Contact: Penny Velander, ext 7479, [email protected]

1. Introduction

1.1. This report builds on the draft report presented to the Health Review Committee on 27 January 2004. It accommodates responses from those agencies cited for taking responsibility in both reviews and presents the updates on:

_ Recommendations for the Health of Children Looked After in Hampshire (Appendix i)

_ Recommendations for the Health of School Age Children in Hampshire (Appendix ii)

1.2. Since the Committee last met meetings have been held with:

· Viv West, Children and Young Peoples Strategic Partnership (C&YPSP)

· Cllr Felicity, Hindson C&YPSP and Social Services

· Cllr Don Allen, C&YPSP and Education

· Robin Thomas, Education

· Maggie MacDonald, Early Education and Childcare Unit

· Malcolm Rittman, Youth Service

· John Buckett and Jon Foley, Environment Department

· Glyn Wright, Education

1.3. Presentations have been given to:

· Children and Young Peoples Strategic Partnership

· PCT Children's Leads

· Directors of Public Health

Feedback from these presentations highlighted the need for health services to have greater participation in health reviews and for a greater understanding of each other's roles, culture and structures.

1.4. Both working groups have met to consider and discuss responses. The deadline for responses was 1 March 2004 however this was extended in order to get further feedback, especially for the Children Looked After review.

1.5. Press releases subsequent to the January meeting led to much media interest in the review reports and findings. Cllrs Banks and Ellis responded to several requests for radio interviews, a national care magazines and several local newspapers ran cover stories, plus neighbouring authorities have expressed interest.

1.6. These reviews were mindful of responsibilities under the Race Relations Act (2000) and the obligation to consider the Act in the development of new policies

1.7. The Health review programme is a key element in supporting Corporate Strategy Aims 1: `Ensuring that children looked after have life opportunities equal to other children, with the County Council acting as a good parent' and 4 ` Joint working with the NHS and district councils to improve the health and safety of the people of Hampshire promoting good public health and health equality'.

2 Summary of the Health of Children Looked After responses

2.1 Feedback from the C&YPSP for both reviews was exceptionally positive and welcoming. The main point they raised was that Social Services and Education have a legal responsibility for children in Hampshire and this cannot be discharged to the C&YPSP. This is especially important for children who are looked after where the County Council acts as the corporate parent. They would, however, be willing to take on the co-ordination and monitoring of the review recommendations as detailed in Recommendation One. This means they would liaise with agencies taking responsibility for Recommendations Two to Six and feedback progress to the Health Review Committee as outlined in Recommendation Seven.

2.2 Responses were received from four PCT's. A summary of the main points:

· All welcomed and supported the review report and recommendations.

· One PCT and its Professional Executive Committee highlighted the need for greater PCT involvement in the reviews and felt that `there were a number of missing views from the report and questionnaire'. They also felt that smoking should have been included within the scope of the review.

· Several reported that they recently have, or are in the process of, appointing a specialist nurse for children looked after. That person would play a key role in multi-agency working and representing the needs of children in care.

· It was acknowledged that there is inequity in the way that the children's health reviews and assessments are delivered and that alternative approaches need to be sought. Best practice could be shared between PCT's more, especially where there are already designated nurses for children looked after.

· The reviews concern over the transfer of information was shared by PCT's. They recognised that better methods for keeping, up-dating and sharing health records need to be established

· One PCT suggested that a fast-tracking system could be established for children looked after to gain access to specialist services eg CAMHS

2.3 Three Children's Home Managers responded, feedback varies according to the type of establishment they are running:

· Stonecroft -Commented that the recommendations were positive. The manager does not foresee a problem with young people becoming more involved in cooking. There is a cook on the premises and a degree of involvement already with menu planning

· Swanwick - Children are already involved in menu creation, have cookery lessons and invite their families in for meals that they have cooked. A variety of cultural events are also offered to encourage the children to try alternative foods. The manager is currently undertaking a review of the dietary needs of the children and links in terms of behaviour. He would be interested in looking at this issue across all aspects of residential care.

· Glendalyn - The manager feels that health and safety issues may be a concern at this home due to aggressive and violent outbursts from the children. The home has been without a cook for three years and so this task falls on existing staff as an additional workload. The manager may need support to look at alternative ways of meeting this demand for children at Glendalyn

· Both Swanwick and Glendalyn provide additional feedback on health assessments stating that they had good procedures either within the home or locally for dealing with these. Glendalyn added that access to dentists did present a problem.

2.4 Social Services response endorses that of the C&YPSP and `welcomes the focus given by the Health Review Committee to the health needs of children looked after'. They comment that the review findings will help support work that is already underway in this area.

2.5 A new annexe has been added listing participants and stakeholders in the review (Appendix iii)

3. Summary of Health of School Age Children responses

3.1 C&YPSP comments as in 2.1 plus a wish to work closely with the Directors of Public Health for Recommendation Two.

3.2 The Directors of Public Health (DoPH) discussed the report and recommendations at their February meeting. They agreed to take account of the need for baseline data through the Obesity and Exercise Programme that is being developed through the DoPH Network. Christine Jackson, DoPH for Eastleigh and Test Valley South will be the lead for this work.

