Service Specification: Looked After Children Designated Doctor and Nurse for Looked After Children January 2016

Transcription

1 1. Ppulatin Needs 1.1 Definitins A child is defined as being lked after by a Lcal Authrity if he r she is in their care r is prvided with accmmdatin fr a cntinuus perid f mre than 24 hurs by the authrity. There are fur main grups: 1. Children wh are accmmdated under a vluntary agreement with their parents (Sectin 20) 2. Children wh are subject t a care rder (Sectin 31) r interim care rder (Sectin 38) 3. Children wh are the subject f emergency rders fr the prtectin f the child (Sectins 44 and 46) 4. Children wh are cmpulsrily accmmdated, including children remanded t the lcal authrity r subject t a criminal justice supervisin rder with a residence requirement (Sectin 21) The term LAC is used thrughut this dcument t abbreviate Lked After Children and Yung Peple, r Lked After Child / Yung Persn. This specificatin is fr the Designated Dctr and Designated Nurse rle fr Lked After Children. The rles f health prfessinals in prviding clinical care fr lked after children are included in the Cmmunity Paediatric, 0-19 Public Health Nursing and Child and Adlescent Mental Health specificatins. 1.2 Natinal cntext LAC share many f the same health risks and prblems as their peers, but ften t a greater degree. They ften enter care with a wrse level f health than their peers, in part due t the impact f pverty, pr parenting, chatic lifestyles, abuse r neglect. Natinal figures suggest that 45% f LAC have been assessed as having a mental health disrder, and this rises t 72% fr thse in residential care. Tw thirds f LAC have at least ne physical health cmplaint and are mre likely t have speech and language difficulties, bedwetting, c-rdinatin difficulties and sight prblems. 1.3 Lcal cntext The Care ppulatin in Bristl experienced an increase f 5% between 2012 and 2013, frm 685 t 720 children and yung peple. This was mainly as a result f the increase in the verall child ppulatin in the city, as the rate f lked after children per 10,000 ppulatin has remained stable. In March 2014 the number had fallen slightly t 703. The number f children lked after fr mre than twelve mnths increase frm 484 t 495 in 2012/13. In that perid 299 children entered care and 269 left. Page 1 f 8

2 Suth Glucestershire has experienced a slight increase in 13/14, frm 167 children in care in March 2013 t 170 children in March The children in care ppulatin reached its lwest (158 children) in December 2013 and has experienced a gradual increase frm January It is envisaged that the children in care ppulatin wuld remain between and nt vary significantly frm this. The recent reductin in the number f children and yung peple in care is a reflectin n the increased numbers f children leaving care rather than a reductin f the numbers f children entering care. Suth Glucestershire Cuncil has the 4th lwest rate f LAC per 10,000 natinally and is significantly lwer than statistical neighburs (29.9 per 10,000 t 43 per 10,000). Similarly Suth Glucestershire has the 2nd largest percentage in the reductin f the children in care ppulatin f all Lcal Authrities between There has been little variatin in the age prfile f children in care in either Bristl r Suth Glucestershire ver the past 12 mnths. There has been a slight reductin in the number f children in care within the under 1 year age grup and the 1-4 years age grup tgether with a small increase in the 16+ age grup. Table A: Age f children in care Suth Glucestershire Bristl Age March 2013 March 2014 March 2013 March 2014 Under Years Years Years Ttal LAC Lcal perfrmance % f children with up t date Health Assessment % f children with up t date dental checks % f children with up t date immunisatin schedule % f eligible children with up t date SDQ scre Bristl March 2014 March 2015 Suth Glucestershire March March % 91% 85.3% 85.6% 87% 82% 81.9% 84.7% 78% 84% 98% 90.1% 73% 76% 35% 36% Page 2 f 8

3 2. Outcmes 2.1 NHS Outcmes Framewrk Dmains & Indicatrs Dmain 1 Preventing peple frm dying prematurely Dmain 2 Dmain 3 Dmain 4 Dmain 5 Enhancing quality f life fr peple with lng-term cnditins Helping peple t recver frm episdes f ill-health r fllwing injury Ensuring peple have a psitive experience f care Treating and caring fr peple in safe envirnment and prtecting them frm avidable harm 2.2 Lcal defined utcmes The percentage f children and yung peple cming int care t have an initial health assessment within 28 days The percentage f children lked after cntinuusly fr at least 12 mnths, wh had their teeth checked by a dentist during the previus 12 mnths The percentage f children lked after cntinuusly fr at least 12 mnths and wh had an annual health assessment during the previus 12 mnths (6 mnths if aged under 5) The percentage f children and yung peple aged six and ver, wh have been in care cntinuusly fr at least a year t have a Strengths and Difficulties Questinnaire cmpleted The percentage f children and yung peple wh have been in care cntinuusly fr at least a year wh have an up t date childhd immunisatin schedule apprpriate fr their age 90% 90% 90% 75% 90% 3. Scpe 3.1 Aims and bjectives f service Purpse f the Service The purpse f the LAC Designated Dctr and Nurse is t prvide strategic Page 3 f 8

