In 2002, Department of Health guidance entitled Promoting the Health of Looked After Children suggested standards of both content and timeliness of health assessment for children newly looked after. As a result of the consultation a working group was established to look at ways to improve the health situation for looked after children (LAC) in East Berkshire.
Prior to the publication of the guidance, the three Primary Care Trusts in East Berkshire, with support from the conterminous social services department, undertook an audit looking at the assessment content and a range of indicators. This demonstrated low rates of completed health assessments (62% of those eligible had had a review health assessment), ineffective follow-up of health plans and inadequate basic information on routine health input such as immunisations, where only 32 per cent were recorded as completed, developmental checks (19%) and dental checks in those over two years (54%).
An Integrated Care Pathway (ICP) was developed and featured as an example of good practice in the guidance as Appendix 5. The ICP was based around the guidance premise that all children coming into the care of the local authority should have a holistic comprehensive health assessment by an appropriately trained medical practitioner, and that a health report should be available for the first social services review at one month; also that any actions, and particularly referrals, should be addressed in a timely fashion and that children should not be disadvantaged if they moved out of area.
Most importantly, it incorporated the following timescales for completion of Initial Health Assessments (IHA) and reports based on the guidance consultation and local discussions:
notification by social worker to health of admission to care within five days;
IHA to be completed within 14 days;
report to be sent to the social worker with a health care plan prepared by the LAC nurse in time for the first review at one month.
A team of health professionals was established to develop a better service, including a medical adviser, 1.5 nurse specialists, a mental health nurse and, crucially, an administrator who provides the focus for operations, receiving notifications, arranging the assessments and fielding the paperwork, a task which had previously been managed by social workers, with carers arranging appointments directly with the child's GP.
The variances from the ICP were reviewed...