Promoting the Health of Looked After Children and Young People in Bolton

Children and young people who are Looked After are amongst the most socially excluded of all young people and include children who are Remanded to Local Authority Accommodation or Youth Detention Accommodation. They are frequently reported in government research, policy and guidance to have greater needs than their peers, yet are less likely to receive adequate health care and treatment or be supported in developing their knowledge and skills in making decisions that promote health and well- being. They need to receive care in a setting that actively promotes health and well-being for children and young people, as well as staff and carers.

Legislation and policy guidance covering aspects of the factors directly affecting the health and well-being of Looked After Children and young people includes:

Children Act 2004 and Every Child Matters Agenda

The “Every Child Matters” agenda highlighted the need for Councils to look more closely at models of integrated working and how a range of services can be delivered in local areas at one access point.

Adoption and Children Act 2002

Implementation of Legislation and Regulations January 2006.

Private Fostering Agreement Regulations 2005

Re-launch of requirements undertaken in October 2005.

Asylum & Immigration Act 2004

Climbié Recommendations

Care Matters

The Children (Leaving Care) Act 2000 specifies that health considerations should form an integral part of pathway planning (DHSC 2001).

The Care Standards Act 2000 places a duty on Care Homes to promote and protect the health of children.

Care Planning, Placement and Case Review (England) Regulations 2010 provide that a Looked After child’s first Health Care Assessment must be conducted before their first placement or, if not reasonably practicable, before the child’s first Looked After Review (unless one has been done within the previous 3 months.) Each Looked After Child’s Care Plan must incorporate a Health Plan in time for the first Looked After Review.

Legal Aid Sentencing and Punishment of Offenders Act 2012 extends the category of children considered as Looked After Children.

In order to achieve effective continuity of health services, agencies involved in caring for young people should ensure that personnel at all levels of their organisations understand the implications of this policy and what is required of them in order to put it into practice.

Young people will be provided with the knowledge and information to enable them to make informed choices in relation to their health and will be supported in accessing services that can help them.

The document recognises the most important promoters of health are the workers and carers who have regular face-to-face contact with young people. It is hoped this policy and statement of service provision will help to raise the confidence and awareness of these people in engaging with young people and providing them with accurate information, help and support.

Bolton Integrated Care Board (ICB) will, together with other agencies, contribute to building the capacity of organisations to deliver this health promotion agenda. Joint training of care staff and foster carers will be undertaken on a regular basis.

The specific roles and responsibilities of all agencies to maintain and promote the health and well-being of Looked After Children and Young People are outlined in detail in the following pages.

• Ensure that the health and well-being of Looked After children and young people is an identified local priority;
• Ensure that structures are in place to plan, manage and monitor the delivery of health care for all Looked After children;
• Ensure that clinical governance and audit arrangements are in place to assure the quality of health assessments and Health Planning;
• Ensure that there is a named public health professional, who will input into children in need issues, including child protection, as necessary. Looked After Children are part of this wider group of children in need;
• Identify a Designated Professional (doctor and nurse) to provide strategic leadership and advice in relation to the health needs of Looked After children;
• Where a child is placed “out of authority”, ensure systems are in place to provide continuity of the health assessment and planning process;
• Through the commissioning process ensure that Looked After children are registered with GP's and dentists near to where the child is living;
• When Looked After children need to register with a new GP (e.g. when they enter care or change placement), ensure systems are in place to “fast track” the GP held clinical and dental records;
• Ensure systems are in place through the commissioning process to make sure that Looked After children are not disadvantaged when they move from one ICB to another, i.e. NHS waiting lists;
• Ensure that arrangements are in place for the transition from child to adult health services;
• Ensure that an appropriate data set is collected and reviewed annually.

