Health planning and response

In Kent, the number of unaccompanied asylum seeking children reached over 1,000 in 2015/16. The sudden influx put enormous pressure on all systems across health, social care, police, education, housing and the voluntary sector.

We have reflected on our learning from those system-wide pressures and below are our recommendations to developing an emergency health response.

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Strong foundations

Building good health response systems

Senior members of statutory agencies have an established mechanism to meet and coordinate the delivery of UASC response – this includes a multi-agency agreement to establish the tipping point at which providers cannot manage the increased demand against the commissioned service. This response must have strong links with safeguarding and corporate parenting boards.

LAC commissioners and providers, with oversight from LAC Designated Professionals must establish robust information sharing protocols and develop strong operational pathways. A critical indicator for success is an open and honest working relationship between the Local Authority, CCGs, police and providers.

GPs and Primary Care are key to supporting improved health outcomes for UASC in addressing immediate health concerns and ensuring the ongoing health recommendations from Initial Health Assessment are completed. CCGs should ensure that primary care practitioners are offered support and/or trained in understanding, recognising and managing the health needs of UASC. Should your local authority area indicate a large number of UASC may enter your area, you may wish to consider developing GP with special interest roles to support the health care response.

All those in contact with UASC should have access to information and support regarding key challenges and vulnerabilities the population face.

  • Provide guidance for social care staff and foster carers on when to use hospital emergency department, and immediate support regarding sleep issues (body clock) and nutrition
  • Ensure UASC are registered with a GP as a matter of priority and have access to primary care and immunisations. This could include mass treatment protocols such as scabies.
  • Children, who have been moved from Kent through the National Transfer Programme, will have had Fitness to Transfer (FTT) health screening, delivered by appropriately trained staff that are supported and work is quality assured by the designated doctor for Kent. Make sure that the screening report is considered at the earliest point of a child arriving into your area.
  • For those young people becoming looked after and remain in your Local Authority care will need an Initial Health Assessment. It possible this could overwhelm your current Initial Health Assessment commissioned service. Stay close to your provider and ensure that they are kept informed of numbers and Local Authority commitments to take in UASC.
  • Ensure allied services required to meet the health recommendations that come from the Initial Health Assessment are aware and mobilised. These include dental, ophthalmology, sexual health, TB screening, mental health, blood borne infection screening etc.
  • Ensure that 3 months after the Initial Health Assessment, that the health care plan is reviewed to ensure actions have been progressed. All partner agencies have a responsibility to ensure that all health actions are being progressed; this includes health, social care, Independent reviewing officer, mental health etc. Ensure that any additional actions results from screening are manged effectively. For example, the subsequent treatment required for a BBI result.
Foundation

Questions to consider

The Designated Doctor and Designated Nurse for Looked after Children within your CCG areas will have a role in ensuring that there is enough provision within the local area to meet the needs of any UASC placed within the CCG.

They will also work closely with the Named doctor and nurse within your provider organisation to deliver the service.

There will be a Director of Children’s Social Services who will have the overall responsibility for the care of UASC. There is likely to be Assistant Directors with specific areas of responsibility. There is likely to be a LAC/UASC Service Manager and the young person’s social worker.

This will depend on what type of appointment you have with the child/young person.

For example it is important to have a translator at the initial health assessment, but it may not be possible when a young person is accessing emergency care. If you do not have a translator available, you can use language lines or the hospital communication book.

You will need to liaise with your contact within the Local Authority, to confirm whether they have a duty to provide an interpreter. In Kent, interpreters were provided for all Fitness to travel, Initial and Review Health Assessments. There is a section on working with interpreters in the clinical guidance document.

A UASC is a Looked after Child and is afforded the rights as any LAC.

This means that all aspects of promoting the health and wellbeing of LAC (statutory guidance) applies.

Consent needs to be sought for UASC in the same way as for any Looked after Child, but ensuring that information has been given to them in an accessible format. See Initial Health Assessment Consent translated materials and videos.

If they are Gillick Competent, they can provide their own consent, as long as this has been informed. Otherwise the Local Authority responsible for the child would give consent.

Information about Blood Borne Infection consent and immunisation consent is also available on this website.

This should be discussed/referred via your local safeguarding team in just the same way for any other child/young person. You need to pay particular attention to child sexual exploitation, trafficking and human slavery, missing, female genital mutilation and PREVENT policies for your area.

Kent Safeguarding Children Board website.

As any Looked after Child, an unaccompanied child is eligible for free treatment.

For further information please see the clinical guidance for clinicians undertaking IHAs.

This is allocated through GP registration and all UASC are eligible to register with a GP Practice using the Family Doctor Service registration Form (GMS1). We recommend that this is undertaken as soon as they arrive in the UK and prior to any move under the National Transfer Scheme.

The child’s social worker should complete the HC1 form which will enable the young person to have support to pay for dental treatment, glasses or contact lenses or travel to receive NHS treatment.

In our experience, UASC have missed immunisations and therefore should be immunised according to the UK Vaccination of Individuals with Uncertain or Incomplete Immunisation Status Schedule.

Up to date guidance should be sought from Public Health England, but in Kent we recommended universal screening for TB and blood borne infections in light of the needs assessment. There is information available for young people in relation to screening requirements on the Public Health page.

The Kent needs assessment also found a high prevalence of vision and dental needs within the population. We would recommend developing pathways to screening services with local providers and commissioners within NHS England.

There are no validated screening tools for UASC. We have devised the distress screening tool which is part of our fitness to travel work; this can be found on the website. In our Initial health assessment we have been using the moods and feelings questionnaire and the SDQ as these are generic tools used by CAMHS.

The planning page on this website describes the planning and preparation required for incoming UASC.

Generally it will be the responsibility of the CCG that covers the area in which the child or young person has declared their arrival in the UK.

However, if the UASC is to be moved under the National transfer Scheme, the receiving CCG will be responsible.

At this stage there is no additional funding for Health.