annual report for looked after children

LAC Annual Report 2017 - 2018

Annual Report for Looked After Children

1st

April 2017 to 31st

March 2018

Report Author:

Wendy Costello – Named Nurse for Looked After Children, City Health Care Partnership CIC

Report Contributors:

Angie Rawlings – Designated Nurse for Looked After Children, Hull Clinic Commissioning Group City

Health Care Partnership CIC

Dr. Kanika Grover – Designated Doctor for Looked After Children, City Health Care Partnership CIC

Tracy Gamble - Clinical Manager, 0 - 19 Public Health Nursing, City Health Care Partnership CIC

Endorsed by:

Tracy Vickers - Executive Nurse & Care Group Director, Care Group 2


CONTENTS

Glossary of terms

1. Introduction

2. National Guidance

3. Local Commissioner / Provider arrangements

4. 2017 CQC Inspection Action Outcomes

5. Integrated Looked after Children meetings (ILAC/Health & Social Care)

6. Performance

7. Initial and Review Health Assessments

8. Late notifications

9. Consent

10. Dental Health

11. Immunisations

12. Sexual Health

13. Child Sexual Exploitation

14. Emotional Health

15. Substance Misuse

16. Looked After Children and Young People’s Health Team (LACHT)

17. Service User Feedback

18. Conclusion

19. Recommendations

Appendix 1.

Action Plan 2016/17

Appendix 2.

IHA Quality Assurance data from Designated Doctor for LAC


GLOSSARY OF TERMS

CAMHS – Child and Adolescent Mental Health

CAYP – Children and Young People

CCG – Clinical Commissioning Group

CHCP CIC - City Health Care Partnership CIC

CLA – Child Looked After

Coram BAAF - British Association for Adoption and Fostering

CQC – Care Quality Commission

CSE – Child Sexual Exploitation

DFE – Department For Education

DFES - Department For Education and Skills

DH – Department of Health

DoH - Department of Health

ECR – Electronic Care Record

GIDS – Gender Identity Development Service

GP – General Practitioner

HDP – Health and Development Practitioner

HV – Health Visitor

ICRO – Independent Conferencing and Reviewing Officer

IHA – Initial Health Assessment

ILAC – Integrated Looked After Children Team

KPI – Key Performance Indicators

LA – Local Authority

LAC –Looked After Child

LACHT - Looked After Children Health Team

LL – Liquid Logic

MACE – Multi-Agency Child Exploitation Meetings

NICE – National Institute for Clinical Care and Excellence

OOA – Out of Area

RCPCH - Royal College of Paediatrics and Child Health

RHA – Review Health Assessment


RIT – Risk Indicator Tool

S1 – SystmOne (electronic health care record)

SDQ – Strength and Difficulties Questionnaire

SOP – Standard Operating Procedure

SW – Social Worker


1. Introduction

The Statutory Guidance for promoting the health and wellbeing of Looked After Children (2015)

requires the Designated Doctor and Designated Nurse to complete an annual report that evaluates

the delivery of health services to children and young people Looked After within the care system.

This report will provide a brief overview of the local commissioner / provider arrangements detailing

how Looked After Children’s (LAC) health services are delivered by City Health Care Partnership CIC

(CHCP CIC).

It will include an evaluation of the delivery of health services for LAC and young people within the

local care system, with reference to activity and performance outcomes against National Guidance.

The information within this report is taken from data held by CHCP CIC within the electronic care

record (ECR) known as SystmOne (S1) for children and young people who were registered as being

Looked After during the following time frame - 1st

April 2017 – 31st

March 2018.

Government data for LAC is published 1 year retrospectively, therefore the national data discussed

in this report is for the year 2016 – 2017. Nationally the number of LAC has continued to rise; it has

increased steadily over the last nine years.

By 31 March 2017 there were 72,670 LAC in the UK, an increase of 3% on 2016. The number of

children starting to be Looked After has also risen in recent years and has increased by 2% over 2016

- 2017 when compared to the previous year.

Table 1: Number of LAC at 31 March 2013 to 2017

Year ending 31

March

Number of

Looked After

Children

Year on year

change

Rate per 10,000

children under 18

years

2013 68,070 60

2014 68,820 +1% 60

2015 69,500 +1% 60

2016 70,450 +1% 60

2017 72,670 +3% 62

Source: SSDA 903

The number of children ceasing to be Looked After in 2016-17 fell by 2% compared with the previous

year. In 2016 the number of adoptions fell for the first time since 2011, by 12% and in 2017 the

number of LAC adopted has fallen again by 8% to 4,350.

