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Improving Healthcare of Looked After Children in NW Cynthia.fletcher@northwest.nhs.uk

Improving Healthcare of Looked After Children in NW Cynthia.fletcher@northwest.nhs.uk. LAC in England. Almost 60,000 LAC in England March 2008 & increasing PCT – 100,000 – 165 LAC 71% in foster care, 11% in residential care 8% parents, small no. secure homes

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Improving Healthcare of Looked After Children in NW Cynthia.fletcher@northwest.nhs.uk

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  1. Improving Healthcare of Looked After Children in NWCynthia.fletcher@northwest.nhs.uk

  2. LAC in England • Almost 60,000 LAC in England March 2008 & increasing • PCT – 100,000 – 165 LAC • 71% in foster care, 11% in residential care • 8% parents, small no. secure homes • Almost 1/3 are placed out of their area • 63% aged over 10 yrs

  3. Poor health of LAC • LAC some of poorest health • Life opportunities and outcomes poor – health factor • Chronic conditions – visual and hearing unrecognised • Trauma and mental ill-health • Inequitable access to health services

  4. Health of LAC • Same health issues as peers but greater degree • Greater challenges, family discord, frequent changes of home and school, lack access to advice form trusted adults • Reason; poverty, poor parenting, chaotic lifestyles, abuse / neglect. • Long term outcomes much worse than peers

  5. Mental health • Meltzer ONS • High level mental health need esp. residential. • Entry 72% emotional and behavioural problems. • 45% LAC assessed as having mental health disorder (72% for residential care) • Clinically significant conduct disorders common, 12% emotional disorders 7% hyperactive

  6. LAC Physical health • ONS survey 2/3 LAC had at least 1 physical health complaint • More likely to have problems eg speech and language , bedwetting, co-ordination difficulties and eye or sight problems. • Care leavers very vulnerable, teenage parents.

  7. Aftercare health of LAC • Worsen in year after leaving care • 2x as likely to have drug and alcohol (18 – 32%) • Mental health problems (12 – 24%) • Other health problems (28 – 44%) eg flu, asthma, weight loss, allergies, pregnancy.

  8. LAC health good news • Since guidance year on year increase in Health and dental assessments (89% in 2007/8) ? Quality? • All NW areas have LAC nurse(s) • Multi agency teams, LAC Mental Health services • 76% have designated Doctor (2007) Mapping.

  9. but • Quality of health assessments and health plans? • OOArea placement health services • Waiting times for mental health and behavioural problems. • Mental health support for post 16 yr olds? • Birth family support? – many return home

  10. Roles in guidance • Named public health professional (part of JSNA) • Designated doctors and nurses • Lead Health Professional • Primary Care teams contribute • Provider health organisations • PCTs and commissioning

  11. OOA placement issues • Who Pays: Establishing the Responsible commissioner / annex • Most needy no service • LA responsibility holistic health assessment (1st registered medical practitioner) • Health plan by 4 weeks • Coordinating health professional • OOA PCTs agree responsibilities • NW Working group on re-charge for LAC health services

  12. What works • Listening to young people • Drop in Centres – eg Wigan • Young people friendly settings / approaches • Wigan dental services D Card (25% increase) • Taking services to them • Healthy Care Partnership • Healthy Care audit • Healthy Homes

  13. Questions • Do LA staff work closely with health professionals to ensure Lac health needs anticipated and met? • Do SWs ensure each LAC has a Health Plan as part of care plan that is implemented? • Are both Plans reviewed as per regulations? • Does IRO ensure Health Plan is effective and implemented? • Are SDQs carried out for LAC? – data collection? • Is health provision put in place when child OOA? • Are Health providers notified when child placed OOA? • Are all Lac able to access positive activities ? • Care Leavers health provided for – mental and physical as part of the pathway plan?

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