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Responses form looked after children and young people

2

Responses from foster carers

6

Responses from registered managers of children's homes

10

Responses from primary care teams

14

Responses from directors of public health (primary care trusts)

18

Responses from designated teachers for looked after children

20

How can we use this information to bring about positive change?

25

Question 1, 2 and 3

On the whole, they do not have problems in accessing primary health care.

Question 4

The big issue for those responding to the questionnaire - to many, the annual health assessment, or `medical', is, in their words, a pain. They'd like it undertaken more quickly, with less waiting and with simple, straight-forward questions.

Question 5, 6 and 7

The responses to these questions are encouragingly positive, indicating that young persons feel those caring for them take health issues seriously, provide the opportunity for healthy eating and that, for most of them, there is someone they can approach and talk to about health issues that may be worrying them.

1. Are you able to see a doctor or dentist when you feel you need to?

(35)YES / (3)NO

2. Do you have any choice in which doctor you see?

(19)YES / (17)NO / (2)N/A

3. Do you sometimes think that you'd rather see a nurse rather than a doctor for certain things?

(18)YES / (20)NO

4. Do you find the annual medical assessments a pain?

(21)YES / (14)NO / (3)N/A

5. Do you feel that your carers are concerned enough about your health?

(28)YES / (10)NO

Do they take your worries and concerns seriously?

(30)YES / (4)NO / (2)N/A

6. When you need advice on things to do with your health, are you able to speak to someone that you feel comfortable with?

(30)YES / (8)NO

7. Are you given the opportunity to have a balanced diet?

(29)YES / (6)NO / (2)N/A

Do you have any problems with food and drinks where you live?

(7)YES / (29)NO / (2)N/A

Question 4

- About a third of those responding consider that they do not receive enough information about a child's physical health when the child is placed with them.

- Almost a half say they do not receive enough information about the child's mental and emotional health.

- About half say the child placed with them does not have a health care plan.

Question 5

By and large, those responding say they do not have problems accessing primary health care. They do mention problems in finding a NHS dentist.

Question 6 and 7

Almost all foster carers say that they register the children placed with them with their own, local GP. Only short-term respite placements would therefore, in emergency, ask their GP to see a looked-after child as a visitor or temporary resident (when complete medical records would not therefore be available).

1. Name and address

2. Do you provide

long-term care?

21

for pre-school children

11

short-term/respite care?

25

aged 5 - 11

19

aged 12 - 15

17

aged 16 +

12

3. Do you foster more than one child?

(23)YES / (11)NO / (1)N/A

4. When children have been placed with you, have you been given sufficient information about their

· physical health?

· mental health?

· does the child have a health care plan?

(24)YES / (11)NO

(19)YES / (16)NO

(16)YES / (17)NO / (2)N/A

5. Have you been able to get medical, dental or other healthcare for children you have fostered?

· from the GP

· from the dentist

· from the optician

· other (please specify)

(33)YES / (1)NO / (1)N/A

(27)YES / (7)NO / (1)N/A

(29)YES / (4)NO / (2)N/A

hearing tests, eye unit, behaviour therapy, GU, maternity, paediatrician neurologist, orthodontist, grommets, adenoids, child guidance, hospital

6. Have the children you foster been registered with your GP?

(30)YES / (3)NO / (2)N/A

7. Have they remained on the register of the GP where they previously lived?

(7)YES / (25)NO / (3)N/A

Question 2

- Like foster carers, tend to the view that information at placement could be more complete, especially on emotional/metal health problems.

Question 4

- Responses confirm that health examinations concentrate on physical health and do not identify emotional/metal health issues.

Question 7

- No problems in accessing main primary care services of GP, dentist and optician but do indicate problems in accessing (and securing early attention from ) other services.

Question 9

- Approximately a quarter of homes lack arrangements for children and young people to access health advice without approaching staff

0. Name, post and address

1. When children are placed with you, do you receive sufficient information about their

· physical health?

· mental health?

(8)YES / (2)NO / (1)N/A

(5)YES / (6)NO

2. Do children routinely have a health care plan?

(7)YES / (3)NO / (1)N/A

3. Does the health examination following a placement sufficiently identify

· physical health problems?

