Agenda item

The Committee received a report of the Chair of the Starting Well Partnership, County Durham Care Partnership and Corporate Director of Children and Young People’s Services on the work of the Starting Well Partnership (SWP) during 2023/24 which provided an update on outstanding work from the last report (2022/23) as well as work undertaken in 2023/24 (for copy of report and presentation see file of minutes).

Alison Ayres, Commissioning Manager for Children’s Services, County Durham Integrated Commissioning Team, was welcomed to the meeting to deliver the presentation. The Commission Manager introduced the presentation by providing a refresh on the structure and governance of the Starting Well Partnership and its four sub-groups namely; Best Start in Life, Prevention and Early Help, Supporting Young People into Adulthood and Service Transformation. 

The Commissioning Manager provided an update on some of the matters highlighted for discussed during 2023/24. The Committee heard that work was ongoing to identify recurrent funding to continue the Pause pilot which assists families with multiple children removed from their care to break the cycle of repeated removals.

During the year, the Committee also considered mental health issues and one of the outcomes of their discussions was the inclusion of representation by the police on the Autism Steering Group. 

Unaccompanied Asylum Seeking Young People (UASC) were also an area of focus and the Committee discussed that UASC should be screened for their mental health as well as their physical health, on initial entry into care. The Commissioning Manager informed the Committee that this work was ongoing as initial health assessments were required to be undertaken within a statutory timeframe, however, the undertaking of mental health assessments within the same, relatively short, timescale may not be appropriate for UASC, many of whom will have suffered trauma.  In addition, some UASC assigned to Durham’s care, resided outside of the county and that was a factor in the work.

The Commissioning Manager introduced the partnership priorities for 2024/25 which included dental access, dental health and fluoridation.  Whilst the Committee was keen to consider those issues during the current year, initiatives associated with the work had just begun and it was therefore  considered prudent to delay the work until those initiatives were established.  With regard to Preparing for Adulthood, the work in 2024/25 will have a broad perspective and include education, employment and training and mental health issues associated with education attendance.

Ensuring the provision of help, advice and support at the earliest opportunity will also be a priority for 2024/25. The Committee noted the Starting Well Partnership was responsible for the Growing Up in County Durham Strategy and the Operational Management Group determined the areas of focus for presentations to the partnership, considering the objectives of the Growing up in County Durham strategy and the four Starting Well Partnership sub-groups.  The Commissioning Manager provided details of the workstreams for each of the sub-groups.

The Commissioning Manager concluded the presentation by commenting on the key challenges for the future including the increased demand for services, complexity of cases, limited resources and staff workloads.

The Chair thanked the Commissioning Manager for the presentation and the Commissioning Manager answered questions from the Committee.

In response to a question from the Chair as to whether any trends had been identified in relation to the number of unintentional injuries, the Commissioning Manager responded that recent data showed an increase in unintentional injuries across all age groups, however, the increase was not equal across all age groups. The unintentional injuries were predominantly fractures of the forearm, inter-cranial injuries and superficial injuries of the head, i.e. injuries consistent with trips / falls. Evidence suggested that zero-length stays, which occur when a patient attends hospital for a number of hours only, were driving the data.

Councillor Clark questioned whether, in previous years, when there may have been less pressure on services, zero-length stay patients would have been admitted to hospital overnight. The Commissioning Manager replied that pressure on services may be a factor, however, changes in clinical practices may also account for the increase in zero-length stays and she added that she would request further information on the matter.

In response to a question from the Chair as to whether some families were presenting children to hospital with unintentional injuries on a regular basis, the Commissioning Manager agreed to refer to the service for details to be provided.

Angela Gunn acknowledged the importance of monitoring data relating to unintentional injuries, however, she pointed out that children naturally engage in adventurous play which can inevitably result in accidental injuries.

Councillor Scurfield expressed concern at the increase in the number of unintentional injuries, commenting that it would be useful to have more information, particularly in relation to the number of repeat incidents and she suggested that the issue should be considered as a priority action.  

The Commissioning Manager agreed to pass the comments and the request for more detailed information to the Best Start in Life Team.

The Corporate Performance Manager urged caution with respect to the data on unintentional injuries, stating that coding issues within the Trust’s data may have led to Durham having a higher rate than that of neighbouring Trusts.

The Chair raised a question on the child weight management service provided by Harrogate District Foundation Trust and the Commissioning Manager explained the approach was an evidence-based, holistic approach to weight management, over a period of time. There had been issues with regard to the retention of families for the duration of the programme, however, the situation was improving and the service was now being delivered through Family Hubs.