3.3 PCT responses endorse the need for greater collaborative working on children's health and confirm that there is already a lot of activity in these areas especially around the Healthy Schools Scheme. It was felt that this review is timely in light of the Green Paper `Every Child Matters' and the imminent National Service Framework. There is a suggestion that research referencing could have been tighter and the C&YPSP may wish to commission studies to support the review.

3.4 The National Healthy Schools Scheme (NHSS) co-ordinator supports the reports recognition that the NHSS must play a pivotal role in health promotion of healthy eating and physical activity. The NHSS national office has recently commissioned research into the health impacts of the scheme and can show strong links towards better health and improved performance in school through participation. It would be advantageous to duplicate this research on a local level thereby adding to the quantitative data being collected for Recommendation Two. The Hampshire NHSS co-ordinator already links with all the agencies cited in the recommendations plus others at regional and national level. This scheme has the potential to be the `glue' joining all the strands together. Consideration needs to be given to increasing the funding and number of schools becoming `healthy schools'.

3.5 Following feedback from the Environment Department action points 1 and 6 of Recommendation Four have been combined (see Appendix ii). In addition Para 6.5 of the original report has been updated to read `School Travel Plans (STP's). The Environment Department has recently been allocated significant revenue funding by the Department for Transport to provide support and advice to schools wishing to develop travel plans and raise awareness of transport and related issues through the curriculum. In addition the Department of Education and Skills is also making funding available (up to £10k per school) for capital improvements to those schools that have prepared travel plans. The Environment Department is currently working with around 25% of schools in Hampshire on travel plan development of which approximately 80 schools have a fully endorsed travel plan in place. Approximately 25% of all schools have STP's, this must increase to 60% by 2006. In September 2003 the `Hampshire Schools Hands Up Travel Survey' was carried out in 226 schools across Hampshire. The results show that car use for school journeys in Hampshire is higher than the national average (44% compared to 29%). When asked how they would like to travel to school only 23% would like to travel by car whilst the majority (36%) wanted to cycle' (Appendix iv)

3.6 HC3S (formerly Hampshire Catering) agrees with the review recommendations and is happy to be involved where mentioned. They add that although their priority is to promote the take-up of healthy meals in school they do a `lite bite' alternative that matches the lunch box recommendation.

3.7 The Education Department confirmed that it was happy to be the joint lead agency for Recommendations Three and Four. Using the nine sports partnerships that have been developed across the county it will be possible to collect and analyse levels of participation in sport in schools. Similar information can be gathered from schools participating in the physical activity focus for Healthy Schools and Recreation and Heritage will feed back on progress to sports clubs activities. Collectively this information should provide a clear picture of physical activity levels of children across Hampshire.

3.8 The Early Education and Childcare Unit equally supports the review findings and recommendations and will take a proactive approach towards promoting Recommendation Two in all out of school care. They are also keen to extend the recommendations into early years groups where possible.

3.9 Social Services refer to recent research from the Muslim Health Network that identifies health problems relating to obesity amongst Muslim males. They state that in some communities' obesity levels are three times the national average.

3.10 A new annexe has been added listing participants in the review (Appendix v)

3 Recommendations for the Health of Children Looked After in Hampshire

4.1 That the Health Review Committee endorses the following recommendations:

1. A top-level multi-agency group accepts responsibility for the co-ordination and monitoring of the review findings and recommendations to improve all care and support arrangements for children who are looked after in Hampshire

2. Establish a health information scheme which will enable children who are looked after to maximise their health and care choices

3. Provide a comprehensive, responsive and supportive multi-agency network of services to support children looked after

4. That key professionals who are responsible for collating and transferring information should design, establish and monitor a transferral system that meets the needs of children, carers and professionals

5. Develop clear guidance and procedures for health assessments and GP practices

6. Establish a training and support network to enable continual professional development and improve communication

7. Maintain an overall involvement and responsibility for review recommendations

4.2 That the Health Review Committee receives a progress report in November 2004 and an annual report in May 2005 from the Children and Young Peoples Strategic Partnership

4 Recommendations for the Health of School Age Children

5.1 That the Health Review Committee endorses the following recommendations:

1. A top level multi-agency group accepts responsibility for the co-ordination and monitoring of the review findings and recommendations to improve eating habits and physical activity levels for all children and young people across Hampshire

2. Establish baseline information on the health and well being of children and young people across Hampshire

3. Develop a county wide health promotion strategy for healthy eating

4. Develop a county wide health promotion strategy for physical activity

5. Maintain an overall involvement and responsibility for review recommendations

4.2 That the Health Review Committee receives a progress report in November 2004 and an annual report in May 2005 from the Children and Young Peoples Strategic Partnership