NHS BOLTON CLINICAL COMMISSIONING GROUP Public Board Meeting AGENDA ITEM NO: 13 Date of Meeting:..27 th October 2017.. TITLE OF REPORT: Looked After Children Annual Report 2016-2017 AUTHOR: Christine Dixon, Designated Nurse for Looked After Children, Bolton CCG Charlotte Mackinnon, Designated Doctor for Looked After Children, Bolton CCG PRESENTED BY: PURPOSE OF PAPER: (Linking to Strategic Objectives) LINKS TO CORPORATE OBJECTIVES (tick relevant boxes): RECOMMENDATION TO THE BOARD: (Please be clear if decision required, or for noting) COMMITTEES/ GROUPS PREVIOUSLY CONSULTED: Christine Dixon, Designated Nurse for Looked After Children, Bolton CCG The NHS has a major role in ensuring the timely and effective delivery of health services for looked after children. The purpose of the report is to provide the national and local context around looked after children, to outline how Bolton Clinical Commissioning Group s (CCG) statutory requirements are being assured, and to highlight the challenges relating to looked after children and how these are being managed. This report covers the period from 1 April 2016 until 31 March 2017. Deliver Year 2 of the Bolton Locality Plan. Ensure compliance with the NHS statutory duties and NHS Constitution. Deliver financial balance. Regulatory Requirement. x Standing Item. To receive and note the content of the report. Bolton CCG Safeguarding Assurance Group. Gained agreement from John Daly, Head of People s Services, Bolton Council to use council data. Bridgewater Community NHS Foundation Trust and Bolton NHS Foundation Trust have clarified the accuracy of data which pertains to them. 1
REVIEW OF CONFLICTS OF INTEREST: VIEW OF THE PATIENTS, CARERS OR THE PUBLIC, AND THE EXTENT OF THEIR INVOLVEMENT: OUTCOME OF EQUALITY IMPACT ASSESSMENT (EIA) AND ANY ASSOCIATED RISKS: None. Not considered necessary for this report. However the report does note that Bolton CCG needs to continually work to engage with children and young people including vulnerable groups in their planning of services. Not considered necessary for this report as this is not a policy or new service development. 2
Bolton NHS Clinical Commissioning Group Looked After Children Annual Report 2016-17 Artwork by Voice 4U March 2017 Authors Christine Dixon, Designated Nurse for Looked After Children, Bolton CCG Charlotte Mackinnon, Designated Doctor for Looked After Children, Bolton CCG 0
Contents 1.0 Introduction... 2 2.0 Definitions... 2 3.0 Statutory framework, legislation and guidance... 2 4.0 The health needs of looked after children... 3 5.0 Figures and trends for looked after children... 3 6.0 Leadership... 5 7.0 Emotional health and wellbeing (EHWB)... 6 8.0 Voice of the child and engagement... 8 9.0 Quality and assurance (QA)... 9 10.0 Staff training... 9 11.0 Commissioning... 10 12.0 Statutory health care... 10 13.0 Priorities for 2017-2018... 15 Appendix1: Bolton Looked After Children Health Strategy 2016-2018... 16 Appendix 2: Feedback from young people... 17 1
1.0 Introduction The NHS has a major role in ensuring the timely and effective delivery of health services for looked after children. 1 The purpose of the report is to provide the national and local context around looked after children, to outline how Bolton Clinical Commissioning Group s (CCG) statutory requirements are being assured, and to highlight the challenges relating to looked after children and how these are being managed. This report covers the period from 1 April 2016 until 31 March 2017. 2.0 Definitions Throughout this report child refers to as anyone who has not reached their 18th birthday, unless specifically identified as disabled young people who may be 18 years or over but continue to be looked after by the local authority. 2.1 Looked after child A child is defined as being looked after by the local authority if s/he is in their care or is provided with accommodation for a continuous period of more than 24 hours by the local authority (section 22). 2 2.2 Care leavers A care leaver is defined as a person aged 25 or under, who has been looked after by a local authority for at least 13 weeks since the age of 14; and who was looked after by the local authority at school-leaving age or after that date. 3.0 Statutory framework, legislation and guidance There are a number of pieces of legislation and guidance which inform responsibilities and requirements with regard to working with looked after children and the key documents are listed below: Children s Act (2004) Looked After Children: knowledge, skills and competence of healthcare staff (Intercollegiate Role Framework, 2015) NICE Guideline NG26: Children s attachment: attachment in children and young people who are adopted from care, in care or at high risk of going into care (2015) NICE Guideline PH28: Looked after Children and Young People (2010 updated 2015) NICE Quality Standard QS31: Looked after children & young people (2013) Promoting the Health and Wellbeing of Looked After Children (Department of Education and Department of Health, 2015) Who Pays? Determining Responsibility for payments to providers (NHS England, 2013) 1 Department of Education and Department of Health (2015) Promoting the Health and Wellbeing of Looked After Children 2 Children Act 1989 2
