Kevin Woods and Alan Bell Department for Education and Department of Health

Cross-Government action to address the health needs of young people leaving care

What does research show?• There is still evidence of inconsistencies in

services across local authority areas and a high level of need for health services, particularly mental health services (Cameron et al., 2007)

• Many care leavers struggle to build and have relationships with others and are more likely to suffer from depression and other mental health problems (Dixon 2008)

• Poor transitions from care can exacerbate existing health problems (Sten & Dumaret 2011)

What does inspection show?• “The health needs of young people leaving care and care leavers are supported

well. Health assessments take place before young people leave care and a clear action plan was in place in cases reviewed by inspectors.” (Hillingdon 2014)

• “However, support for Care Leavers to manage their health and promote healthy living is not consistently available or effective. Most current Care Leavers have not been provided with a copy of their health history. However, action has been taken to address this.“ (Derbyshire 2014)

• “Arrangements to meet children’s health needs are good. The looked after children (LAC) nurse, based with the throughcare team, is available to talk to children and care leavers, who visit the office or use the drop-in facility, and refers them to specialist health services as necessary.” (Hartlepool 2014)

• “Care leavers are encouraged to have regular medical checks, and are supported in registering with a GP and dentist in the area in which they live. A community psychiatric nurse is available for consultation within the team who can help enable access to adult mental health if this is needed, as well as directly providing one-to-one support. Sexual health and substance misuse services provide support and advice and are available and accessible to care leavers.”

(Sheffield 2014)

Key Government priorities for care leavers

• Four key priorities– Fewer leaving at age 16, more in staying put

arrangements or high quality supported accommodation up to age 21

– Consistent support across the country– Voice of the young person at the heart of all

decision making– Better mainstream and specialist support,

including health

What Government has done (General)• DCS sign-off of 16 & 17 year olds leaving care• Care Leavers Charter• Financial support (Junior ISA, CL allowance)• Developing best practice (New Belongings;

NCAS; From Care2Work)• Cross-Government Strategy– Accommodation/CLG; Health; Benefits/DWP

• Ofsted monitoring – CL sub-judgement

What more Government will do (General)

• “Staying Put” with former foster carers• Innovation Programme – adolescents• Cross-Government Strategy– Accommodation/CLG; Health; Benefits/DWP

• Collecting information on 20 and 21 year olds• Implement SEN reforms – 16-25 year olds

(includes health plans)

What Government and partners have done (Health)

• Mandate to NHS England• Joint Strategic Needs Assessments• Care Quality Commission inspections• NICE quality standard and guidance• Mental health strategy and Action Plan• CAMHS service transformation

What does statutory guidance say?“Young people leaving care should be able to continue to obtain health advice and services at what is often a very stressful time for them. Personal advisers should work closely with doctors and nurses involved in health assessments… Leaving care services should ensure that health and access to positive activities are included as part of young people’s pathway planning”

Statutory Guidance on Promoting the Health and Well-being of Looked After Children (2009)

What more Government and partners will do (Health)

• Update statutory guidance on the health of looked after children

• Multi-agency inspections in 2015• Professional bodies to update looked after children

health care staff competences framework• Revise use of the Strengths & Difficulties Questionnaire• NSPCC “Achieving emotional wellbeing for looked after

children” project• e-learning programmes on children and young

people’s mental health

Local delivery – Key messages for LAs

• Local authorities/Directors of Children’s Services have key role– Working with Clinical Commissioning Groups– Developing Joint Strategic Needs Assessments– Working through local Healthwatch – Holding NHS to account via scrutiny role– Leading on delivery of public health functionsENSURE CARE LEAVERS’ NEEDS ARE A PRIORITY

More information• Care Leaver Strategy

https://www.gov.uk/government/publications/care-leaver-strategy• Mandate to NHS England

https://www.gov.uk/government/publications/nhs-mandate-2014-to-2015

• JSNAs statutory guidancehttp://webarchive.nationalarchives.gov.uk/20130805112926/http://healthandcare.dh.gov.uk/jsnas-jhwss-guidance-published/

• CQC inspectionshttp://www.cqc.org.uk/public/publications/themed-inspections/child-safeguarding-and-looked-after-children-inspection-progr

• NICE quality standardhttp://www.nice.org.uk/guidance/index.jsp?action=byID&o=14140

More information (2)• Looked after children statutory guidance

https://www.gov.uk/government/publications/promoting-the-health-and-wellbeing-of-looked-after-children

• Intercollegiate competences frameworkhttps://www.rcn.org.uk/__data/assets/pdf_file/0019/451342/RCN_and_RCPCH_LAC_competences_v1.0_WEB_Final.pdf

• Mental health strategy – No health without mental healthhttps://www.gov.uk/government/publications/the-mental-health-strategy-for-england

• Mental health action plan – Closing the Gaphttps://www.gov.uk/government/publications/mental-health-priorities-for-change