· mental health problems?

(9)YES / (0)NO / (2)N/A

(1)YES / (8)NO / (2)N/A

4. How soon after placement does health examination take place?

1 day (1 home)

3 days (1 home)

7 days (2 homes)

14 days (3 homes)

(3)N/A

Would it help you if it took place more quickly?

Aim to undertake within

5 days (1 home)

7 days (3 homes)

14 days ok (1 home)

(4)N/A

5. Is there sufficient access to specialist support services?

(4)YES / (6)NO / (1)N/A

6. Have you been able easily to get medical, dental or other health care for children resident with you?

· from the GP

· from the dentist

· from the optician

· other (please specify) ______

(10)YES / (0)NO / (1)N/A

(7)YES / (2)NO / (2)N/A

(9)YES / (0)NO / (2)N/A

CAMHS (1 home)

Various specialists (1 home)

No other (9 homes)

7. Does a psychologist visit the home to help you both in recognising that a child is having problems and in tackling those problems?

(2)YES / (7)NO / (2)N/A

8. Are there arrangements so a child can discreetly and confidentially seek help and general advice on personal and social health care without approaching staff?

(7)YES / (3)NO / (1)N/A

Question 2

Only a few practices have designated a `lead' person for looked-after children - and it is in all cases a GP rather than a practice administrator or nurse.

Question 3

About a third already have in place arrangements that would alert a GP that a patient is a looked-after child or young person. Few practices include the child's or young person's health assessment and health care plan with medical records.

Question 4

Few practices record who should be asked to give consent for treatment of a looked-after child. This can be a less than straightforward issue when consent is needed for treatment of looked-after children.

Question 6

GPs are of the general view that they are consulted no less or more frequently by looked-after children than by children in general.

Question 7

Half those responding have `occasional' problems in securing past medical records for looked-after children. 20% say they `never' have that problem.

Question 8

The responses indicate that most GPs answering this question are satisfied that the NHS services to which they would wish to refer patients who are looked-after children are available. A slightly smaller proportion were satisfied that, having made the referral, the patient is seen sufficiently quickly and the necessary treatment provided.

Question 10

It is clear from the responses that GPs see Social Services as the focus for information about looked-after children - and their additional comments (see below) make suggestions for improvements.

1. Name, post and address

2. Has your practice designated a `lead' for health care of looked-after children?

(1)N/A

None

GP

Practice Administrator

Practice Nurse

16

5

1

9. Do your practice records

· alert you to a patient being a looked-after child?

· include a looked-after child's health needs assessment?

· include a looked-after child's health care plan?

(8)YES / (14)NO / (1)N/A

(5)YES / (17)NO / (1)N/A

(4)YES / (18)NO / (1)N/A

10. Do your records show who should be asked to give consent for treatment of a looked-after child?

(4)YES / (19)NO / (2)N/A

11. Please give an indication/estimate of the number of looked-after children registered with your practice.

(9) average answer 14.9

(9)unknown

(4)N/A

14. In your experience/opinion, are you consulted as frequently by looked-after children as by children in general?

(4)N/A

less frequently

as frequently

more frequently

3

13

3

15. Have you had problems in securing past medical records for looked-after children?

(4)N/A

frequently

occasionally

never

3

12

4

21. When you have referred looked-after children to specialist support services within the NHS, do they get the service they need?

· Availability of service

· Timeliness of service

(14)YES / (3)NO / (6)N/A

(12)YES / (4)NO / (7)N/A

22. Are there other specialist support services outside the NHS to which you would refer

looked-after children if they were available?

Please specify: (7) no, (14)N/A, (1) already use Home Start, (1) counselling

23. We know there are problems in the sharing of information about looked-after children between agencies:

· do you routinely share information about looked-after children with Social Services?

(10)YES / (10)NO /(3)N/A

Question 2

There are Department of Health general guidelines on how primary care should deal with situations where patient records are not available or incomplete. PCTs do not therefore generally have `local' guidance. One PCT's response records that its Child Health Unit follows up when a child's patient records are missing and attempts to trace them by contacting previous GPs/PCTs, carers and Social Services.