4.0 The health needs of looked after children Most children become looked after as a result of abuse or neglect and they are one of the most vulnerable groups in society. Although they may have the same health issues as their peers the extent of these is often greater because of their past experiences and it is recognised that children in care have significantly higher levels of health needs than children and young people from comparable socio- economic backgrounds who have not been looked after. Past experiences, a poor start in life, care processes, placement moves and transitions can mean that children are often at risk of having inequitable access to both universal and specialist health services. 3 Nationally almost half the children in care have a diagnosable mental health issue (45% rising to 72% for those in residential care) this is compared to 10% of the general population. 4 11% are reported to be on the autistic spectrum and many others have developmental problems. Two thirds of looked after children have been found to have at least one physical health complaint such as speech and language problems, bedwetting, coordination difficulties or sight problems. There are generally higher levels of teenage pregnancy and drug and/or alcohol use. 5 Statutory guidance states that CCGs and officers in the local authority who are responsible for looked after services should recognise and give due account to the greater physical, mental and emotional health needs of looked after children in their planning and practice. 6 5.0 Figures and trends for looked after children It is important to understand the data around looked after children in order to plan services effectively. Bolton Council has kindly provided the data tables for section 5 which are still to be validated at the time of the writing of this report. 5.1 Numbers of looked after children in Bolton As at March 2017 there were 584 looked after children for whom Bolton Local Authority have responsibility which is 87.95 children per 10,000. This is an increase from March 2016 when the numbers were 563 (85 per 10,000 of the population) and is in line with an upward trend over the past 14 years. Figure 1 compares Bolton 2017 data with Bolton and North West 2016 data and this highlights that Bolton has similar numbers of looked after children to other local areas but the rates are higher than the national average of 60 per 10,000 children under 18 years. 3 Bolton JSNA (2013) 4 Melzer et al (2003) The Mental Health of Children Looked After by Local Authorities in England. London, Stationary office 5 Intercollegiate Role Framework (2015) Looked after children: Knowledge, skills and competencies of health care staff 6 Department of Education and Department of Health (2015) Promoting the Health and Wellbeing of Looked After Children 3
Figure 1 180 160 140 120 100 80 60 40 20 0 47 51 61 Looked After Children per 10,000 - North West Comparison - March 2016 68 71 71 71 72 72 78 85 85 87 87 88 89 91 95 99 103 105 113 115 164 LAC per 10,000 Bolton England North West 5.2 Numbers of children placed out of area As can be seen in figure 2, 136 of Bolton children (23%) are placed out of area which compares favourably to the national average of 40% and is a reflection of Bolton s commitment to placing children close to home. Bolton CCG retains responsibility for commissioning and monitoring health services for those children who are out of area. Figure 2 As at March 2017 there were 218 children and young people placed within Bolton by other authorities for whom health organisations have a duty to provide care. 7 There is an ongoing piece of work with Bolton Safeguarding Children Board, Bolton CCG and Bolton Council to review the makeup of this group of children and young people placed in Bolton. 7 Source Bolton Council still to be validated 4
6.0 Leadership Local leadership for looked after children has been strengthened in 2016-2017 6.1 Designated professionals for looked after children Statutory guidance requires that CCG s either employs or secures the expertise of designated doctors and nurses for looked after children. CCGs need to demonstrate that their designated clinical experts are embedded in the clinical decision making of the organisation. These roles should also have the authority to influence local thinking and practice. 8 From September 2016, Bolton CCG has employed a full time Designated Nurse for Looked after Children. The Designated Doctor for Looked after Children is employed by Bolton NHS Foundation Trust and provides one session per week as a contractual agreement. These roles have worked together to map current provision, identify strengths and gaps and develop a looked after children action plan in conjunction with wider partners. 