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

2. Better Care Better Health Better Life 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. Better Care Better Health Better Life 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. Better Care Better Health Better Life 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. Better Care Better Health Better Life 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. Better Care Better Health Better Life 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. Better Care Better Health Better Life 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. Better Care Better Health Better Life 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. Better Care Better Health Better Life 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. Better Care Better Health Better Life 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. Better Care Better Health Better Life OOA placement issues Who Pays: Establishing the Responsible commissioner / annex Most needy no service LA responsibility holistic health assessment (1 st 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. Better Care Better Health Better Life 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. Better Care Better Health Better Life Questions 1.Do LA staff work closely with health professionals to ensure Lac health needs anticipated and met? 2.Do SWs ensure each LAC has a Health Plan as part of care plan that is implemented? 3.Are both Plans reviewed as per regulations? 4.Does IRO ensure Health Plan is effective and implemented? 5.Are SDQs carried out for LAC? – data collection? 6.Is health provision put in place when child OOA? 7.Are Health providers notified when child placed OOA? 8.Are all Lac able to access positive activities ? 9.Care Leavers health provided for – mental and physical as part of the pathway plan?