Child Health Commissioners
14 June 2012
Minutes
Present:
Child Health Commissioners
Jim Carle (Chair) NHS Ayrshire and Arran
Sally Egan (deputy Chair) NHS Lothian
Sally Amor NHS Highland
Emelin Collier NHS Western Isles
Louise Wilson (teleconference) NHS Orkney
Dr Simon Hilton NHS Grampian
Geraldine Queen NHS Lanarkshire
Kay Fowlie NHS Tayside
Dr Zelda Mathewson NHS Tayside
Kathy Collins NHS National Service Scotland
Mandy Brotherstone NHS Borders
Scottish Government:
John Froggatt Deputy Director, Child and Maternal Health Division
Gillian Garvie Head of Children and Young People’s Health Branch
Dr Kate McKay National Clinical Lead for Children and Young People
Bob Fraser GIRFEC
Pauline Davidson GIRFEC
Apologies:
Lorraine Currie NHS Grampian
Gary Dover NHS Greater Glasgow and Clyde
Catriona Renfrew NHS Greater Glasgow and Clyde
Val Hatch NHS Fife
Susan Manion NHS Fife
Dr Graham Foster NHS Forth Valley
Dr Sarah Taylor NHS Shetland
Dr Rachel Wood NHS Information Services Division
Dr Deirdre McCormick Chief Nursing Officers Directorate
Guest Speakers:
Peter Doran
Stuart Robb
Maria McGill
Dr Pat Carragher
ITEM 1: INTRODUCTION
1.1 Jim welcomed everyone to the meeting and introduced Geraldine Queen to the group. Introductions were made by those present. Jim then provided apologies.
ITEM 2: MINUTES OF PREVIOUS MEETING
2.1 Jim asked Sally Egan to go over the minutes and Action Points of the last meeting which was chaired by Sally.
The group discussed:
· Kathy Collins updated the group that Julie Adams returning to NSD from Patient Safety Programme in near future.
· Mandy Brotherstone confirmed Action Point to discuss LACSIG had been taken forward and she would provide updates as and when.
· Sally Egan confirmed Action Point on end of life care / SCYPPCEx to speak to Pat Jackson had been taken forward and that she thought Pat might be attending the joint Children and Young People’s Health Support Group and Child Health Commissioners joint meeting.
· Kay informed the group that Angus in Tayside was the development site for testing out the proposed methodology for the future scrutiny and improvement of integrated children’s services(¾ way through) - the new Children's Inspectorate. Kay discussed with the group that key work was under taken in Angus to raise the Inspectorates understanding of Getting It Right For Every Child (GIRFEC) and that further work would need to be undertaken. Bob Fraser informed the group that he had spoken to the Inspectorate and a big piece of work was being undertaken to further their understanding of GIRFEC. Sally Egan advised that Jacquie Pepper, Senior Inspector, Care Inspectorate, had given a presentation to the Lothian and Borders GIRFEC Steering Group.
· Jim confirmed that information on inpatient age limit policy for paediatrics had been circulated by Stewart.
Action Point: Jacquie Pepper to be invited to speak to Child Health Commissioners.
ITEM 3: MATTERS ARISING
3.1 Jim gave an update to the group on discussions over the agenda for the joint Children and Young People’s Health Group and Child Health Commissioners group meeting to be held on 29 August 2012. Jim explained that it went well and added that it was felt that it was critical to know the role of each group and its responsibility. Jim then went through the proposed agenda.
3.2 The group held some conversation on a point Sally Amor raised on Children’s Systems. Sally discussed the importance of synergy between services and work needed to be around a joint commissioning process which would be critical to care packages. Sally asked the group for their support and warned against the need to rush into putting in Clinical care. Sally also asked John Froggatt if the C&YPHSG could also provide support. John informed Sally that the C&YPHSG was grateful for Sally’s input and that he believed it was important to discuss at both groups.
3.3 Jim asked Sally if their should be a list of questions or points for clarification. Kay supported Jim’s suggestion and Sally agreed to prepare a list of outcomes.
Action Points: Sally Amor to prepare a list of outcomes on Highland Agency and Stewart Squire to circulate to Child Health Commissioners.
ITEM 4: LOOKED AFTER CHILDREN STRATEGIC IMPLEMENTATION GROUP (LACSIG) OUT OF AREA PLACEMENTS
4.1 Jim asked John to speak to the group regarding out of area placements for Looked After Children. John provided to the group with some current background on LACSIG and the Health Hub. John also added that one idea would be for CHC’s to be involved and that the Boards need to be at looking at new ways to deliver.
4.2 John informed the group that he had been involved in conversations with NHS Dumfries and Galloway about placements and he noted two main issues; cross border placements within Scotland and placements outside Scotland. John explained the differences in the guidance for Scotland and England and issue of “ordinarily resident” which is found in the 2004 Guidance.
4.3 John further explained that “ordinarily resident” meant the address that a child gave at the time as their residence. The Board that the residence was situated in was responsible for payment for services. John added that this was a critical issue and believed that it would be better for it to be resolved between the Boards themselves. Also discussed was cross border placements in England, John noted that there was some pressure on Boards. John welcomed input from the group.
The group held discussion on:
· Kay explained that there was a further layer which was placement for education reasons, not just health. John noted that he understood this but the problem was the established guidance is not being followed and that there is a distinction between boarding school placements and care home residence.
· Mandy informed the group of the pressures in NHS Borders due to placements in NHS Cumbria.