6.2 Bolton health action plan A looked after children health action plan was developed in November 2016 which has since been incorporated into a strategy and covers the following key areas: 1. Leadership 2. Emotional health and wellbeing 3. Quality and assurance 4. Training 5. Voice of the child and engagement 6. Commissioning This action plan is formally overseen at the Bolton Children and Maternity Strategic Planning Group which is a group of senior leaders from health provider organisations and commissioners, Bolton Council, the Third sector and a representative from Health Watch. These six areas have also been reported on within this report. Please see a copy of the strategy in appendix 1. 6.3 Looked After Children Health Development Group A quarterly Looked After Children Health Development Group has been set up with a variety of aims including review of progress against the action plan, assurance, raising the profile of looked after children and ensuring that resources in Bolton are being used to best effect. Members have a responsibility to disseminate the work through their organisations. 8 HM Government (2015) Working together to safeguard children: A guide to inter-agency working to safeguard and promote the welfare of children 5
6.4 Greater Manchester wide Bolton CCG plays an active role in the Greater Manchester (GM) Designated Nurses for Looked After Children Collaborative. The current focus of the group is around quality and unwarranted variation across GM. 6.5 Looked after children posts in providers Since the last reporting period there are now dedicated posts for looked after children within provider services as follows: Named Nurse for Looked After Children within Bolton NHS Foundation Trust and Bridgewater Community NHS Foundation Trust Specialist Nurse for Looked After Children within Bridgewater Community NHS Foundation Trust Additional support for care leavers from the Parallel Young People s Service (Bridgewater Community NHS Foundation Trust). There has been tremendous progress over the past year in establishing these dedicated workforce roles for looked after children. Going forwards there is a need to ensure that people in key roles have the right levels of authority in order to advocate effectively for looked after children. 7.0 Emotional health and wellbeing (EHWB) Local authorities, CCGs and NHS England need to reflect the high level of mental health needs amongst looked after children in their strategic planning of child and adolescent mental health services. 9 The provision of appropriate emotional health and wellbeing provision is essential in order to meet the needs of looked after children. 7.1 Strengths and difficulties questionnaire (SDQ) Since April 2008 all local authorities in England have been required to provide information on the emotional and behavioural health of children and young people in their care for more than one year aged 4-17 years. This information is collected using the SDQ which is a short behavioural screening questionnaire used with children which covers details of emotional symptoms, conduct problems, hyperactivity or inattention, peer relationships and also positive behaviour. The questionnaire is completed with the main carer around the time of the child s health assessment. The SDQ scores are collated within Bolton Council. The scoring range is between 0-40. On an individual basis a score of 13 or below is normal and 17 or above is a cause for concern (a score between14-16 is borderline). Figure three on page 7 highlights the return rates and score averages for Bolton and England. Bolton has a consistently higher return rate compared to England and the score averages are broadly the same. 9 Department of Education and Department of Health (2015) Promoting the Health and Well being of Looked After Children 6
Figure 3: Strengths and Difficulties Questionnaires Area Year Percentage SDQ completed Percentage normal scores Percentage borderline scores Bolton 2014-2015 82% 49% 14% 37% England 2014-2015 72% 50% 13% 37% Bolton 2015-2016 75% 49% 13% 38% England 2015-2016 80% 49% 16% 34% Bolton 2016-2017 83.6% 54% 11% 35% Source: DFE 10 and Bolton Council (2017 figures to be validated) Percentage high scores Whilst there is a good return rate for the SDQ in Bolton it is rarely being used to inform practice for individual children. From December 2016 a multiagency working group led by the Designated Nurse for Looked After Children has worked together to develop an SDQ procedure and multiagency pathway. This aims to use the SDQ results for each child more intelligently in order that an appropriate package of care will be put in place. The work will be completed in August 2017 with an aim to roll this out from October 2017. 