Councillor Clark referred to the retention of families on the programme and she asked if there had been any follow-up work done with families to identify underlying reasons for their failure to complete the programme. Councillor Clark suggested that high turnover of staff and a lack of consistency in the service may be factors in the drop-off rate. The Commissioning Manager replied that engagement issues had been addressed and a text message reminder service had been implemented. She added that she would request information from the service as to what action had been taken in respect of follow-up work. 

Councillor Varty commented that she was pleased to see the work undertaken to promote education attendance, highlighting its importance as a foundation for preparing young people for the responsibilities of adulthood. She spoke anecdotally of families who had taken their children out of school, reporting sickness absence when the reason for the absence was, in fact, a family holiday.  Councillor Varty pointed out that there was more work to be done to educate parents.

The Children and Young People’s Service Manager for Operational Support, Clare Nicholls, shared the concern and she clarified that Department for Education guidance stated that when parents report a child’s illness, in general, schools should accept the parent’s word and authorise the absence.  However, when a child had a number of short-term absences without an underlying cause, schools may request additional information and may unauthorise the absence. The Service Manager highlighted that there had been a change to the Attendance Alliance Group to include representation from a GP and a protocol was being established, to share information between schools and GPs to address medical absences and authorisation issues. The process would help to support parents who require assistance with school refusal and it would also help to identify parents whose children miss school on a regular basis but who do not take their child to the GP, which may raise wider safeguarding concerns.

Angela Gunn highlighted that whilst she supported the principle, there were some children for whom that approach to education attendance would not be appropriate, for example those suffering from school anxiety.

Councillor Hunt gave an example of good practice taking place at a primary school which had employed a member of staff to engage with parents at the school gates, to encourage school attendance through offering incentives, which had led to improved attendance. The Service Manager confirmed that schools share examples of good practice.

Angela Gunn raised the issue of the strict criteria for accessing some social care services which may lead to high functioning autistic children who have complex needs, falling short of meeting the criteria. Jennifer Illingworth, Director of Children and Young People’s Integrated Services, informed the Committee that the Preparation for Adulthood work recognised that some young people do not meet the threshold for services and work was being carried out to identify those young people and to promote a needs-led approach. The Commissioning Manager added that one of the aims of the Valuing Neurodiversity work was to remove barriers to services in the future. The Director of Children and Young People’s Integrated Services replied that further information on actions would be provided during the next Valuing Neurodiversity update to the Committee.

Expressing her support for the work of the Family Hubs, Councillor Scurfield queried why there were only fifteen hubs throughout the county, in comparison with the former Sure Start Centres which had approximately forty centres spread across the county. Councillor Scurfield asked what information was available to show the hubs were reaching those most in need and she also asked if outreach work was carried out to assist families unable to access the hubs. The Director of Children and Young People’s Integrated Services confirmed that outreach work was undertaken and the Commissioning Manager added that some services, such as education psychology services, visited the hubs to offer services. Officers acknowledged that the relatively low number of hubs for the size of the county was an area for improvement and they agreed to provide further information for circulation to the Committee on the work done in respect of hard to reach families.

Councillor Scurfield referred to recent media reports on the high number of children admitted to hospital due to tooth extractions and she requested information on the position in Durham and work being done to increase access to NHS dental services in the county. The Commissioning Manager responded that those issues would be discussed at a future meeting of the Starting Well Partnership, including the impact of recent interventions on the data and information would be shared with the Committee in due course.  The Chair commented that the Adults, Wellbeing and Health Overview and Scrutiny Committee had considered oral health and levels of fluoridation in recent months.

Councillor Deinali questioned the work done on neurodiversity in children in our care and she referred to reports of families who had requested support for assessments for neurodiversity symptoms which had been considered by practitioners to be attachment disorder, without an assessment taking place. Some families had also reported frustration at decisions being made about their child, without them having had the opportunity to communicate fully about their child. The Commissioning Manager explained that symptoms of trauma and neurodiversity may present in similar ways and many young people entering care will have suffered trauma and that trauma was required to be supported prior to an assessment for neurodiversity. The Director of Children and Young People’s Integrated Services noted the comments which would be considered during the refresh of panel processes.

In response to a question from Councillor Hunt for information on the issue of bullying in schools, the Service Manager for Operational Support informed the Committee that data in relation to bullying was held at school level and she would request that data be made available for circulation to the Committee. 

Resolved:

The Children and Young People's Overview and Scrutiny Committee noted the contents of the report.