4 leadership and clinical gvernance f health services fr lked after children Strategic bjectives T ensure that all LAC are supprted: T have gd physical, mental, emtinal and sexual health. T access a healthy lifestyle. T avid substance misuse and ther risky behaviurs. T ensure the health and wellbeing f LAC and yung peple is an identified lcal pririty. T ensure that structures are in place t plan, manage and mnitr the delivery f health care fr LAC. T ensure that clinical gvernance and audit arrangements are in place. T ensure that systems are in place s that LAC are nt disadvantaged when they mve frm ne NHS area t anther, e.g. jining new waiting lists. T ensure that systems are in place t cllect and reprt achievement against the key indicatrs fr health f lked after children Operatinal bjectives a) T prvide dedicated time t the strategic designated rles. This is currently 2 PA per week in each rle fr Bristl, 1 PA per week fr Suth Glucestershire in each rle, and (tbc) PA per week fr Nrth Smerset (Designated Dr nly) The individuals may als prvide a direct service t children and yung peple b) The Designated Dctr fr Lked After Children will: Be a senir paediatrician (preferably, but nt necessarily, a cnsultant cmmunity paediatrician). Have undergne higher clinical/prfessinal training in paediatrics and adlescent health. Have substantial clinical experience f the health needs f children in care. The designated dctr is likely t have wrked r be wrking as a medical advisr t an adptin and/r fstering agency. Be clinically active in cmmunity paediatrics in at least part f the gegraphical lcatin cvered by the pst. Have distinct cmmissining respnsibilities as part f the Designated rle. These are detailed belw. c) The Designated Nurse fr Lked After Children will: Be a senir paediatric nurse and hld a health visitr r schl health Page 4 f 8

5 qualificatin Have substantial clinical experience f the health and health care needs f children and yung peple. Have undergne training in the specific needs f children and yung peple. Have distinct cmmissining respnsibilities as part f the Designated rle. These are detailed belw: Fr cmmissining issues relating t clinical practice r cncerns ver individual children r specific incidents, the Designated Nurse fr Lked After Children will reprt t the CCG s Head f Safeguarding. The Designated Nurse LAC will receive regular clinical supervisin at an apprpriate level. The Bristl Designated Nurse will sit within the Children Lked After Nursing (CLAN) Team, wrking jintly with Thinking Allwed. The Suth Glucestershire Designated Nurse will be embedded within the Thrugh Care Team, currently lcated at Suth Glucestershire Cuncil Offices, Badmintn Rad Cmmissining tasks f the Designated rles The Designated Dctr and Designated Nurse have distinct cmmissining respnsibilities as part f their designated rles. These include alerting cmmissiners directly t any cncerns and /r serius incidents and may invlve investigating cncerns n behalf f NHS cmmissiners, utside the nrmal prvider-cmmissiner reprting arrangements. T prvide expertise, strategic and clinical leadership and advice t NHS cmmissiners and the lcal authrity with respect t the health and wellbeing f LAC, in particular relating t planning, strategy and the audit f quality standards f health services fr LAC. T wrk with NHS cmmissiners t mnitr perfrmance f lcal health services fr LAC. T supprt a Health Strategy sub-grup f the Crprate Parenting Steering Grup / Panel. T undertake audits f quality standards including ensuring apprpriate perfrmance indicatrs are in place in relatin t health services fr LAC. T wrk with all health care rganisatins t mnitr perfrmance f lcal health services fr LAC, and t ensure quality assurance and best value f placements including prcesses f audit, fllw up and review. T wrk with lcal service planners and cmmissiner t advcate n behalf f and ensure LAC benefit as apprpriate frm the implementatin f wider health plicies such as Any Qualified Prvider, Persnal Health Budgets. T wrk with cmmissiners and prviders t gain the best utcme fr the Page 5 f 8

