Cheshire and Merseyside “Healthy Care Matters” Network Presentation to the BACCH Mersey Regional Education Day 30 th. June 2010 by Jonathan Smith

Background Former: Director of Social Services Strategic Director (local government) PCT CEO Since February 2005: Founder, and leader, of the Child Health Development Programme [CHDP] Based in Cheshire and Merseyside, but doing local, sub- regional, regional, and national work Specialist children’s service improvement agency Currently within the NHS: planning to become a Community Interest Company, limited by shares, and operating as a social enterprise

Business Plan Objectives: Health of LAC To support, and sustain, a Cheshire and Merseyside “Healthy Care Matters” Network, which: ~ attracts the active engagement of LAC Nurses, Children’s Services and Designated (LAC) Doctors/Medical Advisers, from each Children’s Trust area ~ oversees a number of work-streams, which show evidence of helping to improve the health service offered to LAC

How the Network Developed A recommendation from the Liverpool LSCB, following an SCR Its focus was: how to guarantee that, when a child in care moves to a placement across a Health administrative boundary, the continuity and quality of their health services remains uncompromised We engaged LAC nurses, local authority team managers, and risk managers This project-based ‘coalition’ was morphed into a C&M Network Leadership: myself and two LAC nurses (2 days per month, each) Focus: a C&M protocol to solve this problem Communications: keeping DCSs and PCT CEOs informed

The Network Today Meets quarterly Involves: ~ LAC nurses ~ Children’s Services Team Managers ~ Designated Doctors/Medical Advisers Oversees two major work-streams

Work-Stream 1 LAC Moving Across Boundaries We have produced: Standards Protocol 48-hour process flow-chart Notification form Private providers’ protocol Data collation matrix Root Cause Analysis form (where things go wrong)

Work-Stream 1 LAC Moving Across Boundaries We have instituted the following change management process: Review of local arrangements at each meeting Discussion of any examples of serious failings in the previous quarter, at each meeting At least annual overview of the performance data from across the sub-region In September, preceded by individual performance review sessions with the leadership team

Work-Stream 1 LAC Moving Across Boundaries We have the following ‘wicked’ issues: 1. No success in forging a sub-regional agreement between CAMHS commissioners 2. A wide variation in the capacity of LAC nurse and admin. teams 3. Organisational and personnel changes 4. This is not one of the big priorities for either Health or Local Government 5. A long history of failure to consistently and systematically improve standards 6. This is not a commissioned/funded piece of work

Work-Stream 2 Multi-Site Audit [funded by a grant from HQIP for 3 years] “Medical Services for Children in Care and Adopted Children in Cheshire and Merseyside”: To find out the current compliance of these services with recognised standards, and to repeat the audit on a regular basis, so that progress towards compliance can be monitored. To be one of three distinct, but connected work-streams. The others will be: ~ Qualitative Research, and ~ Listening to the Voices of Young People and Adopters To drive the standardisation of documentation across Cheshire and Merseyside.

Work-Stream 2 Multi-Site Audit In relation to the Audit itself, we have: Designed an Audit Tool for Initial Health Assessments Piloted the Tool Progressed through 60% of the base-line assessment process (using 10% of the IHAs from 2009) Designed a questionnaire for each LAC nurse, and received responses back from the majority In relation to the Qualitative Research, we are: Seeking to identify where we could access the capacity to undertake this In relation to “Listening to the Voices of Young People in Care”, we: Have produced, and disseminated, a proposal for a Reference Group Are seeking £1,050 from each Corporate Parenting Forum

Work-Stream 2 Multi-Site Audit We plan to: Report the findings from our work, so far, to a meeting on Design, and pilot, an Adoption Audit Tool Recommend future standards and CQI process Review our audit tools against up-to-date guidance and examples of best practice Prepare for the start of the on-going initial health assessments and adoption audits from 1.9. Brief DCSs and PCT CEOs Brief doctors involved in the clinical work in relation to both Report progress, or otherwise, over the two years, to the Healthy Care Matters Network Support improvement strategies

Looking Ahead 1. We are planning a C&M conference in November, to look at the full implications of the recently-published national guidance on the Health of Looked After Children. 2. We need to look to the cross-boundary arrangements with our neighbours: Wales, West Midlands, Manchester and Lancashire.