Question 3

Only some PCTs have in place a record of the number of looked-after children in the PCT's area. A number have replied that the information could be obtained by additional interrogation of existing data bases. One is currently compiling the information - and it would seem that compiling a data base of looked-after children can be time-consuming, with a designated nurse spending time chasing records.

Question 4

All PCTs recognise looked-after children as a specifically identified patient group.

Question 5

Questionnaire responses are cautious in answering this question: in essence, no, data is not available, and what data there is relates to too small a sample to be statistically reliable. But some response go on to comment that anecdotal evidence, research studies and general impressions are that looked-after children have greater mental and emotional health needs than children in general - which is coincident with views expressed by other groups of respondents.

Question 6

A difficult question to answer because data not available. Most think looked-after children seek access to services less readily than children in general. There is an interesting comment of anecdotal reports that foster careers are better at seeking advice and accessing health services than children's homes...

1. Name, post and address

2. Because of changes in placement and the circumstances in which some children come into care, there can be difficulty in tracing and transferring medical records. A particular issue can be absence of immunisation/vaccination records. Does the PCT have a policy or issue `best practice guidance' to GPs when medical records are missing/incomplete?

(1)YES / (5)NO

Does it include guidance on re-immunisation/vaccination?

(3)YES / (2)NO / (1)N/A

3. Does the PCT have records of the number of looked-after children

· within its area?

· registered with individual GP practices?

(4)YES / (2)NO

(1)YES / (5)NO

4. Does the PCT recognise looked-after children as a specifically identified patient group?

(6)YES / (0)NO

5. Does data on consultations and treatments indicate that their medical needs are greater than children in general? Please respond separately, if data available, on

· general physical health

· mental health

(2)YES / (3)NO / (1)N/A

(2)YES / (3)NO / (1)N/A

6. Do looked-after children seek help and access to services from which they would benefit as readily as children in general?

more readily

the same

less readily

N/A

3

3

Question 2 and 3

Responses to questions 2 and 3 show most `recognise' in the school's records that a child is a looked-after child, and that the designated teacher is alerted at time of admission.

Question 4 and 5

Responses to these questions suggest that schools will often know which GP a looked-after child is registered with, and may have limited medical information (about allergies and current medication).

Question 6

An encouragingly high proportion of the schools responding routinely share information about looked-after children with other agencies. It is apparent that they see Social Services as the focal point and facilitator for such exchange of information.

Question 7

A high response rate to this question shows schools are alert to the health issues of looked-after children and know how to progress issues related to individual children.

Question 8

A pattern emerges from these responses - that designated teachers perceived the general physical health of looked-after children to be much the same as children in general but a significant majority think they have greater mental and emotional health needs than children in general.

1 Name, post and address

2 When a child is admitted on roll, is it recorded if the pupil is a looked-after child?

(62)YES / (3)NO /(3)N/A

3 Is the designated teacher automatically informed when a new starter is a looked-after child?

(58)YES / (8)NO / (2)N/A

4 Normally, pupil records show who is the child's G.P.: with looked-after children that information may not be provided at registration. If not provided, does the school follow this up to obtain that information?

(51)YES / (13)NO / (4)N/A

5 Does the school keep a record of other health information about looked-after children?

· vaccination/immunisation

· allergies

· medication

· other (please specify)

(19)YES / (40)NO / (9)N/A

(55)YES / (5)NO / (8)N/A

(53)YES / (8)NO / (7)N/A

various medical conditions

6 We know there are problems in the sharing of information about looked-after children, do you routinely share information with:

· social services?

· educational psychology service?

· education welfare service?

· school nurse?

(62)YES / (1)NO / (5)N/A

(53)YES / (10)NO / (5)N/A

(55)YES / (9)NO / (4)N/A

(54)YES / (8)NO / (6)N/A

7 If you consider a looked-after child has unrecognised/unaddressed medical or social health needs

- from whom would you seek advice?

- to whom would you refer the child?

- how would you make that referral?

school nurse/carer/social services

as above/relevant professional e.g. EP or EWO

telephone/letter/referral form

8 In your experience, do looked-after children have more health problems than children in general?

greater needs

same needs

fewer needs

general physical health (2)N/A

6

58

2

mental and emotional health (2)N/A

47

18

1