There was a large rise in the number of unaccompanied asylum-seeking children in 2016 and this

number continued to increase in 2017. The number of LAC at 31 March 2017 who were

unaccompanied asylum-seeking children increased by 6% up to 4,560, compared to 4,300 in 2016

and up 134% from 1,950 in 2013.


Graph 1: Showing the increasing national LAC figures

(Ref: https://www.gov.uk/government/statistics/children-looked-after-in-england-including-

adoption-2016-to-2017)

2. National Guidance

Local authorities, commissioners and providers of health services are directed by primary legislation

and national policy and guidance to share responsibility in improving the health outcomes for

children and young people who are Looked After.

Key policy frameworks that inform and support this guidance are as follows:

• Healthy Child Programme (0 – 5) Pregnancy and the first five years of life (2018)

• New Social Work Act became law in 2017, within this it has extended the provision for Care

Leavers up until the age of 25 years. This came into effect in April 2018.

• Not seen, not heard: a review of the arrangements for child safeguarding and health care for

looked after children in England (CQC) (2016)

• Working Together to Safeguard Children (DFE 2015) was reissued and subsequently the NHS

England Accountability and Assurance Framework was also revised (NHS England 2015).

• Promoting the health and well-being of Looked after Children. Statutory Guidance for local

authorities, clinical commissioning groups and NHS England (DFES/DOH 2015) and the

intercollegiate role framework Looked After Children: Knowledge, skills and competencies of

health care staff (RCPCH 2015)

• Statutory Guidance on Promoting the Health and Well-being of Looked After Children (2015)

• NICE Public Health Guidance 28: Looked After Children and Young People (May 2015)

• NHS Outcomes Framework 2014 – 2015

• Children’s National Service Framework (NSF) (2014)

• The Children and Families Act (2014)

• The Care Act (2014)

https://www.gov.uk/government/statistics/children-looked-after-in-england-including-adoption-2016-to-2017

https://www.gov.uk/government/statistics/children-looked-after-in-england-including-adoption-2016-to-2017


• Ofsted report: From a distance: Looked after Children living away from their home area.

(April 2014)

• Public Health Outcomes Framework for England 2013 – 2016;

• NICE Quality Standard QS31: Quality Standard for the health and well-being of Looked After

Children and Young People (April 2013)

• The Health and Social Care Act 2012

• Healthy Lives, Brighter Futures: the strategy for children and young people’s health (2009)

• DH / DCSF Strategy on the health of children in the youth justice system (2009)

• High Quality Healthcare for All and World Class Commissioning (2008)

• Children and Young People in Mind: National CAMHS Review (2008)

2020 Workforce Strategy (2008)

3. Local Commissioner / Provider arrangements

Since March 2012, City Health Care Partnership CIC (CHCP CIC) has been commissioned by the Hull

Clinical Commissioning Group (CCG) to deliver the LAC service for all children within the looked after

care system.

Until 31st

March 2018 the Designated Nurse for LAC continued to carry out a role that would

ordinarily be carried out by a Named Nurse for LAC, a role that was not separately provided in

Kingston upon Hull. The Designated Nurse for LAC has been recruited to within the CCG and the role

of the Named Nurse for LAC is temporarily recruited to within CHCP CIC. The permanent post for

Named Nurse for LAC is due to be recruited to CHCP CIC in the near future.

4. 2017 CQC Inspection Action Outcomes

The 2016 - 2017 LAC annual report on the review of health services for Safeguarding and Looked

After Children Hull focused on the experiences and outcomes for children within the geographical

boundaries of the Local Authority area and reported on the performance of health providers serving

the area including Clinical Commissioning Groups (CCGs) and NHS England Local Area Teams (LATs).

An action plan was developed with the services involved in the inspection. The actions for the

Looked After Children’s Health Team (LACHT) were:-

• Strengthen the arrangements for using the Strengths and Difficulties questionnaires (SDQs)

in health assessments of LAC.

A dip sample of 34 Review Health Assessments (RHA) undertaken in March 2018 indicate that 84.8%

evidenced reference to the SDQ. The Named Nurse for LAC will continue to undertake 6 monthly

audits of the RHA through 2018-19 in order to monitor and evidence further improvements in the

use of SDQs.