7.2 School readiness project Looked after children will have often experienced trauma and loss; this will affect their ability to function effectively in school. When they begin their reception year, skills that enable them to attend, settle, learn, and participate appropriately in the learning activity, are likely to be delayed, when compared with peers who have experienced a more stable background. A higher percentage of looked after children than non - looked after children also present with emotional and behavioural regulation needs, putting them at risk of school exclusion. Bolton CCG has worked with multiagency partners to develop and commission a school readiness programme which will commence in September 2017 following a period of training and planning. This scheme of work has been funded by CAMHS Transformation monies. The aim of this innovative project is to support looked after children to become school ready. There are two strands to this project which involve working with two groups of looked after children. The first group are children in their pre-school year (aged 4). For these children, the focus will be on promoting basic skills, such as listening and attention, to support cognition and learning, and also on developing emotional and behavioural regulation skills to support engagement and inclusion. The second group will consist of children aged four to ten (primary school age) with high SDQ scores. Intervention for this group will target social, emotional and behavioural development. 10 https://www.gov.uk/government/statistics/children-looked-after-in-england-including-adoption-2015-to- 2016 7
7.3 Child and Adolescent Mental Health Service (CAMHS) Within Bolton, the CAMHS service is currently being reviewed and will be re - commissioned in order build on current good practice and address the changing needs of children and young people. In order to inform the content of the new CAMHS Service Specification in relation to vulnerable and looked after children, specific consultation was undertaken in March 2017 with young people, foster carers, social workers in the looked after children and leaving care teams, residential workers and looked after children education staff. There was also a review of the evidence and research around best practice for looked after children. A number of themes emerged: Access to and flexibility of CAMHS services Transition for care leavers as this is often seen as a cliff edge in care Support and supervision for the wider workforce around EHWB and mental health in looked after children Understanding of thresholds and pathways into the different services Training gaps for the workforce Access to appropriate services for traumatised children and for those children who are in chaotic placements A priority for 2017-18 will be to ensure that the re commissioning of CAMHS takes account of the greater emotional health and wellbeing (EHWB)/ mental health needs of looked after children. Bolton will also need a clear EHWB training strategy for staff across agencies who work with looked after children in order to build confidence and responsiveness to need. 8.0 Voice of the child and engagement The Care Quality Commission (CQC) noted that all children should be involved in giving feedback on and co-designing their local services, ensuring they are as accessible and relevant as possible and that all practitioners, providers and commissioners listen to the children who do not necessarily have a voice. 11 8.1 CAMHS Consultation As part of the CAMHS consultation, the CCG worked with Bolton Council and the Voice 4 U Children in Care Group to facilitate an event with young people in order to understand what skills they wanted from their health worker and also what they needed from health services. Their feedback is noted in appendix 2 and this information has now been incorporated into Level 3 Looked after Children Training within health services. Bolton CCG needs to continually work to engage with children and young people including vulnerable groups in their planning of services. 11 Page 11 Not Seen, Not Heard. A review of the arrangements for child safeguarding and health care for looked after children in England (CQC 2016) 8
8.2 Health passports for care leavers Each young person leaving care should receive a health passport in order that they have relevant information to hand. There is a very basic passport currently in use in Bolton however the Specialist Nurse for Looked After Children in Bridgewater Community NHS Foundation Trust has agreed to lead a piece of work to develop and improve this further. 9.0 Quality and assurance (QA) The CCG must be assured that health service provision for looked after children is effective, safe and of a high quality. 9.1 Quality assurance of health assessments High quality health assessments ensure that a child has their health needs assessed thoroughly and a plan put in place in a timely manner. A key quality indicator is the voice of the child within their assessment. A procedure for QA of health assessments has been developed and agreed by health partners in Bolton. This defines the mechanism by which statutory health assessments will be quality assured in Bolton using a standard Greater Manchester tool. The implementation has been rolled out incrementally from January 2017 with full implementation planned from April 2017. 