6 child / yung persn within available resurces. T develp effective c-rdinatin between varius agencies, including public health, clinical health and CAMHS, t facilitate health prmtin fr lked after children Cmmissiner and Prvider tasks f the Designated rles T take a strategic verview f the service. T ensure rbust clinical gvernance f lcal NHS services fr LAC. T cntribute t lcal children and yung peple s strategies t ensure there is a system in place t check the implementatin and mnitring f individual health plans. T ensure there is a system t check the implementatin f individual health plans. T wrk clsely with ther designated LAC prfessinals reginally. T wrk clsely with the CCG s Designated Dctr and Nurse fr Safeguarding Children Prvider tasks f the Designated rles a) C-rdinatin T wrk pr-actively with the Lcal Authrity t ensure that the Prvider is infrmed f all children entering and leaving care, changing placements and requiring health assessments. T ensure that LAC have access t all elements f the Healthy Child Prgramme, including awareness f public health prgrammes, such as Change fr Life and universal services like the Schl Nurse, in additin t any targeted and specialist services they may access. T ensure that LAC (and care leavers) are registered with a GP and dentist. Active participatin, including advice t and frm, in the fllwing multidisciplinary grups wrking with LAC; Crprate Parenting Grup. Children In Care Cuncil. Safeguarding Children Bard. b) Training and supervisin T wrk with prvider health rganisatins acrss the health cmmunity t ensure that apprpriate training is in place t enable health staff t fulfil their rles and respnsibilities fr LAC. Participating (as apprpriate) in lcal undergraduate and pstgraduate paediatric training t ensure health including mental health f lked after children is addressed. Page 6 f 8

7 Playing an active part in the planning f multi-disciplinary training. T prvide advice including case-fcused supprt and supervisin fr health staff at all levels within rganisatins acrss the health cmmunity that deliver services t LAC. T prduce a supervisin strategy fr the health cmmunity which prvides directin and ptins fr supervisin mdels, as apprpriate t need. T cntribute t the prgramme f training that fster carers access, including basic training n health, hygiene and first aid, with a particular emphasis n health prmtin (e.g. physical activity, eating well, ral health, relatinships, smking, substance misuse) and cmmunicable diseases. See Standard 12 Natinal Minimum Standards fstering services. T ensure they themselves are up t date with develpments in the field by attending apprpriate meetings and reading relevant publicatins. T receive supervisin frm utside the emplying rganisatin. As a minimum this shuld be prvided twice a year. c) Advisry rle T prvide expert health advice n LAC is available t children s scial care, residential children s hmes, fster carers, schl nurses, clinicians undertaking health assessments and ther health staff. T advise clleagues in health and children s scial care n issues f medical cnfidentiality, cnsent and infrmatin sharing. T advise and input int the develpment f practice guidance and plicies fr all health staff and ensure that perfrmance against these is apprpriately audited. T prvide a written reprt t the agency n the health f prspective fster carers, including interpretatin f health and lifestyle infrmatin prvided by the applicant and their GP. T take part in panel cnsideratin f cases and t cntribute t the panel recmmendatin. Attendance t at least 75% f all panels, including training and appraisals. T wrk in partnership with the fstering agency t ensure the written summary health reprt n the ptential fster carers is available t the agency in time t allw advanced circulatin t the panel. T be available at panel t discuss the written reprt and t answer questins n health issues at the request f ther panel members. d) Mnitring and infrmatin management T actively track and target the health needs f LAC via health assessments, health plans and aggregated data frm these; T identify and address health inequalities in relatin t LAC and t put in place preventative measures Page 7 f 8

8 T ensure that the needs f particular grups f LAC are identified, e.g. asylum seekers, disabled children T infrm the prfile f LAC, e.g. fr CYPP needs assessment T cntribute t the prductin f health data n lked after children T review the patterns f health care referrals and their utcmes T evaluate the extent t which LAC views are infrming the design and delivery f the lcal health services fr them T ensure that clinical gvernance and audit arrangements are in place t assure the quality f services fr LAC, including health assessments and health care planning. T prvide an analysis f the range f health neglect and need fr health care fr lcal LAC i.e. case mix analysis. T prvide an annual reprt t cmmissiners t include issues f planning, strategy and an audit f quality standards in relatin t health services fr LAC including; The pints utlined abve and the effectiveness f health care planning fr individual LAC, and describe prgress twards relevant perfrmance indicatrs and targets The results f any independent lcal studies f the accessibility f health assessments t the children and yung peple themselves, t fster carers, parents, scial wrkers and t health prfessinals 3.3 Ppulatin cvered The service will prvide fr all children fr whm Bristl City Cuncil r Suth Glucestershire Cuncil is the crprate parent. Where a child r yung persn is placed utside f the area, the service will assist scial wrkers in securing apprpriate lcal prvisin f health assessment, review and required health service prvisin. The Designated Prfessinals will ensure that a quality assurance framewrk is in place fr ut f area placements. 3.4 Safeguarding Please refer t the verarching specificatin 3.5 Equalities Please refer t the verarching specificatin Applicable Service Standards The Designated Dctr and Nurse will fulfil the statutry requirements f the rle as set ut in Department f Health/Department fr Educatin Guidance: Prmting the Health and Wellbeing f Lked After Children (March 2015) Page 8 f 8