Joint work between CHCP CIC and the Local Authority continues to strengthen and utilise the

information gathered within SDQ responses.

• Ensure the Part C health action plan within RHAs are routinely shared with LAC and their

foster carers.

The LACHT continued to investigate acceptable options for sharing a paper copy of the RHA with

carers or young people during 2017- 2018, however all practitioners undertaking RHAs with children

and young people discuss and agree the health action plan with the foster carer and child or young

person, at the time of the assessment. This process has progressed and since May 2018 and finalised

paper copies of the RHA are sent to young people and their carers as requested.

5. Integrated Looked after Children meetings (ILAC/Health & Social Care)

The Named Nurse and the LAC Administration Team facilitated these meetings which took place in

May 2017, July 2017, November 2017 and January 2018, allowing productive discourse on issues

including the late notification of Children and Young People (CAYP) becoming LAC and its impact on

the timely completion of assessments / Key Performance Indicators (KPIs).

The Named Nurse continues to work with the CCG and LA senior management to improve

representation and the frequency of these meetings. Since May 2018 the ILAC meetings have been

successfully re-established and well attended.

6. Performance

The performance data is provided 1 month retrospectively on a monthly basis, to the CCG as per

contractual requirements. On 31st

March 2017 the total number of Hull LAC was 758, which has

decreased from 774 LAC CAYP as of 31st

March 2017.

This figure includes Hull LAC placed in Hull, Hull LAC placed out of area (OOA) and OOA LAC placed in

Hull. The table below shows that by 31st

March 2018 there were less Hull LAC placed in Hull but

more Hull LAC placed out of area, including in the East Riding, compared to previous years. The

number of LAC from out of area placed in Hull has almost doubled in the last 2 years.

So although the Hull LAC numbers having decreased, the demand on services has remained due to

the sustained total number for the LACHT to provide services to.


Table 2: Showing the number of LAC placed by Hull Local Authority, both in Hull and OOA. The table

also reflects the number of OOA LAC placed in Hull.

Placement Area 2016

Total

Number of

Children

2017

Total

Number of

Children

2018

Total Number

of Children

Hull LAC placed Hull 444 463 417

Hull LAC placed OOA 218 231 243

OOA area LAC placed Hull 54 80 98

Total number of LAC for LACHT caseload 716 774 758

Graph 2: Showing the number of LAC placed by Hull Local Authority, both in Hull and Out of the

Local Area. The table also reflects the number of Out of Area LAC placed in Hull.

From 2017 the completion of Part A of the Coram BAAF IHA within the Local Authority’s Liquid Logic

data system has allowed for more comprehensive figures within this report than in previous years.

Table 3: Child in Need Code for LAC in Hull

Child In Need Code (Reasons for

Becoming LAC) 2016 2017 2018 As a % National

%

Child In Need Code (Reasons for Becoming LAC)

2016 2017 2018 2018 2017

Abuse or neglect 137 180 516 68.12% 62%

Child’s disability 7 6 15 1.97% 3%

Parental illness or disability 4 8 11 1.45% 3%

Family in acute stress 21 17 41 5.4% 8%

Family dysfunction 55 72 143 18.86% 15%

Socially unacceptable behaviour 3 1 5 0.65% 2%

Low income 0 1 3 0.39% -

Absent parenting 9 20 24 3.16% 7%

Total 236 305 758 100% 100%


Graph 3: Child in Need Code for LAC national % compared to Hull %

The ethnic origin data provided within the Liquid Logic data system is more condensed than in

previous years.

Table 4: Ethnic origin LAC Hull

ETHNIC ORIGIN OF LOOKED AFTER CHILDREN AT

31st

MARCH 2018

2018 %

White 682 89.97%

Mixed 27 3.56%

Asian or Asian British 17 2.24%

Black or Black British 5 0.66%

Other ethnic groups 27 3.57%

Total 758 100%


7. Initial and Review Health Assessments

From 1st

April 2017 – 31st

March 2018 there were a total of 190 LAC Initial Health Assessments (IHA)

in Hull and 658 Review Health Assessments (RHA) completed. In comparison to the 2016-2017

figures this is a 14.7% increase in LAC IHA and a 35.3% increase in RHA completed.

