Agenda item

Looked After Health Briefing Update - Escalation of Performance of initial Health Assessments - Quarter 4 and Initial Health Assessments

To receive a report from the Designated Nurse for Looked After Children.



The Chairman asked that the Board take this report and the Initial Health Assessments report together as one item.


The Corporate Parenting Board considered a report on Looked After Health Briefing Update – Escalation of Performance of Initial Health Assessments by the Designated Nurse for Looked After Children and a report on Initial Health Assessments by the Executive Director of People – Children.


The Designated Nurse for Looked After Children informed the Board that during 2018/19 there had been some improvement, but timeliness of consent was still a challenge.  She referred to table 2.3 where assessments were ranging from 65.5% to 44.7% with an average of 52.5% Initial Health Assessments completed in 20 working days.  During the last few months the Pan-Dorset Pathway had been agreed and implemented including guidance for Social Workers regarding their responsibility for meeting the statutory guidance.  There had been increasing challenges on Paediatricians due to a vacancy not being filled, and as there was a national shortage of Paediatricians the CCG were working with Poole Hospital Trust to review the existing model.    


The Executive Director of People – Children commented there were complex issues around why decisions were made.  A little more analysis needed to be researched regarding young people’s wishes about where they need to go to have their IHA.  It was not good that they should have to miss school we want to look at the experience of the IHA for young people and ensure they are able to access them in their local area.  In terms of the workforce we have LAC health nurses and are positive about the new pathway that has been developed.  Meetings had been arranged with Health for the following week beginning 22 July 2019 to discuss progress.


The Foster Carers explained they had been carers for 18 months and during that time they had only been to 2 IHA’s one young person did not want to be there and her birth mother who was present, was asked very little.  Information relating to the family history was recorded as “no information” available even though the birth mother was in attendance.   The second time they attended an IHA was for a very small baby and the medical lasted about 10 minutes – a very quick check over of baby.  The birth mother who was in attendance was not asked any information and this also was recorded as “no information” available. 


The Designated Nurse for LAC was very disappointed to hear that had happened and would take that away with her to check on.  She felt that as both parents were present there had been a missed opportunity.  She went on to explain the statutory requirement for completing IHA’s.


The Executive Director of People – Children mentioned that the Children Act had been written 30 years ago and LAC were very different now compared to then.  If there was a young person who did not want that assessment, officers needed to work with them to establish why.  It was about the child and keeping them safe we need to find out why we are not meeting the target.


The Designated Nurse for LAC confirmed the specialist LAC nurses she worked with would ask young people why they did not want an IHA.  The Statutory requirement would still need to be met as that was how the service was measured.


The Chairman understood the comments about meeting the national targets but for Corporate Parents it was about the young person.


One member commented that it was also about health checks taking place somewhere accessible, how could they be made desirable to young people as it set them apart from their peers.


One member asked about the timescale for an IHA to take place.  The Designated Nurse for LAC explained the timescale.  Officers explained they could achieve the timescale but could not get consent in advance of the child coming into care.  If the child was coming into care on a court order they could not pre-empt the decision.  Ideally notification and consent would be given on day one of the child coming into care this was part of the new pathway.  Health should then receive information as early as possible. 


Martin Hill, Foster Carer agreed that national targets and timescales had to be met but perhaps it would be better if there was more time available to enable children to settle into coming into care.  If this happened there might be a completely different outcome, surely it would be better to have good information and not meet the target than have bad information and meet the target.


The Designated Nurse for LAC considered a change of culture was required about how IHA’s were sold to young people.  Smarter working with social workers and pooling of information was required.


The Corporate Parenting Officer mentioned that Early Services received a great deal of information about the child and wondered whether information could be released from the GP as they would have had a record of the child.


The Chairman asked whether, when first referrals were coming through, there was anything that stated information could be accessed.  The Executive Director of People – Children confirmed there was an issue around informed consent and if they say no, the Authority had to accept that.


One member asked if information could be provided as to the cost of the paediatrician undertaking initial medicals at the child’s placement in the same way that the Looked After Children’s nurses did for the review medicals. The Designated Nurse for LAC confirmed the cost of visiting at a home would be excessive and had been explored previously but this could be scoped with a view to seeing how much it would cost now.  


One member asked for financial information to be provided and the Designated Nurse for LAC agreed she would provide that information at a future meeting of the Board once costings were complete.  She anticipated this would be available for the meeting of the Board to be held on 19 March 2020.


The Chairman commented that the Board did not want this issue to keep coming back to them as a problem, a solution should be sought with flexibility on both sides.  An update on action taken and progress should be submitted to the Board quarterly, the next report to the 9 October 2019 meeting.



1.          That the Designated Nurse for LAC provide financial information at the meeting of the Board to be held on 19 March 2020.

2.          That officers and the Designated Nurse for LAC provide a joint update report on action taken and progress to the meeting of the Board on 9 October 2019.

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