· Sally Egan raised the issue that there was no consistent arrangement for health assessment for out of area placement and not being able to track which health professional held responsibility for a child/young person placed in NHS Cumbria. John explained that under the Guidance there was a shared responsibility between Local Authority and Board to ensure a health assessment was conducted.
· Sally Amor raised the issue of the responsibility of Boards as corporate parents.
· Mandy informed the group that the health hub had been looking at the coordination of health assessment and that they could be a point of contact.
· Bob Fraser noted that there should be someone responsible within the Board and that there should be clarity over the child’s residence. Jim also noted that it should always reflect the child’s best interest and that he could not see transferring of responsibility to another Board was good for the child’s care. Bob added that it all came down to the interagency plan and that the guidance is there.
· Some discussion on ongoing work on the Erskine Bridge FAI. John reiterated that he believed that an agreement between the boards was needed and that the needs of the child must be paramount.
· Some further thoughts were added to the discussion; Sally Amor raised a point that strategic commissioning might need to come up with further guidance. Sally Egan noted that Local Authorities would need to be brought into the discussion. There was also discussion on how the CHC group could support the work of LACSIG.
Action Point: John Froggatt to speak to LACSIG regarding assistance CHC group can provide.
· The group also discussed briefly number of children and young people in placements.
Action point: Mandy Brotherstone to provide John Froggatt with details
4.4 Jim thanked John for speaking to the group today. John left the meeting.
ITEM 5: GETTING IT RIGHT FOR EVERY CHILD (GIREFEC) UPDATE
5.1 Jim asked Bob to provide an update to the group on the ongoing work around GIRFEC. Bob informed the group that there was ongoing work enhance the GIRFEC guidance for children in specific circumstances and development of training materials. There has been a large focus over the last few months on the development of the consultation document for the Children and Young People Bill
5.2 Bob also discussed with the group the Single Child’s Plan (CP) and
noted that development, and coordination of this is likely to have an impact
on Health practitioners particularly if they are the Lead Professional. Sally
Egan asked about the relationship of plans already in place with the CP and
Bob explained that all other plans would need to be included within the CP but
that the CP may be at a higher level than of care plans for patients held by
Individual health professionals.
The group held discussion on:
· The mismatch of different plans, Bob explained that the CP should clearly define what the child’s needs are and actions to address these.
· Conversation was held on health working with education in Board areas. Bob added that there will be a requirement to make it clear who is responsible for the CP and that there needed to be a multi agency conversation between Boards and Local Authorities as to how the CP will be managed and interact with other planning processes
· Bob also acknowledged the challenges there will be introducing the CP for the current child population who already have multiagency involvement; he also highlighted the potential benefits for those who are provided with a CP as soon as there is a need for multiagency involvement, potentially from birth.
· Some discussion was held about the consultation events for the Children and Young People Bill, Pauline noted that the consultation events will provide an opportunity to raise concerns. Gillian also added that arguments will be tested during consultation and that it was important to get as much Health Board input on this as possible.
· The group also discussed the Lead Professional and additional training on the CP for health professionals. Jim suggested that it was important that this training happen as early as possible and that they need to train health professionals at the colleges.
5.3 Jim thanked Bob for his update.
ITEM 6: DORAN REVIEW
6.1 Jim introduced to the group Mr Peter Doran and asked for introductions from those present. Peter began by explaining that the review was coming to an end and that he was due to provide the report by the end of July to Ministers. Peter invited CHC’s to provide comments to the work.
6.2 Peter also explained that the review was a strategic review about how systems were working and that it is a holistic review which takes in a lot of complex interface, looking at outcomes for children and what children required to meet their needs.
6.3 Peter spoke to the group about the challenges in defining complex health needs and the difficulties of collating data around children with complex needs. Peter described the use of independent agencies in the second phase of the report to look at the key questions raised in the first phase of the work.
6.4 Discussion on the broad areas of what the report was looking at was raised and Peter explained that they looked at issues around children and families experiences, how services were provided for the children and families and what the family’s feelings were on that provision. Peter noted that the report will say that interagency working is crucial but that there may still be barriers preventing it, but indicated that positively those services are patchy and some areas were doing very well.
6.5 Peter also spoke about the report looking at skills and the concerns around decreasing skills base. Also discussed was the report looking at the need to keep children in local services when it can be done and the relationship of local and national provision. Peter added that he was very concerned about not reducing capacity and indeed was looking at increasing capacity.
The group also discussed:
· Some discussion was held on building capacity by the use of outreach programmes. Peter talked about the use of the independent sector in building capacity
· Peter also spoke about the groups that have been engaged during the review, and the critical link between education and health.
6.6 Peter finished his presentation by asking CHC’s to provide comments on how it would be possible to bring all the important services together.
Action Point: Child Health Commissioners to provide comments to Peter Doran regarding multi-agency working.
6.7 Jim thanks Peter for coming to the group and discussing the review.
ITEM 7: EARLY YEARS TASKFORCE
7.1 Jim introduces Stuart Robb to the group and introductions are made by those present. Stuart provides some background to the Early Years Taskforce and explained that the taskforce was set up least year and was chaired by the Minister for Children and Young People, Aileen Campbell and the Chief Medical Officer, Sir Harry Burns and the President of COSLA, and its aim was to bring strategic leadership to the early year’s agenda. Stuart also spoke about the use of Community Planning Partnerships (CPP) as the delivery mechanism for the early years change programme.
7.2 Stuart also spoke about the intention to develop an early years collaborative, which would be launched later in the year, and that over the next few months they would be working with stakeholders to develop a proposal. Stuart also spoke about the recruitment process for a team to support CPP’s and that they were currently recruiting for a team leader.