This significant increase in demand has had a noticeable impact on achieving set timescales. For the

year of 2017 – 2018, 51% in total CAYP were offered an appointment for their Initial Health

Assessment within 28 days of becoming Looked After.

Of the 51% who were offered IHAs within timescales, 71% were completed within timescales,

excluding those outside the control of CHCP, for example incomplete parental consent for medical

assessments, late notification of becoming Looked After or cancellation of the appointment.

In regards to RHAs, 100% of LAC aged 0 – 4 years were offered an appointment within 6 months of

their last health assessment and 99% of LAC aged 5 – 18 years were offered an appointment within

12 months of their last health assessment.

Graph 4: Number of LAC who had an IHA per month from March 2017 – February 2018


Graph 5: Percentage of Initial Health Assessments offered to LAC within 28 day timescale

8. Late notifications

CHCP LACHT administration team record within the child’s electronic care record (ECR) when a child

or young person becomes Looked After. It is also recorded if the notification period is over the

agreed 5 working day notification period given by the Local Authority (LA).

The breach information is provided to the Local Authority to investigate why the notification was

sent to the LACHT outside of the agreed 5 working day notification period. The LA findings are given

to Business Intelligence to feedback to the CCG.

9. Consent

There has been a significant improvement in the receipt of the Coram BAAF consent form from the

Social Work teams. As mentioned earlier in the report, there are still some instances where

appointments have had to be cancelled due to the lack of parental consent, but these instances have

reduced from previous years.

As already discussed, consent to share Part C of the RHA has been made explicit, and the consent

form amended accordingly. Practitioners are now routinely sharing the Part C document with the

young people (if over 13 with capacity to consent).


10. Dental Health

In 2017 – 2018, 60.2% of CAYP were already registered with a dentist on entering the LAC system,

this increased to 86.9% at their RHA 6 or 12 months later as appropriate to age. National data states

that 58.2% of the child population were seen by an NHS dentist in the 12 months up to 30th June

2017.

Reference: ( https://digital.nhs.uk/data-and-information/publications/statistical/nhs-dental-

statistics/nhs-dental-statistics-for-england-2016-17 )

Graph 6: Dental registration for LAC in Hull

It can be seen from table 5 that although the Hull statistics are better than the reported national

statistics there remains scope for further work in promoting dental care for LAC. This will continue to

be addressed by the LACHT.

11. Immunisations

In Hull in 2017 -2018, 63.4% of LAC’s immunisation status were up-to-date when they had their IHA,

which is a drop compared to recent years. By the first RHA 88.8% of LAC’s were up to date with

immunisations, an increase compared to the 2016 – 2017 figure. Hull’s figures remain lower than

national trends.

National data shows that in 2016-17, four out of the six routine vaccinations at 1 and 2 years showed

small decreases in coverage compared to 2015-16. This includes coverage for the Measles Mumps

and Rubella (MMR) which decreased in 2016-17 for the third year in a row. Coverage for this vaccine

is now at 91.6 per cent, at a similar level to that reported in 2011-12.

https://digital.nhs.uk/data-and-information/publications/statistical/nhs-dental-statistics/nhs-dental-statistics-for-england-2016-17

https://digital.nhs.uk/data-and-information/publications/statistical/nhs-dental-statistics/nhs-dental-statistics-for-england-2016-17


Nationally 93.4 per cent of children reaching their first birthday were reported to have completed

their primary DTaP/IPV/Hib course (three doses). This compares with 93.6 per cent in 2015-16.

National coverage figures reported for the Diphtheria, Tetanus, Pertussis and Polio (DTaP/IPV)

booster as measured at 5 years show a decrease in 2016-17 for the fourth year in a row.

The LACHT continue to advise carers to attend the child’s GP for immunisations. All LAC

immunisation status is reported within the initial LAC review meeting health report and updates are

provided at subsequent LAC review meetings. The CHCP CIC School based immunisation team

immunise children and young people at home where required, including the residential looked after

children’s homes.

Graph 7: Immunisation status of Hull LAC

12. Sexual Health

The LACHT continue to work with Specialist Sexual Health Services for young people. A central

telephone number for both client and professional referrals is staffed Monday-Friday 9am-5pm and

an answer-machine is available for referrals at all other times.