The Young Person’s Health Advisor will:

• Co-ordinate the provision of annual health reviews for young people 11-18 years, ensuring that each young person is offered a health assessment by an appropriately trained health professional. The first Health Care Assessment must be conducted by a registered medical practitioner. Subsequent assessments may be carried out by a registered nurse or registered midwife under the supervision of a registered medical practitioner, who should provide the Social Worker with a written report;
• Identify and engage ‘hard to reach’ young people, ensuring a health assessment is conducted, Health Plan completed to ensure that health needs are identified and timely referrals made;
• Act as the main point of contact for advice and referral for young people with complex health issues;
• Facilitate the uptake of immunisations of Looked After young people and, where necessary, undertake any outstanding immunisations;
• Advise Looked After young people and their carers that each Looked After child should be registered with a local GP and dentist;
• Act as a specialist health advisor for Looked After young people, focusing particularly on sexual health and relationships, mental health and substance use;
• Provide health promotion advice and support, as required, to young people 11 - 18 years, carers, and social workers with special emphasis on sexual health, behaviour, mental health and substance use;
• Advise and inform carers, social workers, educational staff and others on the health needs of Looked After young people;
• Participate in the training of carers and professionals in relation to meeting the health needs of young people Looked After;
• Work collaboratively with key partners including YOT, Project 360, BEST and The Parallel in identifying and addressing the health needs of Looked After young people 11- 18 years;
• Work in a multi-agency and multi-disciplinary environment in order to develop links with young people and their families/carers, statutory and voluntary organisations that provide services for Looked After young people;
• Attend statutory reviews of Looked After young people as appropriate;
• Report regularly to the Safeguarding Steering group.

NHS Practitioners have an important role to play in the identification of the health care needs of children and young people who are Looked After. They often have prior knowledge of the child, birth parents and carer, helping them to take a holistic and child-centred approach to health care decisions.

NHS Staff will:

• Act as advocates for the health of each child or young person who is Looked After;
• Conduct Health Needs Assessments in respect of Looked After young people aged 11 years plus, where that young person has identified a preference for a GP assessment;
• Ensure timely access to a GP or other health professional when a child requires a consultation;
• Ensure that the relevant health information is available, on request; to the health professional who is carrying out the health needs assessment on Looked After children, subject to appropriate consents;

• Maintain a record of the health assessment and contribute to any necessary action within the Health Plan;
• Ensure that the clinical records flag up the “Looked After status” of the child, so that their particular needs can be acknowledged;
• Ensure that the GP records of Looked After children transfer quickly and efficiently within 2 weeks when there is a change of GP;
• Ensure that Looked After children are identified as such within any referral letters to other community or secondary paediatric services, together with the name and contact details of the social worker;
• Alert the service provider within the referral letter if the Looked After child has been on a waiting list for a similar service in another area.

The Designated Professionals

The broad role of the designated doctor and nurse is to assist relevant NHS bodies in fulfilling their responsibilities as commissioners of services to improve the health of Looked After children. They will advise relevant bodies on, and contribute to planning, strategy and audit of quality standards for health services for Looked After children. As well as providing expert advice, the designated doctor and nurse will take a strategic overview of the service and monitor quality.

The Designated Doctor and Nurse will:

• Develop and ensure awareness of relevant policies, procedures and roles in relation to Looked After children and young people;
• Maintain regular contact with local health staff undertaking health assessments. They will also liaise with social services departments and other areas over health assessments and Health Plans for out of authority placements;
• When a child moves from Bolton to another area, the responsibility for the child will transfer to the area in which the child now resides. Therefore, it will be the responsibility of the Designated Doctor to provide health data to the relevant NHS bodies;
• Ensure that all relevant staff are appropriately trained in undertaking health assessments for Looked After children;
• Monitor the quality of the health assessments ensuring that sensitive health promotion is offered to all;
• Contribute to the production of health data on Looked After children ensuring an effective system of audit is in place;
• Produce an annual report, evaluating the delivery of health services for Looked After children and young people.

Information presented will include:

• Number and % of LAC registered with a GP/dentist near to the address of the placement;
• No and % of LAC who have attended a dentist on an annual basis;
• No and % of LAC with outstanding immunisations identified;
• No and % of LAC referred to specialist services following assessment;
• No and % of LAC referrals actioned and completed within 3 months;
• No and % of LAC who had Health Plans agreed by the time of first review;
• No and % of LAC receiving initial health assessment within 28 days of being notified by social services that the child is in care;
• No and % of LAC receiving annual reviews within an interval no more than 13 months from the previous review;
• No and % of LAC receiving sensitive health promotion information.

