was difficult to know. He reported that there was emerging evidence that the health and wellbeing of unaccompanied asylum seeking children was a cause for concern. He reported that immunisations and dental checks for children in care were good but stated that there was a underreporting of dental health amongst the general population. He explained that young females in care were more likely to become pregnant but he was unable to state the number of young women in care who were expecting or had delivered a baby because of data limitations.

 

Q – How could the data be improved?

 

(6)          Andrew explained that a multiagency group including the Police and Social Care was pulling data together to produce a database to improve system knowledge and provide a whole picture of children in care. The system was due to go live shortly.

 

Q – What sexual health services are available to children in care?

 

(7)          Andrew stated that Public Health commissioned standard genitourinary medicine (GUM) and outreach health promotion and sexual health services. He reported that they had developed a mobile phone app which helped young people to access emergency contraception and had improved access to chlamydia testing through user friendly testing kits available from pharmacies. He noted that there had been a shift from family planning to a focus on the needs of young people. He reported that if a young female in care arrived in a sexual health clinic, she would be treated like anyone else.

 

Q – Does the chlamydia test enable self-assessment?

 

(8)          Andrew explained that the test needed to be sent away for scientific analysis. He reported that improved access helped to reduce barriers to services. He noted that the Teenage Pregnancy Strategy published last week showed that teenage pregnancies continued to fall.

Q – What percentage of teenagers, who are pregnant, are children in care?

 

(9)          Andrew reported that this figure was unknown. He explained that teenage pregnancies in Thanet had reduced except for Cliftonville due to the turnover of population and different cultures including Roma, Slovak and Eastern Europeans.

 

Q – Are the Police and Social Services gathering data for the new database?

 

(10)       Andrew stated that with the new information system they would be able to gather data. Public Health had requested that the social care case management system, Liberi, include the NHS number of the client so that the data could flow into the data collected by GPs, Hospitals, Community Services and other providers. He stressed the importance of connecting the health service data with the social care Liberi data.

 

Q – Is the Teenage Pregnancy Strategy effective for children in care?

 

(11)       Andrew explained that the strategy was reducing teenage pregnancy overall in Kent due to good PSHE and sex and relationship education. He noted that because the data was not connected, it was difficult to provide sub analysis on children in care. As the overall number of teenage pregnancies was reducing, it could be assumed that the rate of teenage pregnancies in children in care was also reducing. He highlighted the importance of connecting the Liberi and NHS data.

 

Q – Maidstone previously had the highest teenage pregnancy rate in the Country due to the availability of one and two bedroom flats which resulted in out of area placements, has the teenage pregnancy rate reduced?

 

(12)       Andrew explained that the teenage pregnancy rate in Parkwood and Shepway had come down. He acknowledged that it was not just due to the health service and local authority, it was a societal response. He noted that the dataset did not include out-of-area children in care; CCGs should be notified when a child is placed within their area but this does not happen very often. He reported it was difficult to know the totality of children in care due to data limitations.

 

Q – If a 14 year old is diagnosed with a sexually transmitted infection, is there an obligation on the GP to notify the child’s social worker?

 

(13)       Karen reported that GP’s have statutory safeguarding duties. There is also Department of Health best practice guidance for doctors on the provision of advice and treatment to YP on contraception, which outlines that Doctors and health professionals have a duty of care and a duty of confidentiality to all patients, including under 16s. However where any health professional believes that there is a risk to the health, safety or welfare of a young person or others and it is so serious it outweighs the young person’s right to privacy, they should follow locally agreed child protection protocols In these circumstances, the over-riding objective must be to safeguard the young person.

 

(14)       Karen reported that there was a statutory duty for a GP to use Gillick competence to decide whether a child (16 years or younger) was able to consent to his or her own medical treatment, without the need for parental permission or knowledge. She noted that if a child was closer to 16 years, they may be more competent in comparison to a 14 year old presenting without an adult. She explained that she would expect the GP to apply competency and report it to the social worker if they deemed the young person not to be competent.  Andrew stated that the CCGs had undergone a lot of training to understand safeguarding responsibilities and recognise safeguarding issues.

 

Q – How can communication be streamlined?

 

(15)       Andrew noted that there was a complex system in Kent due to the two tiers of local authorities. He stressed the importance of putting the child at the centre of the process. He highlighted the importance of integrating health records so the JSNA had the totality of the data to inform commissioning. He reported that Kent was one of the few systems which kept its health information service together. This meant it was able to hold multiple datasets and publish pseudo-anonymised data. He reported that Kent County Council’s Public Health team had been “highly commended” at the Health Service Journal Awards for its work in combining Adult Social Care and NHS datasets for the Kent Year of Care Commissioning Model.

 

(16)       Karen reported that Health Visiting and the Family Nurse Partnership Programme for young mums had transferred to Public Health last week. This transfer had enabled Public Health to have much quicker access to the data as it was previously held by NHS England. She noted that under the new information system; it would not matter who held the data, it would be shared amongst the multiagency group. She advised that the CCGs commissioned and held data about health assessments. She also noted that a significant proportion of young mums involved in the Family Nurse Partnership could be children in care.

 

(17)       Andrew explained noted the Corporate Parenting Panel and Social Care DMT had received the recommendations from the Kent Children in Care JSNA Chapter Summary Update which included addressing the data limitations. He explained that the Looked After Children Fostering Health Group, chaired by the CCGs, had drawn up an action plan to implement the recommendations. He acknowledged that there was pressure on the system due to unaccompanied asylum seeking children and health assessments was the current priority.

 

Q – What are the mental health needs of children in care?

(18)       Andrew reported that children in care were more at risk of developing mental health issues. He stated that the statistics were held by the providers.

 

Q – Is the CAMHS contract fit for purpose?

 

(19)       Andrew stated the current pathway does not function properly. CAMHS is a secondary tier of the pathway. He stressed the importance of preventative services for children and young people, if effective they would not require CAMHS. He acknowledged that there had been significant work to improve the pathway.

 

(20)       He noted that unaccompanied asylum seeking children had profound mental health needs; they could have faced abuse in their home country or on their way to the UK. He reported that the Looked After Children Fostering Health Group was developing a health needs assessment for unaccompanied asylum seeking children.

 

Q – Who is responsible for the Looked After Children Fostering Health Group?

 

(21)       Andrew explained that it was chaired by Hazel Carpenter as the lead CCG commissioner for children in care. The group reports to the CCG and provides updates to the Children’s Health and Wellbeing Board.

 

Q – What can the Select Committee do?

 

(22)       Andrew stressed the importance of the dataset and sharing clinical data between social care and health. He noted that it was key for Kent County Council as a commissioning authority, to have the whole picture.

 

(23)       A Member of the Select Committee highlighted an article in The Observer about refugee children arriving in Kent, the funding implications, and what is being done for them. The article was circulated to the Committee at the conclusion of the interview.

 

(24)       On behalf of the Committee, the Chairman thanked Andrew and Karen for attending the meeting and answering questions from Members.