Agenda item

To provide an update to members on the areas of the Lancashire Care Quality Commission (CQC) action plan for Looked After Children (local authority care) that are relevant locally, and provide assurance on the current provision for the health needs of Looked After Children in Blackpool.

Hazel Gregory, Head of Safeguarding, Blackpool Teaching Hospitals NHS Foundation Trust and Kelly Gorrie, Named Nurse Looked After Children, Blackpool Teaching Hospitals NHS Foundation Trust presented a report on the health needs of children in Blackpool Council’s care (‘looked after children’).

Care Quality Commission - ‘Not Seen, Not Heard’

Ms Gregory explained that the Care Quality Commission had produced a report in July 2016 entitled ‘Not Seen, Not Heard’. The report had followed a review of how the health and safeguarding needs of ‘looked after children’ were being met across Lancashire. The review had not included Blackpool but the Commission’s recommendations had led to a Lancashire Improvement Plan which contained some aspects relevant locally. The Teaching Hospitals did provide services across Lancashire and locally for people resident in Lancashire but not Blackpool.

Ms Gorrie explained that they were ‘frontline’ issues with high numbers of ‘looked after children’ (1295) across Lancashire including over 500 in Blackpool. There were a number of homes with children being placed there, in partially independent placements or in short break placements. She cited the speed and challenge of placement turnover with six new placements in December 2016.

Ms Gorrie explained that the Care Quality Commission had made four key recommendations: ensuring that young people had a ‘voice’; outcomes-focused care; identifying young people at risk of harm; and access to emotional / mental health support. In particular, for outcomes, the Commission recommended use of the ‘so what’ approach, i.e. the impact of work and decisions needed to be effective otherwise reviewed. The recommendations had generated a number of actions.

Current service provision and outcomes in Blackpool

Ms Gorrie referred to the actions table within the report which displayed the current service provision for each action and also the outcomes that had been achieved.

Health assessments

The Chairman noted that the outcomes were stated as improvements and enquired what evidence there was to demonstrate improvement. Ms Gorrie referred, in particular, to 100% of health assessments being quality assured. Assessments not meeting quality standards were returned to practitioners).

Ms Gregory added that initial health assessments needed to be completed within 28 days (20 working days) of the Hospital Trust being notified of a new child in care. There were sometimes delays due to not being notified by the care authority (council) of a new child. However, even though there were nearly 1,300 ‘looked after children’ across Lancashire, the Hospital Trust had a robust tracking and monitoring system.  The Trust was aware if a child had failed to attend an appointment, the reasons for non-attendance and would ensure that they were seen within another week. She added that there were regular tracking meetings with the local authority.

Involving ‘looked after children’

The Chairman noted the range of current provision in place and enquired what improvements to the service were being proposed and what happened when a child complained about the service. Ms Gorrie explained formal complaints processes would be discussed with a child and relevant other parties would be made aware. The young person would be offered appropriate support through any process including someone to support them at meetings. Greater effort was being applied to attracting the views of young people. They liaised with the ‘Just Uz’ Youth Council and were developing an app that would support the health assessment process including views of young people. They were also reviewing the route (pathway of care) that ‘looked after children’ undertook to ensure the most robust health assessments were secured.

Ms Gregory added that ‘looked after children’ might not engage with a service. In those cases, different approaches and encouragement needed to be tried. On a wider note, social media was a particular form of communication that needed to be tapped into. She gave the example of ‘Kayleigh’s Love Story’, a nationally known short film which highlighted dangers to young people of online conversations with strangers. Essentially they needed to use tools that worked for young people.

Emotional and mental health

The Committee referred to high levels of suicide locally involving young people of both genders and enquired how ‘looked after children’ with mental health issues were being supported.

Ms Gorrie acknowledged that this was a challenging area particularly taking into account that ‘looked after children’ had often been through traumatic experiences. She referred to the National Society for the Prevention of Cruelty to Children which gave practical guidance on children’s mental health and suicide prevention. A more holistic approach to supporting children was advocated. She gave examples of young people not liking the way they looked and sexual issues, i.e. society creating a pressurised environment. It was important to work with young people (and foster carers) to support their emotional health and wellbeing.

Ms Gregory added that counselling was important through the ‘Connect’ therapy service and Child and Adolescent Mental Health Services (CAMHS). Counsellors worked hard to encourage vulnerable young people to speak about issues.

Transitional support (moving on from Children’s Services), monitoring and tracking

The Chairman enquired what support was provided for ‘looked after children’ moving from Children’s Services onto Adult Services taking into account the high numbers of ‘looked after children’ and staffing levels to meet challenges. They also enquired about support for young people not in care and the challenges of transient populations.

Ms Gorrie agreed that transition was an important area and there was a robust tracking and monitoring system in place with annual health assessments for ‘looked after children’. Young people aged 18 or under were entitled to receive ‘universal’ services which were open to all people in that age range. To help bridge the transition, they provided young people, from age 16 years onwards, with a ‘health passport’ which provided lots of independent advice and guidance for moving into an adult environment. It was important to empower young people and also promote relationships of trust that they might find with people.

Early support and wider partnership working

Ms Gregory explained that the ‘Looked after Team’ were co-located with the Safeguarding Team which meant that concerns about any young people were identified early, well before children might come into care. She added that good home environments were ideal in working with families. But when these broke down, the Looked after Children and Safeguarding Teams were alert to individual’s issues and risks.

She added that there were no additional staff available but new ways of working were being explored and developed. Work took place with health visitors and could start as early as the pre-birth stage of a child. She gave other examples of crossover working such as liaising with school nurses and clinics to support the healthy weight of a child and also school nurses linking into child sexual exploitation work. Other important areas included good dental health which could often be neglected leading to low self-esteem. All ‘looked after children’ were registered with a dentist. She added that regular meetings took place with this wider range of health staff reviewing the care and health needs of ‘looked after children’. With reference to transience, there was a robust system in place that allowed children to be tracked across Lancashire and across the country.

Dr Rajpura added that a more comprehensive health visitors’ service had been introduced.  This would extend the current five mandatory visits to a family to eight visits, to help establish and support the progress of a young child from birth as part of the universal service. The new approach meant the first visit was much closer to after a child was born. He highlighted the benefits of supporting early pre-school development in the first two years of a child’s life. The early years approach helped better prepare a child for school taking into account a range of needs such as health and speech and provided long-term benefits. He referred to the Better Start programme which supported families with children aged 0-5 years old in seven ward areas. Helping defend against stress and abuse was important, recognising that self-harm was a particular concern amongst young people. He added that the HeadStart programme helped build resilience and support the emotional health and wellbeing of 10-16 year olds.

With reference to the ten-year Better Start programme, Members enquired as to its effectiveness. Ms Gregory and Ms Gorrie explained that research had shown it took time to change lifestyles which had developed over generations. Dr Rajpura re-iterated that early years support was critical to promote better outcomes such as good diet and effective speech. The Better Start programme was still in its early stages.

Nathan Parker, Young Person’s Participation and Engagement Lead, HeadStart added that a key priority of HeadStart work was to support ‘looked after children’ and help them build resilience. He confirmed that supporting ‘looking after children’ was a key area of focus for all services.

The Committee agreed that young people who wanted to express interest in acting on any form of sounding board (set up by Blackpool Teaching Hospitals) relating to health needs of young people in care, could do so through Scrutiny channels who would forward on details to the Hospital’s Looked after Children Team.