The School Nursing Service will:

• Ensure every school age child, including those who are formally excluded from school, has a named School Nurse;
• Advise the Carer that each Looked After child should be registered with a GP and Dentist;
• Conduct Review Health Assessments and complete Health Care-plans in respect of Looked After children, copies of which will be sent to Halliwell Admin who will send a copy to the child’s Social worker and their GP;
• Provide health promotion, support and advice, as required, to Carers and Looked After children, focusing particularly on sexual health, mental health and substance use;
• Support the Social Worker in the completion of health information in the LAC system;
• Attend statutory reviews in respect of Looked After children;
• Support Looked After children in schools with specific health needs;
• Ensure immunisations are up-to-date.

Health Visitors will (for Children below the Age of School Entry):

• Ensure that the agreed Child Health Promotion Programme is carried out as per local protocols - the contact should be a face-to-face contact with both the Looked After child and their carer/s.
  
  Special consideration should be given to:
  • Speech and language;
  • Gross and fine motor function;
  • Vision and hearing;
  • Play and pre-literacy skills;
  • Social and self help skills.
• Advise carers that all Looked After children should be registered with a GP and dentist;
• Attend statutory reviews in respect of Looked After children;
• Conduct Review Health Needs Assessments in respect of Looked After children as deemed appropriate by the Designated Doctor. This will include a holistic assessment of the child’s health care needs and will incorporate relevant health promotion topics, e.g.:
  • Attachment behaviour;
  • Physical health;
  • Growth;
  • Diet;
  • Immunisations;
  • Play and early learning;
  • Safety;
  • Oral and dental health.

A Health Plan will be completed which will identify areas of need, plan of action and eventual outcome. A copy of the plan will be forwarded to the designated doctor for inclusion into the child’s GP medical record and social services care plan. The original copy will remain within the child’s health visiting record.

Community Children's Nursing Service will:

• Ensure that specialist community nursing services will be provided, as needed, for Looked After children.

The Children and Young People’s Mental Health Services (CYPMHS) will:

• Consider all referrals for Looked After children at their weekly allocations meeting;
• Where appropriate, offer Looked After children direct services to meet their needs;
• If a direct service is not deemed appropriate, CYPMHS will offer the referrer a consultation to consider the mental health needs of the child and how these might best be met;
• Attend statutory reviews, as appropriate, and provide written reports when this is not possible.

The CYPMHS-LAC Service will:

• Liaise with CYPMHS and Children’s Services to develop procedures to limit duplication and ensure effective interagency working regarding the mental health needs of Looked After children;
• Provide an additional resource to meet the demand for direct work and consultation;
• Offer joint training with Social Services to staff and carers on the mental health needs of Looked After children;
• Evaluate the effectiveness of training and consultation;
• Develop further projects in consultation with the steering group;
• Will regularly report to the steering group and to the ‘Towards a Brighter Future’ group.

The Social Worker will:

• Complete all of the necessary sections relating to health needs in the Looking After Children documentation, including details of immunisations, forthcoming appointments, treatment, medication and family history of illness. As prescribed by Looking After Children guidance, this should be completed prior to the first Annual Health Assessment; if this is not done, then the social worker must attend the initial medical and provide background information to the medical examiner;
• Actively engage the Looked After child in discussions about health and health promotion issues and, where appropriate, provide information to assist the Looked After child;
• Ensure their relevant administrative office informs all appropriate health professionals when a child becomes Looked After;
• Attend LAC reviews and provide written updated health care information, attaching the Health Plan to LAC information;
• Proactively ensure that the Looked After child is enabled to attend all necessary health and dental appointments;
• Act as the co-ordinator to ensure that the health needs of the Looked After child are appropriately addressed (consulting with the appropriate health professional where necessary);
• Ensure that health professionals involved have all the necessary information relating to the background and circumstances of the Looked After child;
• Request the ‘red book’ (personal child health record) from the parent and provide this to the Carer. For older children ensure access to health fax;
• Inform the Carer of any health issues, either initial or ongoing, for the Looked After child or their family, e.g. via the Health Plan;
• Keep parents fully informed of any health issues and, wherever possible, involve parents in appointments or treatment for the Looked After child;
• Obtain the appropriate consent for any medical treatment from the birth parent, wherever this is possible (cross reference to consent);
• Inform all appropriate health professionals when a Looked After child moves placement or ceases to be Looked After;
• Keep self up-to-date on relevant issues important to the needs of Looked After children.