9.2 Assurance framework In October 2016 the CCG developed an assurance framework around looked after children which was based on requirements in statutory guidance and learning from recommendations in national Looked after Children and Safeguarding Inspections. This assurance framework was completed between November to December 2016 by Bolton NHS Foundation Trust and Bridgewater Community NHS Foundation Trust and each provider then developed a local action plan. The main priority areas for both providers were timeliness and quality of health assessments, training of the workforce and the voice of the child. 10.0 Staff training Throughout 2016-2017 the health economy has developed a greater understanding of the training needs of the workforce and the current gaps in provision. In January 2017 Looked after Children Training was delivered to 100 GP safeguarding practice leads with extremely positive feedback. A simple practice guidance sheet was also developed which contains information to enable practices to manage the care of looked after children more effectively and safely. 9
A health economy level 3 training package as per requirements of the intercollegiate document (2015) is currently being developed for staff who may contribute to care planning for looked after children. 12 The plan is to roll this out to all relevant staff by September 2017. 11.0 Commissioning The designated professionals for looked after children have an important role influencing the commissioning cycle in both the CCG and the wider health economy. 11.1 Service specifications Health services for looked after children are commissioned by Bolton CCG and also Public Health within Bolton Council. In relation to the services which Bolton CCG is responsible for commissioning, a service specification has been developed for looked after children services provided by Bolton NHS Foundation Trust. A priority in quarter one (April to June) of 2017-2018 will be to ensure that this service specification is agreed and signed off and fully implemented. 11.2 Payment by results A national payment by results (PBR) tariff has been agreed for looked after children placed out of area. 1314 Greater Manchester (GM) Commissioners have an agreement whereby there will be no cross charging for health assessments for looked after children placed within GM. In Bolton, it is the responsibility of the provider to recharge for health assessments undertaken for children placed in Bolton from out of the GM area. A priority for 2016-2017 was to review payment by results with Bolton providers however little progress has been made in this area as our priority has been around key roles and improving processes around delivery of care. Therefore this will remain a priority in 2017-2018 11.3 Placement decisions Bolton CCG in conjunction with Bolton Council has commenced looking at how placement decisions are made for our most vulnerable children including looked after children. We have had some positive individual examples when this planning has worked well and it remains a priority to improve these systems and processes for all situations in order to benefit from multidisciplinary expertise. 12.0 Statutory health care The local authority has a responsibility to ensure that initial and review health assessments are carried out for every child they look after irrespective of where they live and that health care plans are made, reviewed and delivered. The assessment of 12 Intercollegiate Role Framework (2015) Looked after children: Knowledge, skills and competencies of health care staff 13 NHS England (2013) Who Pays? Determining Responsibility for Payments to Providers 14 NHS England (2016) 2016-2017 National Tariff Payment System 10
children in care involves co-operative working between children s social care, health visitors, school nurses, designated and named nurses and doctors, GPs and clerical staff. 15 Completion of health assessments combined with immunisation and dental screening rates are used as indicators for the health of looked after children nationally and locally. Local authorities are required to submit an annual data return in June (for the period April to March) to the Department of Education for the children they are responsible for. This is shared nationally in the published annual statistics from central government. 16 A new local method of data collection for timeliness of health assessments and exceptions commenced in October 2016 therefore the timeliness figures are reported for October 2016 to March 2017 only. An emerging issue in December 2016 was around the availability of consent for both initial and review health assessments as the historical custom and practice between social care and health did not provide the necessary assurance that consent had been obtained. This has caused delays and led to some children not receiving their health assessment on time. Going into 2017-2018 this matter is not resolved and it will be important that this is addressed in order that children receive their health assessments in a timely manner. 