This ensures that the referrals into Sexual Health services are dealt with swiftly and efficiently. Joint

visits between practitioners are arranged where it is felt that this will help facilitate engagement

with young people. Proactive information sharing has developed considerably between the two

teams, supported by CHCP CIC safeguarding team.


Referrals made by Sexual Health Services to Children’s Social Care access and assessment team are

now saved on the child’s ECR. The Specialist Sexual Health Services for young people are now invited

to child protection conferences.

A standard operating procedure (SOP) supports these processes and facilitate the timely sharing of

relevant information and early identification of risk and/or sexual health need for Hull LAC and other

vulnerable young people.

13. Child Exploitation

The Child Exploitation Team is now a permanent service within Children’s Social Care and work has

been completed on the Risk Indicator Tool (RIT) which is now firmly embedded in practice.

CHCP CIC Safeguarding Practitioners attend the MACE meetings and liaise with the LACHT in regards

to LAC where appropriate.

The Specialist Sexual Health Service practitioners have access to the ECR. This ensures that if a young

person accesses the service, relevant practitioners will be aware if they subject to the MACE process.

14. Emotional Health

The LACHT administrative staff circulate a set of SDQs for completion 3 months after a child or young

person becomes Looked After, to facilitate a baseline assessment for the Social Worker (SW) and

Independent Conference Reviewing Officer (ICRO) about the emotional health of the child or young

person entering the Looked After system.

A second set of SDQs are sent out to correspond with the first RHA to enable the Social Worker to

demonstrate the emotional health status of children as they come into care and compare this with

the relevant score after being in the Looked After system for 6 months or a year, depending on the

age of the child. The LACHT use the SDQ responses to inform a holistic health assessment for LAC. If

the SDQ is not available to inform the RHA, this is included as an outstanding action in the child /

young person’s health plan.

Where a child or young person is assessed as having an emotional health need requiring extra

support they will be offered additional contacts by the LACHT. If the assessment deems that

specialist support is required a referral to CAMHS will be made.

All referrals to CAMHS are now made electronically. The 9 pathways that have been developed by

CAMHS are embedded into the screening tools within the child or young person’s ECR. There is a

hyperlink into the electronic referral system so that CHCP can report on the number of referrals

made into CAMHS, improving the quality of information overall.


15. Substance Misuse

When CAYP are assessed by the LACHT as having an identified need around substance misuse they

are automatically referred to REFRESH, the adolescent substance misuse service. The LACHT

continually work with REFRESH to strengthen the existing referral and assessment pathways. Joint

visits between practitioners are arranged where it is felt that this will facilitate engagement with

young people.

16. Looked After Children and Young People’s Health Team (LACHT)

Table 5: Number of LAC within on LACHT caseload on 31st

March 2018

Hull LAC placed in Hull Boys Girls

Age 0 -1 years 39 18 21

Age 1 – 4 years 147 80 67

Age 5 – 9 years 179 95 84

Age 10 – 15 years 268 153 115

Age 16 – 17 years 125 67 58

Graph 8: Percentage of LAC on LACHT caseload on 31st March 2018


In August 2017 the post of Designated Nurse for LAC was reappointed. During 2017 – 2018

processes have been developed to enhance efficiency in working practice.

The LAC RHA document in use has been updated to the Coram BAAF 2017 version. The RHA

documents are now completed by the LACHT practitioners directly within the LAC ECR. This change

in process has reduced the number of administrative steps, thereby reducing the length of time the

LACHT practitioners and administrative staff need to spend on the process.

The SOP for ECRs of adopted children has been completed and ratified ensuring that when a child is

adopted their new ECR is created and the old ECR is ended securely guaranteeing there are no

familial links between each ECR.

LAC Review Meeting reports have been standardised to ensure all practitioners include essential

information for ICRO’s and SW’s. Training has been provided for new practitioners within the LACHT

in completing the RHA documents to an exemplary standard.

The Designated Nurse attended ICRO team meetings on a quarterly basis to create a better

understanding of roles, enhance communication and provide updates to the ICRO’s in regards to

changes in practice within the LACHT. The Named Nurse for LAC will continue this meeting

attendance through 2018 – 2019.

