Agenda item

To receive a presentation from the Leicester City Clinical Commissioning Group on the CQC review for Looked After Children and Safeguarding.

Adrian Spanswick, Lead Nurse Adult Safeguarding, Leicester City CCG and Chris West, Director of Quality, Leicester City, CCG gave a presentation on behalf of the Leicester City Clinical Commissioning Group on the CQC review for Looked After Children and Safeguarding.

It was noted that:-

f)    The CQC Action Plan was divided into 11 sections and attributable to the following organisations:

·       Leicester City CCG

·       NHS England

·       Leicester City Local Authority

·       Leicestershire Partnership Trust

·       University Hospitals of Leicester NHS Trust

·       SSAFA

·       Leicester Recovery Partnership

·       Staffordshire and Stoke on Trent NHS Partnership Trust

g)   The 11 sections in the action plan covered the 59 recommendations highlighted by the CQC.  However, there were 172 planned actions identified in the CCG plan to achieve improved outcomes following the CQC review.

h)  Significant progress had been made by March 2017 against the delivery of the action plan. This included:

•     143 (of 172) planned actions had been completed.

•     28 planned actions were currently being implemented and were on            track.

•     1 action, dependent on national work (Child Protection Information Sharing Project), was currently in progress but behind anticipated delivery.

i)    The CCG continued to work with partner organisations to collate evidence of progress against actions relating to each recommendation. This involved detailed confirmation and challenge from the CCG Hosted Safeguarding Team on each provider’s submission as part of the CCG quality monitoring process.  The Quarter 4 submissions and updates were due to be received in April 2017.

In response to Members’ questions the following comments were received:-

a)         All evidence submitted as part of the action plan was reviewed with the provider by the quality lead for that action and the Lead Nurse for Adult Safeguarding.  The evidence was also reviewed by each work stream and LPT and UHL’s internal safeguarding committees and boards.

b)         NHS England also had a role in overseeing the action plan and endorsing the improvements achieved against the action plan.  In addition, the CQC could also make further planned and unplanned visits which focused attention on achieving the improvements required within the action plan.

c)         Some of the services provided were shared with the other 2 CCGS in the LLR footprint and they had yet to be inspected.

d)         Domestic Violence was a focus for the Safeguarding arrangements and a Domestic Violence Board was being created which would be chaired by the Police.

e)         Each of the organisations involved in the responses to the improvements in the Action Plan had done what they said they would do.  However, the CCG as the as safeguard lead, were also asking organisations to identify where further work was required to get better improvements.

f)          A number of elements of children’s health and wellbeing had been improved to become more resilient. For example a new GP Safeguarding Assurance Tool had been launched on 1 April and the initial feedback from GPs indicating it was working well in referring children to the access team.  Phone access was available to respond to those in crisis and referrals could be made where appropriate. All children were now being assessed promptly and the service was committed to providing services to those who needed them most at the earliest possible time.

g)         It was acknowledged that some areas were taking too long to achieve required standards. Often there was more than one organisation involved in working together to achieve the improvement.  It was felt that the direction of travel in these instances was positive.  LPT had made considerable progress in carrying out the Initial Health Assessments with the 13 week target.  They were now working to reduce the time between the assessment and subsequent treatment.  It should also be recognised that young people often failed to attend their appointments which caused further delays in lost appointments.  Further work was needed to understand the reasons for this and to address increased access to the services.

h)        Little was currently known about the demographic profiles of young people accessing the services and further work to providing information to determine, age, sex and rural/urban profiles would be helpful. 

Members made comments and expressed concerns as follows:-

a)         The backlog of children who had been assessed and were still awaiting treatment was still of concern.

b)         Providing some support to looked after children after they became adults was considered desirable.  Some looked after children still required assurance and support to access public health and GP services after losing the support of their looked after children nurses who helped them to arrange medical and dentists appointment etc.  There were many community/religious groups within communities and neighbourhoods that could provide support and help in these circumstances and it may be that those requiring the services were unaware of the pathways to access them.  It was also recognised that many looked after children who had been fostered stayed in touch afterwards and it may only be a minority that felt they needed extra support when they reached adulthood.

c)         Members were disappointed they had not been provided with a copy of the Action Plan.  Whilst it was recognised that the Action Plan was being monitored by the Safeguarding Children’s Board and the Improvement Board; reports made no reference to the involvement of the Council’s scrutiny process.  It was also felt that officers should involve Scrutiny Chairs (particularly the Chair of the Children, Young Peoples and Schools’ Commission) in reports that were submitted to the Improvement Board.

The Strategic Director of Adult Social Care commented that the ongoing issue of providing support to individuals transitioning into adulthood who had traditionally received support from a wide network of services had always been a challenge, as there were inadequate resources to provide any support services post care where there was no ongoing statutory requirement to do so. He supported the suggestion of a community network pathway to offer community and peer support where there was no statutory requirement to provide support.

The Deputy Director of Public Health responded to the Chair’s comments in relation to re-commissioning services for schools nurses and health visitors after budgets had been top sliced by a 10% reduction.  He indicated that a report on this area of concern could be submitted to a future meeting.  He also confirmed that the Director of Public Health was committed to ensuring that there was a continual and collective response covering both public health and safeguarding.  A copy of the CQC’s letter would be provided to the Commission.

AGREED:

1)         That the CCG representative be thanked for their attendance and their presentation.

2)         That the Children, Young Peoples and Schools Scrutiny Commission and the Health and Wellbeing Scrutiny Commission work jointly to consider the quarterly update reports to satisfy themselves of the progress being made.

3)         That a copy of the CQC’s letter to the local public health team on services provided by the NHS, but commissioned by the local authority, be forwarded to the Scrutiny Policy Manager and sent to members of the Children, Young Peoples and Schools and the Health and Wellbeing Scrutiny Commissions.