The Foster Carer will:

• Ensure that the Looked After child is registered with a local GP and Dentist;
• Keep an accurate and dated record of all health issues and treatment relating to the Looked After child and ensure this record along with any health concerns the carer may have in respect of the child. are presented at statutory reviews;
• Proactively ensure the child or young person is enabled to attend health appointments and clinics, to attend with the child or young person unless agreed unnecessary and provide the health professional with any relevant information in respect of physical and emotional well-being, including behaviour;
• Keep the Social Worker informed of any health and dental issues relating to the Looked After child;
• Involve children and young people in discussions and decisions regarding their health care in accordance with their age, understanding and in consultation with the child’s social worker, including issues around eating, hygiene, alcohol, drugs and sexual health;
• Promote healthy living home environments and health awareness for all children and young people being Looked After and encourage the child in age-appropriate personal responsibility for own health and hygiene;
• Encourage children and young people to participate in leisure activities, hobbies and sport. These should be tailored to the needs of the individual, including those with special needs, seeking the advice and support of their supervising social worker where necessary;
• Provide nutritionally balanced meals with young people being encouraged to eat a varied and healthy diet. They should be encouraged to participate in the planning, purchase and preparation of food to gain an understanding and appreciation of healthy eating;
• Participate in the development of Health Plans for children and young people, monitoring and initiating any required action Encouraging and supporting contact and communication with the child or young person’s family, appropriately, as agreed in Care Plans;
• Keep self up-to-date on relevant issues important to the needs of Looked After children, e.g. through active participation in knowledge and skill development opportunities, supervision, training, etc.

The Residential Support Worker will:

• Ensure that the Looked After child is registered with a local GP and Dentist;
• Keep an accurate and dated record of all health issues and treatment relating to the Looked After child;
• Proactively ensure the child or young person is enabled to attend health appointments and clinics, to attend with the child or young person, unless agreed unnecessary, and to provide the health professional with any relevant information in respect of physical and emotional well-being including behaviour;
• Keep the Social Worker informed of any health and dental issues relating to the Looked After child;
• Involve children and young people in discussions and decisions regarding their health care in accordance with their age and understanding, including issues around eating, hygiene, alcohol, drugs and sexual health;
• Promote healthy living home environments and health awareness for all children and young people being Looked After and encourage the child in age-appropriate personal responsibility for own health and hygiene;
• Encourage children and young people to participate in leisure activities, hobbies and sport. These should be tailored to the needs of the individual, including those with special needs;
• Provide nutritionally balanced meals with young people being encouraged to eat a varied and healthy diet. They should be encouraged to participate in the planning, purchase and preparation of food to gain an understanding and appreciation of healthy eating;
• Attend statutory reviews in respect of the Looked After child and provide a written update re any health issues and appointments, highlighting any concerns;
• Participate in the development of Health Plans for children and young people, monitoring and initiating any required action;
• Encourage and support contact and communication with the child or young person’s family, as agreed in Care Plans;
• Keep self up-to-date on relevant issues important to the needs of Looked After children, e.g. through active participation in knowledge and skill development opportunities, supervision, training, etc.

The Supervising Social Worker (Fostering or Adoption Team) will:

• Ensure that the foster carer has received all necessary Looking After Children documentation from the placing social worker, that all of the necessary sections relating to health needs in the Looking After Children documentation, including details of immunisations, forthcoming appointments, treatment, medication and family history of illness are fully completed and that consent for the child to receive medical treatment is appropriately obtained;
• Ensure that the foster carer has received a written Health Plan and that they understand how to use, maintain and share it appropriately with the child;
• Ensure that all foster carers are properly trained in health care, first aid, hygiene issues, communicable diseases and health promotion matters;
• Support the foster carer in developing the skills and knowledge to actively engage the Looked After child in discussions about health issues and, where appropriate, provide information to assist the Looked After child and, if necessary, advocate on behalf of the child;
• To support the foster carer in proactively ensuring that the Looked After child is enabled to attend all necessary health and dental appointments;
• Keep self up-to-date on relevant issues important to the needs of Looked After children;
• Provide information about health services local to a placement when proposing a placement for a child, to ensure that any specialist health services for a child do not break down due to placement;
• Help the foster care to secure appropriate health services for the child, where necessary.