Professional links have been strengthened between the Designated Nurse for LAC and all the CAYPs

Social Care Teams as well as the ICROs. This has had a significantly positive impact on

communication pathways. Social Care Team administrators and many of the SW’s have the direct

contact details for the LACHT, including the LACHT administrative team and the Designated Nurse

for LAC. They are able to directly discuss queries or issues with regards to the health or well-being of

any LAC or foster placement and are better able to co-ordinate professional meetings. This

professional relationship has continued with the Named Nurse for LAC.

Several members of the LACHT have been trained as Foster Panel members. Their attendance at

Foster Panel has given them greater insight into the legislative requirements for foster carers and

foster placements. This knowledge and practice has enhanced their work when supporting LAC and

carers.

Several members of the LACHT attended a Foster Carer Event. This allowed the LACHT to highlight

their extensive role in supporting foster carers and LAC. The event generated new referrals into the

team for support from carers, evidencing the success in raising the team profile.

LACHT members have been invited to attend Hull foster carer support groups in both Hull and East

Yorkshire. This will allow practitioners to provide up to date health advice to carers and continue to

raise the profile of the LACHT’s role.

Links have been made with the Local Authority training team and plans are in progress to provide

foster carers with health training updates through 2018 – 2019.

Nationally the term “LAC” is being phased out in favour of the term Children Looked After (CLA). This

term is being embedded in practice by the LACHT, the ICRO’s and SW’s in the Local Authority. The

2018 -2019 LAC Annual Report will reflect this in the terminology used.


The 2017 CQC review of health services in Safeguarding and Looked After Children’s services in Hull

highlighted some excellent work offered within the skill mix team including:-

• A strong adolescent offer which enables effective safeguarding and provides good

opportunities for identifying and responding to additional needs.

One example of such work was engagement with a young person in foster care who had tried to

conceal an unplanned pregnancy. The LACHT practitioner was able to co-ordinate an effective

support plan for the young person ensuring appropriate professionals were kept informed as

needed.

Another example was the support given to a young person identifying themselves as transgender.

The LACHT practitioner was able to make a direct referral to the Tavistock Centre, a Gender Identity

Development Service (GIDS) and reassure the young person about the counselling and assessment

process.

• Good relationships with education, good knowledge of missing from home and home

educated children.

There remains a dedicated School Health Practitioner for home educated

CAYP. The pop-in clinics at the pupil referral unit, which are attended by a number of LAC continue,

and are an excellent forum for addressing health needs.

• Regarding the Health and Development Practitioners (HDP) the inspectors saw some good

outcomes and examples with good direct engagement with young people.

The LACHT HDPs have maintained monthly staff liaison meetings with the children’s homes within

the city. This has proven useful in partnership working and information sharing for safeguarding

purposes.

Some of the exceptional work provided by the HDPs within the LACHT team include:-

A relative carer was provided with some nutritional advice and support for her 2 grandsons, one was

under-eating and the other was over-eating. After several visits the carer was pleased with the

effectiveness of the strategies she had been given for both the young people, she was also proud to

tell us that having followed the advice she had lost 2 stone.

A HDP successfully encouraged a vulnerable young person to receive contraception. This young

person had adamantly refused to engage with the Specialist Sexual Health Services prior to this.

• An improved relationship with CAMHS. In 2017 the LACHT have held regular monthly peer

supervision meetings with the CAMHS practitioners. All practitioners within the LACHT continue to

have telephone consultations with the LAC psychologist employed within the Local Authority, in

respect of individuals they are jointly working with.


An example of a positive outcome would be a referral made for a young person to CAMHS being

accepted, with an expected consultation within 7 days of the referral, evidencing the LACHT

practitioners’ skill and accuracy in the assessment of emotional health and well-being of children

and young people.

• Good quality LAC health assessments. Assessments were of a high quality and focussed on

the needs of the children, they had smart outcomes, showed continuity of care, were child focussed,

with the child at the heart of the assessment.

Some examples of the effectiveness of quality assessments include:-

A LACHT practitioner identified a young person with unusual growth and referred him to the

endocrinologist. Further tests identified a significant endocrine problem.

The persistence of reappointing and rearranging a RHA for a young person for 5 months. The young

person would agree to have the assessment, but cancel at short notice. Despite this the practitioner

continued to offer support, at the LAC review meeting, the young person happily agreed to remain

after the meeting in order for the practitioner to undertake the outstanding RHA.

