Agenda item

The Children in Care (Health) Team Manager will be in attendance to provide the Panel with information in relation to its current scrutiny topic from a health perspective.

At its previous meeting the Panel agreed to invite a representative from the Children in Care Health Team to provide an overview of how children and young people with care experience are supported to ensure their physical and emotional health needs were met.  Accordingly, K Dudding, Named Nurse with the Tees Valley Children in Care service was in attendance to provide a presentation to the Panel.

By way of background, the Panel was informed that from 1 April 2022 responsibility of initial health assessments (IHAs) and review health assessments (RHAs) for South Tees NHS Trust was amalgamated into a Tees Valley Children in Care contract.

All children coming into the care of the local authority must have an initial health assessment within 20 days to ascertain an overall view of their physical and emotional health needs and to ensure that they were registered with a GP and dentist.  A Health and Care Plan was also devised.  Children in care aged five and under had a review health assessment every six months and this was carried out by a nurse within the Team.  For children over the age of five, review health assessments were carried out on an annual basis.

Where there was an identified health need, this would be passed to the 0-19 service which included health visitors and school nurses to provide ongoing support.  Where there was a bespoke health requirement, for example an issue with emotional health and well-being, the case-holder would be responsible for supporting the child and co-ordinating an additional package of support.

Once the young person reached 15, the Team would start talking to them about their Care Plan and review health assessments and amalgamate the information into a Health Passport.  The Health Passport would handed over to the young person at around 17 and a half years of age.

It was highlighted that some areas of the country would only hand over the passport to the young person if they consented to accept it, however, the decision was taken to not give that option in Middlesbrough so that all young people would be given their health passport and it would also be sent to their GP so that they would have it on record.  It was clarified that the young person was still required to give consent for the passport to be shared with their Social Worker, therefore, if they did not give consent for this it could not be shared with the Social Worker.

The passport contained details of childhood immunisations, GP, dentist, opticians, attendance at A&E, family history.  All of this information would be collated once the young person became 16 then discussed with them at their final health review assessment at age 17 at which point the information from the final HRA would also be added to the passport.

Once completed the health passport was sent to the young person and their GP and would remain on their GP record so that they could access it at any point in the future.

During a discussion, the following issues were raised:-

·        It was queried whether all of the information provided within the passport was already on their health record with their GP.  In response it was explained that the NHS IT system used to record health information, System One, was not user-friendly for non-professionals and generated excessive amounts of paper to print off any records, whereas the passport provided a condensed summary of everything on the young person’s health record in an easy to understand format.

·        It was queried whether the Team ensured that the young people were registered with a GP and dentist and whether this was followed up.  It was explained that there was no budget within the contract to follow up, however, up to the age of 18, or 25 if the young person had an identified SEN, each young person should be registered with a GP, dentist and optician.  If the team became aware of a young person who was not registered with a GP, this would be identified within their care plan and rectified.  The Panel was informed that a new pilot scheme had been launched in January across the Tees Valley to ensure that any young person who had not been seen by a dentist within the last six months could be referred to a dentist that had signed up to the pilot.

·        In response to a question regarding how many young people in Middlesbrough were open to the team and how many were about to become ‘care leavers’, the Panel heard that when the Team took over the contract there was a backlog of health assessments across the south tees which had now been cleared.  There were around 40 young people open to the service in Middlesbrough, with around 10-12 due to become care leavers in the near future - a total of between 50 and 60 in Middlesbrough alone.

·        Clarification was sought in relation to the final review health assessment and it was confirmed that this took place before the young person’s 18^th birthday.  The information for the health passport was collated once the young person was 16 and the team started to talk to the young people about the health passport at around 15-16 to explain what it was and the information that would be contained in it.  Once the final RHA had taken place, the information from that was added to the other collated information and the passport was completed.

·        A Panel Member asked what percentage of children/young people were not registered with a GP when they first became open to the service.  The Panel was advised that this figure was minimal and was 1.6% for children in Middlesbrough.  In terms of those registered with a dentist, the figure was 11.2% in Middlesbrough, prior to the start of the pilot scheme, however, this figure could be slightly skewed as it did not ask when the young person last saw a dentist so it could be that they had seen a dentist but were not registered with one or that they had been automatically deregistered with a dentist because they had not seen one for six months.

·        A Panel Member asked whether young people were prepared to take up the passport.  The Panel was informed that they were not given a choice as it was felt it was a very important document that provided a user friendly summary of their health record.  There was also a tendency for young people who felt fit and healthy to feel that they did not need a health passport, however, this way they were able to access their health records at any point in the future if required.

·        It was queried whether health passports were also made available to young people who were adopted.  It was explained that for a young person who went on to be adopted, the System One database was closed in respect of that young person, however, HDFT were providing a health summary containing details of the young person’s birth (date, place, delivery, weight), family health history, etc so that there was a record allowing health professionals to have background information on the young person in order to know the best way of supporting them.  There was currently no national guidance in relation to this, however, it was something that had been due to be examined by NHS England prior to the Covid pandemic.

The Chair thanked the HDFT Tees Valley Children in Care Health Service representative for attending the meeting and for the valuable information provided.

AGREED that the information be noted and considered in the context of the Panel’s current scrutiny topic.