The Independent Reviewing Officer will:

• Remain independent and within the Looked After Child Review process, seek the views of the Looked After child or young person about their own health needs. The views should preferably come directly from the child or young person, using the views booklet as a tool, or be represented via an advocate;
• If a Looked After young person has chosen to opt out of the statutory medical or health assessment process, then guidance should be offered and they should be signposted to alternative advice and support in relation to their general health and welfare;
• Monitor the effectiveness of Health Plans for children and young people who are Looked After;
• If the health needs of a Looked After child or young person are not being appropriately met, the reviewing officer will address this through the Looked After Child reviewing system and ensure that the relevant professionals are aware of the issues;
• Promote the health and welfare of the Looked After young person by ensuring that they are provided with a Health fax and enough information to guide them and support them in making informed choices and taking responsibility for their own health needs in the future;
• Provide statistical information about the health and health assessments of Looked After young people and children.

360 (Young Persons Substance Misuse Team)

See Drug strategy 2017

Project 360º is an integrated multi-agency team of substance misuse workers providing holistic assessment and treatment services targeted at the more serious and complex end of substance misuse amongst young people less than 19 years.

The team includes:

• Nurse;
• Substance misuse workers;
• Family support workers;
• Emotional Health Practitioner.

Services available for Looked After Young People and their carers include:

• Holistic assessment;
• Full assessment of health needs and appropriate treatment;
• Sexual health and contraceptive services;
• Counselling;
• Substitute prescribing;
• Community detoxification;
• Harm reduction;
• Referral for inpatient detoxification;
• Relapse prevention;
• Family support;
• Consultation and advice for professionals and carers;
• Training for professionals and carers.

The Parallel (Bolton's Young Peoples Health Centre) can:

Assist Looked After or young people leaving care aged 11-20 (20 to 25 yrs if they have Special Educational Needs or Disability) to access GP’s and other health services based at The Parallel, ensuring that information can be shared with the young person’s own GP, with the young person’s consent.

Bolton Children’s Services Department will:

Assist in young persons health programme by:

• Providing free swimming passes to all Looked After children which will also allow carers or other significant adults to accompany them to local facilities;
• By engaging with social care staff, help to assess and promote the individual leisure requirements of Looked After children and care leavers allowing free access to leisure facilities where possible;
• Where appropriate, provide work experience placements for the LASE scheme which seeks to allow Care Leavers an extended work placement within local authority workplaces.

The following information should be read with recognition of Children Act (1989) and subsequent legislation and guidance, which places duties on all social care staff to recognise the potential for harm to the child or young person caused by significant ‘drift and delay’ in decision making. If in doubt seek legal advice.

Informed consent must be sought for any health assessment, examination or treatment after careful explanation has been given to the young person, parent or adult with Parental Responsibility (explanations given to children and young people should be age-appropriate.) Young people aged 16 and 17 years are presumed to have the competence to give consent for themselves. Younger children who understand fully what is involved in the proposed procedure can also give consent (although ideally parents will be involved - or those with Parental Responsibility).

What is a Caldicott Guardian Caldicott?

A Caldicott Guardian is a senior person responsible for protecting the confidentiality of people’s health and care information and making sure it is used properly.

All NHS organisations and local authorities which provide social services must have a Caldicott Guardian.

The Caldicott principles

1. Justify the purpose(s)
   
   Every proposed use or transfer of personal confidential data within or from an organisation should be clearly defined, scrutinised and documented, with continuing uses regularly reviewed, by an appropriate guardian.
2. Don’t use personal confidential data unless it is absolutely necessary
   
   Personal confidential data items should not be included unless it is essential for the specified purpose(s) of that flow. The need for patients to be identified should be considered at each stage of satisfying the purpose(s).
3. Use the minimum necessary personal confidential data
   
   Where use of personal confidential data is considered to be essential, the inclusion of each individual item of data should be considered and justified so that the minimum amount of personal confidential data is transferred or accessible as is necessary for a given function to be carried out.
4. Access to personal confidential data should be on a strict need-to-know basis
   
   Only those individuals who need access to personal confidential data should have access to it, and they should only have access to the data items that they need to see. This may mean introducing access controls or splitting data flows where one data flow is used for several purposes.
5. Everyone with access to personal confidential data should be aware of their responsibilities
   
   Action should be taken to ensure that those handling personal confidential data — both clinical and non-clinical staff — are made fully aware of their responsibilities and obligations to respect patient confidentiality.
6. Comply with the law
   
   Every use of personal confidential data must be lawful. Someone in each organisation handling personal confidential data should be responsible for ensuring that the organisation complies with legal requirements.
7. The duty to share information can be as important as the duty to protect patient confidentiality
   
   Health and social care professionals should have the confidence to share information in the best interests of their patients within the framework set out by these principles. They should be supported by the policies of their employers, regulators and professional bodies.