17. Service User Feedback

At RHAs, the Health Assessment Feedback forms are left with carers and young people aged 11 years

and over to complete and send back in a stamped addressed envelope allowing anonymous

responses. There were 244 collated feedback forms for 2017 - 2018.

Table 6: Feedback Form responses from RHAs How much do you agree with the following statements Health

Visitors

School

Nurses

Confidentiality was discussed with me 94.4% 93%

I felt I could discuss sensitive issues with the nurse 100% 89.44%

The nurse listened to me 100% 100%

The nurse was friendly 100% 100%

I would see the nurse again for support 97.76% 94.72%

I would recommend the nurse to a friend if they had

health concern

98.88% 90.76%


Graph 9: Feedback form response at RHA

Comments from Feedback Forms at RHA

• Very friendly and easy to talk to

• Prompt on the visit, structured questions so I feel we covered everything, I have contact

phone number if needed, and nurse contacted me to arrange appointment, very happy

child’s info. Extremely professional and offered good advice.

• Thank you come again!

• I felt totally at ease with the nurse and felt she listened and was interested in my views and

concerns, she was very professional and explained things I didn’t not understand in a way

that made sense to me. Thank you. The person I was talking to was nice.

• The nurse turned up on time, she was very friendly and professional

• Every question answered fully

• Thank you, you really took time listening to child as she does struggle at times

• Nurse is very friendly and easy to talk to about anything, she is able to put young person at

ease.

• I hope that next time I have a health meeting I have the same nurse

• Felt very comfortable, nurse was very helpful and easy to talk to and discuss life events /

problems

• She was really nice and comfortable / easy to talk to


18. Summary

The number of LAC within Hull for as at 31st March 2018 decreased compared to 31st March 2017,

but remains significantly higher than previous years. The upward trend in Hull mirrors an upward

trend nationally. This trend may be influenced by the national reduction in adoption figures.

During 2017 - 2018 there was a 14.7% increase in LAC IHAs and a 35.3% increase in RHAs. These

figures have had a significant impact on performance figures and work continues within the

Community Paediatric Team to meet the increase in demand.

During 2017 there continued to be significant difficulties created by late notification of LAC status

for CAYP. It has been recognised that the late notifications to LACHT by the social care teams has

had a significant impact on enabling the IHA’s to be completed in a timely manner. The issue was

escalated to Hull CCG through the contracting report and to the Local Authority through the ILAC

meetings. LACHT and the Local Authority continue to work towards solutions to this issue.

The LACHT have undergone significant changes in staffing structure during 2017 – 2018, leading to

the Designated Nurse for LAC during that time period managing a LAC caseload alongside

undertaking the role requirements. Significant effort has been made to ensure this had a minimal

impact on performance. The role of Designated Nurse for LAC was transferred to the CCG on 1st

April

2018, with the Named Nurse for LAC role remaining within the provider service as recommended by

the unpublished joint agency pilot inspection in 2014, previously referred to in the 2016 – 2017 LAC

Annual Report.

The actions for the LACHT from the 2017 CQC review of health services in Safeguarding and Looked

After Children’s services in Kingston upon Hull have been met. The excellent work provided by the

LACHT highlighted within the 2017 CQC review has been embedded into practice and can be

evidenced through client feedback and SW feedback.

Due to changes within the LA’s data systems and completion of the Coram BAAF IHA Part A

document, data for reasons for LAC entering the care system could be included in this report. It can

be seen in Table 3 of the report that abuse or neglect is by far the most common reason within Hull

at 68.12%. The next most common reason is recorded as family dysfunction at 18.86%. These figures

mirror national trends. Information from the Local Authority indicates that 89.97% of LAC in Hull on

31st

March 2018 were of white ethnic origin. The Local Authority were unable to provide a separate

figure for unaccompanied asylum seeking children within Hull for the 2017 – 2018 time period.

Dental registration statistics for Hull are similar to national statistics. Improvement in dental

registration after a child or young person has entered the care system are similar to the 2016 – 2017

level. The rise from 60% at IHA to 86.9% at RHA evidences the dental health education that is

reinforced by the LACHT.


Immunisations statistics for Hull are lower than the national average, but 88.8% of LAC have their

immunisations brought up to date by the first RHA, evidencing the effectiveness of the advice and

information provided to SWs, ICROs and foster carers at LAC Review meetings by the LACHT.

