Agenda item

Report of Interim Strategic Director, Care Wellbeing and Learning

The Committee received the annual report on the work of the Looked After Children and Young People Health Team in 2015-16.

Key activity over the last year includes the work of the Designated Doctor, Dr Helen Palmer, in identifying children who have evidence of Foetal Alcohol Spectrum Disorder. Work has been ongoing to ensure children becoming looked after have Initial Health Assessment’s, of the 180 notifications received over the year, 172 had their Initial Health Assessment’s completed, 47% of which were completed within 28 days.  It was also reported that 85.9% of the 313 Review Health Assessment’s carried out were completed within 28 days of their due date.

It was noted that work is ongoing to ensure care leavers receive their Leaving Care Health Passports, this identifies any health needs. In terms of statistical returns there was a high percentage had health assessments, dental appointments and immunisations. Overall this was above national, regional and previous year’s figures, although it was noted that dental appointments dipped due to reporting after 1^st April, however there are no concerns regarding looked after children’s access to dental services.

Work continues around the development of the Expanding Minds Improving Lives project and within that looked after children have been identified as a priority group.  In terms of drug and alcohol services there were 42 referrals received, this is an increase on the previous year figures, however it was acknowledged that the previous year’s data was limited. The majority of referrals were for nicotine, cannabis and alcohol.  It was reported that there were 59 looked after children contacts into sexual health services, these contacts were for contraception, pregnancy testing and STI screening.

It was noted that Dr Palmer is a member of the Adoption Panel, 52 medicals were undertaken during the year and 27 matches were made, this is an increase on the previous year.  Dr Palmer also attended 10 Foster Panels over the last year and it was reported that there was a fall in the number of adult medicals requiring medical advice compared to the previous year.

Training has been provided to foster carers, including specific training on caring for children with Foetal Alcohol Spectrum Disorder. Looked after children’s health needs were also included in safeguarding training to GP’s and A&E obstetric and paediatric staff.

The Clinical Commissioning Group has invested additional resources into the team, with a Specialist Nurse and part time administrator being appointed. The Designated Nurse LAC, Linda Hubbucks, is now Designated Nurse in the CCG and will have a strategic role covering Newcastle and Gateshead. The position on the team has been replaced by a Named Nurse LAC. Work is ongoing to develop RAG rating for young people, in relation to their health needs, to prepare them for independence and support their transition to leaving care. The RAG rating with tie in with the young person’s pathway plans and will profile their individual needs. In addition, there is work continuing on the development of a database to record and analyse health needs. This will help the team to profile the total population of Gateshead.

It was noted that during the current year further development and monitoring of the strengths and difficulties questionnaire process will be undertaken as well as improving timeframes for Initial Health Assessments. It was reported that Dr Palmer will be retiring at the end of 2016 so contingency planning is underway.

Dr Palmer spoke to the Committee about her work on identifying looked after children with Foetal Alcohol Spectrum Disorder. It was reported that this has become apparent through fostering concerns. The only clinic in the country to deal with the disorder is in Southampton, which would be robust psychological testing over a number of days. It was felt that this would not be appropriate to the children diagnosed within Gateshead, therefore training has been provided on how to diagnose the disorder through the Children and Adolescent Mental Health Service. A pathway has been drawn which fulfils international criteria.  There is a lot of work ongoing to identify affected children in Gateshead, for example looking at how they have come into care. It is important to identify early in order to prevent secondary diseases occurring, in addition many are not mature enough to leave care at 18 therefore this needs to be taken into account during pathway planning.

It was acknowledged that this has increased since 2015 with one third of looked after children having that disability, therefore a lot of training has been delivered, for example to foster carers.  It was also recognised that there is a huge stigma attached to Foetal Alcohol Spectrum Disorder and now expectant mothers are being advised that no amount of alcohol is safe during pregnancy.

It was questioned whether this was the findings of a conclusive study. It was noted that this has been through diagnosis and also has been exemplified through an increase in Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder, with more complex needs and worse outcomes for children and young people. It was confirmed that training is in place for foster carers and schools are visited after diagnosis.

It was queried whether there was any scope in health authorities coming together to develop a specialist unit in a more central location in the country. It was acknowledged that there needs to be a local resource as there are too many children, with approximately 500 within Gateshead’s population. It was noted that the clinic in Southampton would only take children with evidence of Foetal Alcohol Spectrum Disorder, however this can be diagnosed locally anyway, it is also felt that it would be too stressful for children.

It was questioned how these learning difficulties can definitely be attributable to Foetal Alcohol Spectrum Disorder when learning difficulties can be for a number of reasons and include a lot of contributory factors.  It was noted that there has been a vast increase in Autism Spectrum Disorder and this is one of the causes. It was reported that there are 600-800 children and young people in Gateshead and Newcastle who do not have typical Attention Deficit Hyperactivity Disorder, and the wider parameters need to be examined.

RESOLVED    -           That the comments of the Committee be noted.