12.1 Statutory initial health assessments (IHA) Children coming into care should receive an IHA within 20 working days of becoming looked after and this should be undertaken by a registered medical practitioner. IHA s for children placed outside Bolton are completed by the health provider in that area. Bolton NHS Foundation Trust is responsible for completing IHA s for children placed within Bolton. According to national statutory guidance 17 the health assessment should include relevant information from other health records including the national child health system, CAMHS, information from the community child health system and the GP in the form of a summary report. From September 2016 information is now consistently requested from the registered GP in order to inform the IHA and month on month the response to this request has been improving. Between, October 2016 to March 2017 58% of initial health assessments for Bolton children placed within Bolton were completed within 20 working days which is comparable with the figure for 2016 2017 at 57%. There is no national data set for IHA s however many local areas report challenges around their timeliness due to the tight deadlines. The figures with exceptions are noted in figure 4. 15 Department of Education and Department of Health (2015) Promoting the Health and Wellbeing of Looked After Children 16 Department for Education (2016) Children looked after by local authorities in England. Guide to the SSDA903 collection 1 April 2016 to 31 March 2017 17 Department of Education and Department of Health (2015) Promoting the Health and Wellbeing of Looked After Children 11
Figure 4: October 2016 March 2017 initial health assessment data Numbers due Numbers on time %age completed on time Delay in notification Cancelled by carer Child not brought Staffing Consent not available NHS net Email issue Bolton child in Bolton 77 43 56% 1 6 4 6 4 12 Child from out of area 4 1 25% 2 1 Information provided by Bolton NHS Foundation Trust. 12.2 Statutory review health assessments (RHA) The review health assessment must be carried out by an appropriately qualified registered nurse/midwife. The assessment must be reviewed on a six-monthly basis until the child attains the age of 5 years and then be completed annually for all looked after children aged 5 years and above. Review health assessments are commissioned by Public Health within the Local Authority in collaboration with Bolton CCG. Pre-school health assessments are delivered by Bolton NHS Foundation Trust through the Health Visiting service and health assessments for children and young people aged over 5 years are delivered by Bridgewater Community NHS Foundation Trust through the 5-19 service. The local authority collects data in relation to review health assessments according to the national data set. This specifically reports every child who has been in care for 12 months and the numbers of these children who have had a health assessment within the past year. In the past year the council have recorded that 98.6% of children had their health assessment (noting this figure is awaiting validation). In the period 2015-2016 96.7% were recorded as having their health assessment in the year compared to an England average of 90% 18 The local authority figures do not report on timeliness of health assessments Between, October 2016 to March 2017 70% of review health assessments for Bolton children placed within Bolton were completed on time (there is no comparison data for 2015-2016). 73% of children from out of borough received their health assessment on time. The figures with exceptions are noted in figure 5. 18 https://www.gov.uk/government/statistics/children-looked-after-in-england-including-adoption-2015-to- 2016 12
Figure 5: October 2016 March 2017 review health assessment data Numbers due Numbers on time %age completed on time Delay in notification Cancelled by carer Unable to engage with young person Child not brought Staffing Consent not available Paperwork delays Admin issue Other Bolton child in Bolton Child from out of area 249 174 70% 1 10 6 9 14 36 5 8 16 75 55 73% 2 3 1 1 3 8 2 Data provided by Bolton NHS Foundation Trust and Bridgewater Community NHS Foundation Trust 12.3 Health reviews for children placed out of area NHS service providers have a duty to comply with requests from local authorities in support of their statutory requirements. Where a looked after child is placed out of area, the service is expected to cooperate with requests to undertake their health assessments on behalf of the originating CCG; Bolton CCG therefore retains responsibility for ensuring the provision of statutory health reviews for children placed out of the local authority. Data is available for quarter 4 (January to March 2017) for review health assessments for Bolton children aged 5-18 years placed out of area. In this time period 15 children aged 5-18 required a health assessment and 4 (27%) were completed on time. More than 50% of the exceptions were due to lack of consent. Currently there is no data available for children placed out of area who require an IHA or a RHA (0-4 years) as currently Bolton NHS Foundation Trust do not manage this administration process. This provision will be included in the new service specification which is due to be agreed in 2017-2018 (as per section 11.1) and a priority will be to introduce this new administration process quickly. 12.4 Immunisations Childhood vaccination rates are monitored locally for all children. Within Bolton the uptake of vaccinations for looked after children is consistently high as highlighted in figure 6. 13