What is the Data Protection Act 2018?

The Data Protection Act 2018 became law in May 2018 and incorporates the UK General Data Protection Regulations and describes the standards which must be satisfied when obtaining, recording, holding, using or disposing of personal data.

These are summarised by 6 Data Protection Principles

As well as information held electronically on computers, the Data Protection Act 2018 also covers hard copies/paper files.

The Data Protection Principles

Personal data must:

• Used fairly, lawfully and transparently;
• Used only for specified, explicit purposes;
• Used in a way that is adequate, relevant and limited to only what is necessary;
• Accurate and, where necessary, kept up to date;
• Kept for no longer than is necessary;
• Handled in a way that ensures appropriate security, including protection against unlawful or unauthorised processing, access, loss, destruction or damage.

Further information can be found on the Information Commissioner website.

 (See Part 3, Chapter 2, ‘Principles’, Data Protection Act 2018)

Principle 1

Processed Fairly and Lawfully

There should be no surprises, so inform data subjects why you are collecting their information, what you are going to do with it and who you may share it with:

E.g. when formulating a research project remember to be open and transparent about what you will be doing with the information.

E.g. when working in a team, ensure that the patient/client is aware of whom the members of the team are, and that all those involved with their care may need to see their notes.

• Be open, honest and clear.

Principle 2

Processed for Specified Purposes

Only use personal information for the purpose(s) for which it was obtained.

E.g. personal information on a Patient Administration System must only be used for healthcare purposes - not for looking up friends’ addresses or birthdays.

• Only share information outside your practice, team, home, ward, department or service if you are certain it is appropriate and necessary to do so.
• If in doubt, check first!

Principle 3

Adequate, Relevant and not Excessive

Only collect and keep the information you require. It is not acceptable to hold information unless you have a view as to how it will be used. Do not collect information “just in case it might be useful one day!”

E.g. taking both daytime and evening telephone numbers if you know you will only call in the day.

• Explain all abbreviations;
• Use clear legible writing;
• Stick to the facts - avoid personal opinions and comments.

Principle 4

Accurate and Kept Up-to-date

Take care inputting information to ensure accuracy. How do you know the information is up-to-date? What mechanisms do you have for checking the information is accurate and up-to-date?

E.g. each time a patient attends a clinic, they should be asked to confirm that their details are correct - address, telephone number, etc.

• Check existing records thoroughly before creating new records;
• Avoid creating duplicate records.

Principle 5

Not Kept for Longer than Necessary

• Follow retention guidelines:
  • For the Record (HSC 1999/053);
  • GP Records (HSC 1998/217).
• Check your organisation’s retention policy;
• Ensure regular housekeeping/spring cleaning of your information;
• Do not keep “just in case it might be useful one day”;
• Check your organisation’s disposal policy;
• Dispose of your information correctly.

Principle 6 (Practical)

Protected by Appropriate Security (Practical and Organisational)

• Ensure security of confidential faxes by using Safe Haven/Secure faxes;
• Always keep confidential papers locked away;
• Do you have a clear desk policy?
• Ensure confidential conversations cannot be overheard;
• Keep your password secret;
• Ensure information is transported securely.

Principle 6 (Organisational)

Protected by Appropriate Security

Your organisation should have …

• Good information management practices;
• Guidelines on IT security;
• Staff training;
• Confidentiality clause in employment contracts;
• Procedure for access to personal data;
• A disposal policy/procedure for confidential information;
• Confidentiality contracts with third parties.
  
  E.g. archiving companies, cleaners, temporary staff, outside contractors.

To sum up, remember that information must be:

1. Held securely and confidentially;
2. Obtained fairly and efficiently;
3. Recorded accurately and reliably;
4. Used effectively and ethnically;
5. Shared appropriately and lawfully.