Effective partnership working is embedded in practice with the LACHT and can be evidenced through

the positive outcomes for LAC. The LACHT continue to work closely with the Specialist Sexual Health

Services, REFRESH, CAMHS and all the SW teams.

The LACHT ensure promotion of the health and well-being of all Looked After CAYP at every contact

made with the CAYP as well as the professionals involved in each CAYP’s life. The team is proud of

the recognition of this perseverance through the positive feedback they receive from the CAYP, SWs

and foster carers.

13. Recommendations

The appointment of the Designated Nurse for LAC within the CCG and the forthcoming permanent

appointment of the Named Nurse for LAC will facilitate a continued Improvement of the health

profiling for Looked After CAYP.

The Designated Nurse and the Named Nurse for LAC will continue to work with the Local Authority

to improve the timeliness of the notification process for Looked After Children.

The Designated Nurse and the Named Nurse for LAC will continue to work with the Local Authority

to transfer the responsibility for administration of the Strengths and Difficulties Questionnaires back

to the CAYP Social Care Teams. See Appendix one Action plan 18/19.

The LACHT will continue work with foster carers on the importance of promoting bonding and

attachment in looked after children. A formalised training package for foster carers will be

implemented jointly with the Local Authority Training Department. See Appendix one Action plan

18/19.


APPENDIX 1

ACTION PLAN 2018 – 2019

Recommendation Actions Responsibility Timescale

1. Transfer the

administration of the

Strengths and

Difficulties

Questionnaire

(SDQ) to the Local

Authority

Steering Group to

develop clear transfer

process

Training sessions to be

provided to all Hull Social

Care area Teams in

regards to administration

and interpretation of

SDQ’s

Designated Nurse

for LAC

Named Nurse for

LAC

December

2018

2. To improve the

notification of a LAC

child process

• To continue the ILAC

meetings to engage

with the Local authority

• To use the escalation

process

• Implement, evaluate

and monitor progress

through performance

reporting

Designated Nurse

for LAC

Named Nurse for

LAC

December

2018

3. Develop a training

package for foster

carers regarding the

development of

children, infant

feeding and nutrition

and bonding and

attachment.

• Designated Nurse to

develop training

package in

collaboration with

• the Local Authority

training team

• associated

professionals within

the CHCP CIC 0-19

CAYPS, including the

Infant Feeding Co-

ordinator and the

Dental Health Team

Administration

Team

Designated Nurse

March 2019


APPENDIX 2

IHA Quality Assurance data from Designated Doctor for LAC

The Designated Doctor for Hull Looked After Children undertakes an annual audit of a random

sample of Initial Health Assessments. From this audit, recommendations are shared with the

Community Paediatricians to ensure an excellent standard is maintained when completing the IHA

documents.

Dr. Grover undertook the audit in November 2017. Utilising a formatted quality assurance tool, Dr.

Grover’s analysis was as follows:-

Date; those present; sources of information; consent detail; background information; current health

and developmental status; emotions/ behaviour/mental health and lifestyle; quality of health plan;

summary and contact information.

Dr. Grover noted that the standard for adequacy of the care plan recommendations was 100%. Dr.

Grover’s recommendations from the audit of the IHA’s for age 10 -17 years were as follows:-

• Health recommendation should include a time limit for registration with GP/ dentist.

• Outstanding immunisations should be specifically identified

• The Health Care plan should address all issues uncovered in discussion including emotional

and mental health; and education

• Appropriate professional responsible for identified actions should be named

• Time targets should be specified for each task arising from issue(s) identified

Dr. Grover noted that the standard for adequacy of the Care Plan recommendations was 100%. Dr.

Grover’s recommendations from the audit of the IHA’s for age 0 - 9 years were as follows:-

• Even if the parent information is available but there is no consent to share this information,

it should be clearly stated as such on part C.

• If parent information is not available, a request for the SW to supply, within the Health Care

Plan.

• Parental health information can be directly obtained from them if present at the health

assessment. Similarly Maternity history too can be obtained directly from mother when

present.

• Neonatal screens’ reports should be included as part of birth information.

• Health recommendations should include a time limit for registration with GP/ dentist.


The LACHT have noted that the standard of IHA document information has improved since the last

audit with full health chronologies where appropriate and clear recommendations with specific

timescales. This ensures that information shared at LAC review meetings is precise and roles and

responsibilities are unambiguous.

annual report for looked after children

Documents