The report of the Designated Team for Looked After Children - Bradford District and Craven Clinical Commissioning Group (CCG) (Document “M”) provides a summary statement on the first annual report for Children Looked After and Care Leavers to include background, content – successes and challenges - and future focus.

Recommended -

(1)  Members are asked to consider the information provided within the report.

(2)  Members are welcome to ask a question or raise a comment at the meeting to gain clarity or for assurance.

(Dr Kate Ward - 07985378532

The report of the Designated Team for Looked After Children - Bradford District and Craven Clinical Commissioning Group (CCG) (Document “M”) provided a summary statement on the first annual report for Children Looked After and Care Leavers to include background, content – successes and challenges - and future focus.

Members noted that this was the first report of its kind and while not a necessity, it was good practice to produce an annual report.

Members learned of the complexities of providing healthcare to Children Looked After (CLA), and the challenges of the provision of care, in meeting statuary timescales and the increase in the number and complexities of the children who become CLA in the Bradford District.

Members understood that a new clinical model has been implemented and had provided success for the Designated Team for Looked After Children, and that it was this that had allowed for an annual report to be produced.

Officers stressed the strategic role of the Designated Doctor and a move away from the clinical tasks of the Named Doctor for CLA.

Members understood there had been improvements to the statutory timescales of initial assessments and an improvement in the system used to accurately identified at which stage a CLA child is at in the process.

Members were keen to understand If the statutory guidance was being delivered and if the Designated Team for Looked After Children was falling short.

Members were asked to understand that this was guidance, and that children were no longer falling through the gap. Furthermore, the difficulty was in the timescales of 21 days, to provide an initial healthcare assessment for a child or young adult. This was inevitability difficult to adhere to as obtaining consent can be difficult. The team was not seeing every child within the timeline but this is improving. There are delays especially with services such as CAMHS. Members were told it is not realistic to say every need is being met, and the priority going forward is to meet need.

Members sought clarity on the issue of consent and who is responsible for obtaining consent.

In response, officers from the Designated Team for Looked After Children, stressed that it is preferable to gain the parent’s consent. It is the responsibility of social workers to obtain consent. In the event that a parent would be unwilling or unable to consent on behalf of the child, the social work manger can sign and subsequently give consent. Furthermore, the Local Authority can seek a court order. In the case of a young person they may have capacity to give their own consent. There is no set age but it is usually those young adults over 13 or 14 years’ old that can consent for themselves.

Members understood that the obtaining of consent can cause delays for the service. The number of children that do not have consent is reviewed in a weekly triage meeting in which these cases are reviewed and a plan can be put in place for that child to receive consent and subsequently their initial health assessment.

Members asked to what extent had Covid-19 prevented health services being delivered. They were assured that whilst there were remote arrangements made, the service had since resumed in person appointments. Additionally, dental care was an ongoing issue. There is a large backlog of children waiting to be added to a local dentist. In the instance of children being in foster care, the families they are with make their own arrangements with their own dentists.

Members sought calcification on the process of children being placed out of district and whether they are brought back to the Bradford District for their assessments or they receive them in their local districts.

In response, many of the children who are placed out of district are with friends and family. It is the Designated Team for Looked After Children who are responsible for conducting their initial assessments for children placed out of district. They also ask local CLA teams to do initial assessments, some have the time and capacity and others do not. Children in West Yorkshire at a reasonable distance can be brought in or clinicians can do a home visit if appropriate.

Members also asked officers about their recommendations and thoughts on the services provided by Designated Team for Looked After Children with regards to the budgeting of the council for next year. Officers demonstrated a need to maintain priority in early help and prevention which has been excellent. There is a need to maintain the capacity to gain consent, this was worrying but has improved. Anything that affects the budgeting in these areas would have a negative impact on the service.

Members were concerned that children who are placed out of area did not receive the same level of service, which is due to their circumstance and subsequently not in their control. Officers divulged that this is dependent on where the child is placed, but yes. This is worrying as these children that move around often are the one that really need to be seen, as these are the children with complex needs.

Members were concerned about the number of health assessments that had not taken place and wanted to know if this had improved since April 2021. Officers assured members that this was not something that is independent to Bradford, and it would be unusual to find an authority that met the deadlines due to issues of obtaining consent. Officers were more concerned with giving children in depth and quality health assessments than they are meeting deadlines. Members were told that although children may be waiting for health assessments, they are still seen by the nursing team weekly. Members were assured that the service has improved because of the new system in place which means the situation the service was in a year ago will not happen again. 

Members were keen to receive an update on the statistics in three months’ time.

Members also sought to understand the definition of backlog. Officers explained there will always be children waiting, but it is not the same children waiting. Therefore, the numbers may remain the same but it is different children who make up the numbers. This language of ‘backlog’ is something officers wished to improve on because of the negative connotations of the term.

Members also wanted to understand the difference between a designated doctor and a named doctor. It was clarified that the named doctor is a trust appointment and is someone who leads on clinical advice. They are essentially clinicians with additional responsibilities. Officers explained that the designated doctor is not a clinical role but working at a strategic level.

Members were told that keeping people in the roles of designated doctor and named doctor has been a challenge. One person cannot do it all because it needs to be a localised service where the doctors are close to the children. If they get this service right, then children do not become persistent users of the service.

Members asked whether the budgets should be reviewed and stated the success of school nurses in lessening the number of children who are suffering. Officers stated there were plans in the process and that a review is currently under way. Officers would welcome sight on this at a later meeting of this committee.

Members were made aware that there is no legislation that sets out a timeline of how long children should be seen in. Members demonstrated a need to check in which children who are ill, as they would with their own children, in their capacity of corporate parents.

Officers outlined that the service is not there, so to set timelines would be futile and create failure. There is a need to look at the medical need as priority.

Members thanked the NHS Team and Dr Ward for their presence and contributions.

Resolved –

(1)  The Committee would like to thank officers for their attendance and contributions.

(2)  This Committee requests that a report be presented in 12 months.

(3)  That more up-to-date statistics in relation to the timeliness of Children’s Health Assessments, be circulated to members of this Committee in three months’ time.

(4)  This Committee requests that the findings from the review into children’s health assessment caseloads be presented to the Committee, in the new municipal year.

Action – Strategic Director of Quality and Nursing

                                                                  (Michelle Turner)

                                                                  (Dr Kate Ward – 07985378532)