Development of a Gold Standard Service for Children in Public Care (Looked after Children) in a University Teaching Hospital in the UK

Background: Looked after children (LAC) are a vulnerable group of society who have signficant healthcare needs. In 2016 there were > 70,000 looked after children in England. Each year this number has risen by >1% and includes growing numbers of unaccompanied asylum seeking children.

Objective: Following RCPCH & NICE recommendations, we created a streamlined, standardised healthcare tool for the initial health assessment (IHA) of children in public care. By sharing our experiences, we hope to contribute towards practices in other centres.

Methods: All children placed into care within the region are referred by social services to a specialized LAC health team. Social services reports and parental health-assessments are sent using a secure online system (Part A). Part B allows young persons to consent.

There are five protected consultant-led clinics, creating a minimum of 10 IHA medicals a week. A paediatrician will complete Part C (child/young person/asylum seeker) detailing the implications of social, education and health information for the child’s current and future wellbeing. This comprehensive report is a standardised pro-forma and evidence based medicine statements are used for health implications to create consistency amongst clinicians.

A strict 20 day completion ensures multiagency professionals focus on timely care. The completed report is securely shared with general practitioners, social services and other essential agencies.

To enhance practice, all clinicians complete an online health data survey after each consultation. We ask carers for feedback to monitor satisfaction and aid quality improvements.

Conclusion: Looked after children are a vulnerable group of society and their exposure to adverse life events is associated with poorer outcomes across social, education and health. Tackling these health inequalities requires multiagency collaboration. We have successfully created a quality standard health tool to facilitate this. Sharing information, gaining feedback and working together is pivotal for a holistic service for these children.