Your looked- after child needs

you all!

Commissioners & Providers

My GP

My carers

My IRO

My social worker

Designated nurses and

doctors

My named professional

My designated teacher and

Virtual School Head

My parents

My friends

To help them be healthy

DCS, DPH, Lead member

Promoting the health and well-being of looked-

after childrenWhat the revised statutory

guidance means for you… and them!

Michael Allured and Alan Bell Department for Education and Department of Health

Status of the guidance

• Issued by Secretary of State under s7 Local Authority Social Services Act 1970

• Must be followed by LAs unless there is a good reason not to

• Issued under s10 and s11 of the Children Act 2004 and LAs, CCGs and NHS England must have regard to it

Our approach

The trouble with life isn't that there is no answer, it's

that there are so many answers.

(Ruth Benedict, Anthropologist, 1887-1948)

The overarching ‘golden’ principles

• Many have a part to play in promoting the health of looked-after children

• Mental and emotional health are as important as physical health, as they impact on reaching potential and all aspects of life

• Cooperation and communication – e.g. fast-track GP health records

• Understand the needs of your looked-after population through the JSNA process and plan for them

• Looked-after children should always be registered with a GP and have access to a dentist

• Looked-after children should never be denied a service because of the location or length of their placement

• Keep the child’s voice at the centre of what you do

Strategic planning is key • Everyone’s responsibility: LAs, CCGs and NHS England• All commissioners of health services should have appropriate

arrangements and resources in place to meet the physical, emotional and mental health needs of looked-after children

• Gather information to inform strategic priorities through the JSNA process – ensure looked-after children on the agenda

• Commissioning of services for individual looked-after children should be consistent with the responsible commissioner guidance

• CCGs should have access to the expertise of designated doctors and nurses

• Plan for smooth transitions out of care • Commissioned services should meet certain requirements (para 20)

Health assessments, plans and reviews

• The Care Planning Placement and Case Review Regulations (England) 2010 set the legislative framework for care planning

• Assessments and plans cover areas in schedule 1 of the regs • LA, as corporate parent, is responsible for making sure this

happens – and CCGs should cooperate• Initial health assessment must be done by a doctor; review

health assessments can be done by a nurse• Requirement to have a statutory health assessment doesn’t

apply if a child refuses it

The principles of a good health assessment

• Some of the principles described in paragraphs 44 to 48 of the statutory guidance:– they aren’t isolated events– they focus on the whole child and inform all aspects of care planning– they are undertaken with the child’s consent (if he or is competent to give it); are child centred and take account of individual needs, wishes and feelings; are age-appropriate– they result in the child having clear expectations of future consultation and treatment– they pay particular attention to health conditions that may be more prevalent in looked-after children – they are integrated with any other assessments or plans

Promoting good emotional and mental health

• Understanding the whole child’s needs (the links between emotional, mental and physical health): integral to care planning

• It’s not just the responsibility of CAMHS – and not all looked-after children will need CAMHS

• How do you know if a child’s emotional and mental health issues need addressing? How are you using the SDQ screening tool?

The bottom line:– CCGs, LAs and NHS England should work together to ensure that CAMHS and other services provide targeted and dedicated support to looked-after children according to need, in a tailored way

The Taskforce report on children’s mental health

Dismantle barriers for vulnerable children to get support:• Care pathways incorporating evidence-based interventions• Flexible acceptance criteria for referrals, based on

presenting needs and level of concern• Sensitive enquiry about neglect, violence and abuse• Strengthened lead professional approach• Pilot roll-out of teams specialising in supporting e.g. looked-

after and adopted children, possibly on sub-regional basis• Embed mental health practitioners in services or teams

working with e.g. looked-after children

What primary care teams should do

• Ensure timely access to a GP or other appropriate health professional when a looked-after child requires a consultation

• Provide summaries of the health history of a child who is looked after

• Maintain a record of the health assessment and contribute to any necessary action from the health plan

• Make sure the GP-held clinical record for a looked-after child is maintained and up-to-date

• Transfer health records quickly when a child moves or leaves care

• If in doubt, avoid temporary registrations

The roles of designated and named health professionals

Designated doctors and nurses:• Strategic – help commissioners to fulfil

responsibilities for looked-after children• Ensure arrangements to meet health needs of

looked-after children placed out of area

Named doctors and nurses:• Provide advice and expertise for fellow

professionals • Coordinate provision of services• Ensure timeliness and quality of health

assessments

See the Royal Colleges’ intercollegiate framework

Out of authority placementsIn deciding on the suitability of a placement, LAs should ask:• Will my child be able to access the health services he or she will

need?• Have there been the appropriate discussions with any specialist

health services in the area?• Will the CCGs ensure continuity of healthcare?• Who will be best placed to undertake health assessments?• As the LA corporate parent, have I complied with the care

planning notification requirements? • Has my DCS signed off the decision to place out of authority?• Has the child’s voice been heard? How will we avoid ‘out of sight,

out of mind’?

Transitions from careBecause health needs won’t change just because a child or young person leaves care, health professionals and social workers should ensure:• that there are suitable transition arrangements in

place so that the child’s health needs continue to be met

• in particular, that prospective adopters and care leavers know how to obtain information about local health services, advice and support

Key messages for practice – how to use this guidance

• Unpack each section and audit your practice against it. There’s more there than you think

• Don’t look for the guidance to tell you all the answers• Understand how it relates to other statutory guidance• Use the resources cited at the back of it• Use it to influence discussions about strategic

planning as well as day-to-day practice

If I...

At the end of the road,At the end of the walk,

I’ll take my time to look back.If I were to die there and then,

Would you cry?What if I caught you?

Would you lie?

If I broke downAnd tears came streaming down my face

Would you think I was a sad case?If I were to ask you this,

Would you lie and take the mick?

HW (age 11)

Contact detailsMichael Allured DfE Lead: Education and Health of Looked After ChildrenDepartment for Education020 7783 8081michael.allured@education.gsi.gov.uk Alan BellTeam Leader – Vulnerable ChildrenDepartment of Health020 7210 5246alan.bell@dh.gsi.gov.uk

Thank you for participating in the consultation and joining us for this workshop today