Archived decisions

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1. Summary and purpose of report

1.1 At its last meeting, the Committee asked for a report setting out recommendations necessary for work to commence on the first health scrutiny review. This report accordingly makes proposals for the establishment of a review working group and the suggested method of undertaking the review.

2. Issue for review

2.1 The last meeting of the Committee agreed the overall theme for the first health scrutiny reviews to be carried out by the Committee - `The health of our children and young persons'. This theme encompasses a range of services and issues and the County Council's consultation paper, published last October, proposed 4 separate reviews:

· health care for looked-after children

· health of school age children, focusing particularly on health inequalities

· mental health service for children & mental health problems of 14-19 year olds

· access to therapy in schools.

On this basis and with the agreement of the Chairman, since the last meeting members of the Committee have been invited to express their interest in joining working groups for the first two reviews which could be commenced within the coming year. It is proposed that the remaining two reviews should follow later. This report sets out proposals for carrying out the first review, health care for looked-after children.

3. Health care for looked-after children: the review subject area

3.1 Applying the criteria agreed at the last meeting, this is a review where conclusions can be reached and recommendations made to appropriate bodies which should `make a difference'. It should be possible to undertake the review within a short period. The undertaking of the review would `add-value' to work already programmed.

3.2 There is a new requirement on Social Services authorities and their NHS partners to ensure looked-after children have a health assessment when taken into care and for there to be a health plan for each child which is regularly reviewed (Children Act (Miscellaneous Amendments) (England) Regulations 2002). This new requirement has arisen out of a national recognition that these are issues and problems in managing information and health care decisions relating to looked-after children. A programme of work has recently been agreed within the Social Services Department which would inform the review, and the work undertaken in this review would complement and extend that already intended within Social Services.

3.3 There are other issues which could appropriately be considered within this review. Some may not be particular to looked-after children, but incidence may be higher for this group than amongst children generally. Some may be a consequence of a particular characteristic of looked-after children, that care arrangements may change, with consequent change in their placements. The working group may consider including within the scope of the review provision of health information and advice to looked-after children, and whether life-style decisions of looked-after children, as a group, result in higher health risk than for children as a whole.

3.4 There is overlap between the 4 issues within the overall scope of the theme `The health of our children and young persons'. It is therefore important that in the first stage of each review compatible decisions are made about when, where and how specific issues will be considered.

4. The Review Process

4.1 The Committee's method of working will develop as Members become more familiar with the task and working with partners in the NHS and elsewhere. As a means of enabling this first review to move on to key issues quickly, and not be distracted by considerations of appropriate process, it is suggested that initially the Best Value process be used to help guide work on the first review. The first stage will, therefore, be scoping of the review - deciding issues on which to focus.

4.2 As this is the first review, the Committee should allow the working group scope to develop an appropriate style of working within the outline discipline of the Best Value process. As indicated above, experience in undertaking this first review may suggest the approach to be taken in subsequent reviews.

4.3 Arrangements proposed take account of the newly published Department of Health `Overview and Scrutiny of Health - Guidance'. There is no prescribed form which a review should take in collecting data, undertaking research and finding out about the experience, and views, of users and providers of the service under review. There has been a general presumption of an investigative and participatory approach to undertaking health scrutiny.

4.4 The first task for the working group will be to scope the review - to identify information required and arrangements for securing an appreciation of the views of those involved in providing and using the service and, if considered relevant, the wider community. In the case of this review, a considerable amount of data is already available nationally and, with effort in compilation, locally. The working group will have to consider mechanisms for judging provider, user and community views.

4.5 The report from the working group must set out the evidence it took into account in reaching its conclusions.

4.6 Another report to this meeting of the Committee proposes that the working group does not exercise the statutory power of an overview and scrutiny committee to require information from NHS bodies and attendance of officers of NHS bodies to answer questions. The working group should secure the information it considers it requires by agreement and not compulsion. It may request NHS bodies to provide information and answer questions, and to allow visits and discussion with those providing and using the service.

4.7 The arrangements made by the working group will need to reflect the presumption that reviews are conducted in an open way. It may want to consider sessions which the public, and especially relevant interest groups, may attend and in which they may perhaps participate and to which they may contribute.

5 The core working group

5.1 The Committee have resolved that work on individual reviews should be undertaken by a working group, led by a Member of the Committee who would report back to the Committee on the progress of work.

5.2 The Committee will need to decide the `lead Member' or chairman of the working group for this review, and to nominate four or five Members to form the core working group. The working group may consider co-opting additional persons to that core group representative of local and topic expertise. This is not a project with a particular geographic or locality focus so it would not be appropriate to include locality expertise. But additional members could be brought in at the invitation of the working group representative of, for example,

· Persons who have been looked-after children

· National action groups in the field

· General Practitioners

· Those in the NHS locally who have specialised in the issue.

5.3 For this first review, it is recommended that Cllr Mrs Banks, who is also Chairman of the Social Care Policy Review Committee, should take the lead. Additional membership of the group can be considered in the light of members' responses to the request to indicate interest in the working groups for the 4 initial reviews.

6 Programme and report

6.1 The Committee should set a fixed date for completion of a report by the working group, setting out the evidence it has assembled and taken into account, the conclusions it has reached and such recommendations as the working group considers the Health Review Committee should make to NHS bodies, the County Council's Executive (Cabinet or individual Executive Members) or other bodies, organisations and individuals.

6.2 It has been the Committee's intention that this first review should be concluded quickly: it is therefore proposed that the working group be set the target of completing a report by the end of 2003 so it can be considered by the first meeting of the Health Review Committee in 2004.

6.3 It is proposed that the working group should commence work immediately. Its first task should be preparation of a scoping report identifying the information it will bring together (and sources from which it will be sought - thereby notifying NHS bodies of information likely to be required from them), the ways it will undertake securing views of users and providers of the service and, most importantly, the major issues of concern which it intends to consider.

6.4 The scoping report should be completed by late July. It is proposed that the Lead Member for the working group should agree that scoping report with the Chairman, and inform the Committee at its meeting on 29 July.

6.5 Stage 2 of the review, to be undertaken over the autumn, will be compilation of information and experience/views.

6.6 Stage 3 is production of a report, in whatever form the working group considers appropriate, for consideration by the Committee at its first meeting in 2004. It is important to keep to this target. However, the process of review may raise other issues which the working group considers worthy of investigation but which cannot be dealt with within the timescale. The working group may, therefore, on its report to the Health Review Committee, make recommendations for a further review.

Recommendations

1. That Members be appointed to a working group to undertake a review of the health care of looked-after children.

2. That Cllr Mrs Banks be asked to lead, or chair, the working group.

3. That the working group be invited to use the overall Best Value approach and process as a way of structuring its work, and that its first task be to prepare a scoping report setting out information required and arrangements for securing that information and the views of those involved in providing and using the services under review and to report to the next meeting of the Committee.

4. That the working group completes a report by the end of 2003 setting out evidence taken into account, persons seen to collect views and information and conclusions and recommendations, for informal consultation with NHS bodies and other bodies to whom recommendation are addressed prior to formal consideration by the Health Review Committee.