Figure 6 Source: National LAC data returns and Bolton Council (2017 figures to be validated) 12.5 Oral Health The data for dental care remains consistently high and is well above the national average year on year as highlighted in figure 7. Figure 7 Source: National LAC data returns and Bolton Council (2017 figures to be validated) 14
13.0 Priorities for 2017-2018 A number of priorities have been identified in this report and these are also reflected in the strategy in appendix 1: To ensure that people in key roles have the right levels of authority in order to advocate effectively for looked after children To ensure the effective roll out of the Strengths and Difficulties Questionnaire Procedure in October 2017 To ensure the effective roll out of the school readiness programme To ensure that the commissioning of CAMHS takes account of the greater emotional health and wellbeing /mental health needs of looked after children. To ensure that there is a clear training strategy for staff across agencies who work with looked after children in order to build confidence and responsiveness around EHWB/ mental health Bolton CCG needs to continually work to engage with children and young people including vulnerable groups The CCG to support the development of a care leavers passport To ensure all staff who may contribute to health care planning receive level 3 training To ensure the service specification for looked after children is signed in quarter 1 of 2017-2018 To review payment by results for Bolton providers To develop a level of health contribution to placement planning in particular for children placed out of borough To ensure issues around consent and paperwork are addressed in order to ensure that children receive their health assessment in a timely manner Thank you to the following organisations that have provided data for this report: Bolton Council Bolton NHS Foundation Trust Bridgewater Community Healthcare NHS Foundation Trust 15
Appendix1: Bolton Looked After Children Health Strategy 2016-2018 LOOKED AFTER CHILDREN HEALTH STRATEGY 2016-2018 THEME Quality and Performance ALL UNDERPINNED BY STRONG LEADERSHIP Emotional health & wellbeing (EHWB) Voice of children/ young people & engagement Commissioning of services Staff development and training AIMS Quality assurance of all health assessments as per GM tool Ensure all relevant information is available for health assessments including consent & Part A Health assessments completed in a timely manner That the health plan is fully embedded in care planning and is not a one off event Multiagency SDQ pathway developed and embedded in practice School readiness programme in place Clear pathways developed for EHWB/ mental health of looked after children to ensure needs are identified and addressed early All care leavers have a high quality, meaningful passport To improve access, involvement and worker- child relationships for all children and young people in care including those children where staff struggle to engage LAC provision is commissioned effectively including the provision of CAMHS Payment by results introduced To improve health involvement with placement planning To commence profiling of health needs Staff within health providers receiving training as per intercollegiate document Health supporting foster carer training Multiagency training plan around EHWB/ mental health OUTCOMES High quality, timely health assessments Health needs of looked after children are identified and met Placement stability Positive experiences of services and good engagement Placement stability Positive relationships with peers and carers Improved overall wellbeing SDQ score informs health assessment Reduce impact of ACES Improved attainment Positive experience of services Positive transitions Responsive services Improved self esteem Improved engagement and accessibility Positive relationships with professionals Parity of esteem for physical & mental health Greater awareness of local health needs to inform planning Reduce unwarranted variation Positive experience of services Foster carer confidence addressing health needs Increased confidence around EHWB = more responsive care Improved quality of health assessments/ care 16
Appendix 2: Feedback from young people 17
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