Table of contents

Current services in relation to need

Background papers: children :: Looked After Children :: Current services in relation to need

Early Help & Edge of Care

Medway Council recognises that key to ensuring children have the best start in life is providing support to families, so that children don't become “Looked After”. As such in addition to providing and supporting universal services Medway Council has also developed a range of early intervention and prevention services that focus on supporting the family for example the use of Family Group Conferences. An Edge of Care Strategy is currently being developed and will focus on providing crisis intervention and mediation in order to prevent family breakdown.


The Looked after Children's Health Team is managed by Medway Foundation Trust and is based at Medway Maritime Hospital. The aim of the service is to provide assessments and monitoring of Looked After Children and training for foster carers within Medway. This includes undertaking:

• Initial health assessments
• Review health assessments
• Adoption assessments
• Health histories
• Foster carer training.

The service is required to meet the statutory timeframe of 28 days as set out in the Statutory Guidance under section 9.8 for the first health assessment. Between January and March 2015, a total of 159 health assessments were requested. Of these 52 were for initial health assessment and 107 were for review health assessments. In Q.4 January to March 2015 81% of initial health assessments were completed within the statutory time frame. In addition 96 of the 107 review health assessments were seen on time. Of the remaining eleven health review assessments, 3 were refused, 4 were not completed as the looked after child was no longer being looked after and 4 were overdue. Adoption assessments continue to perform well and continually exceed the 85% target. Completion of health histories remains a challenge as refusal from the young person to engage in the process is a recurring theme. During October to December 2014 only 50% of health histories were completed with refusal to engage being cited in all cases.

Mental Health and Emotional Well-being

The services in Medway are based like many across the country around a 4 tiered approach.

Tier 1

Universal services which support and promote emotional wellbeing. Services are provided by Schools, Public Health and the Voluntary sector

Tier 2

Services are managed by Sussex Partnership NHS Foundation Trust although the majority of the staff are employed by Medway Council. The tier 2 provision for Looked After Children is the specialised Children in Care CAMHS service. The Tier 2 team does work with the Children in Care CAMHS service however these are meant to be two distinct teams in order to ensure that there is a clear focus on supporting Looked After Children.

Tier 3

Services are in the main provided by Sussex Partnership NHS Foundation Trust (SPFT). Specialist provision is supported on the basis that the condition is assessed as moderate to severe in nature.

Tier 4

Services are provided by South London & Maudsley NHS Foundation Trust (SLAM) which provides inpatient and outreach services. During 2013/14 there were a total of 30 in-patient admissions for Medway.

Additional commissioned services are provided such as All Saints for post sexual abuse, Oakfield Psychology (MFT) who offer therapeutic intervention for psychological and developmental difficulties, the NSPCC 12 week programme and Chilston which offer behavioural interventions and counselling.

Some of the services listed above are accessed via Single Point of Access which provides advice, support and signposting to referrers to ensure that decision making is timely. In 2014/15, 1021 referrals were received with 37 being referred to Tier 3 Looked After Children Services. However in some cases the services are spot purchased and as such there is no interface with the single point of access. This can lead to delays and several hand offs as referrals are not being logged or tracked. Waiting times for Children in Care and Tier 3 CAMHS have varied from 27 working days to 77 working days. In contrast to 20 Looked After Children referred to Oakfield Psychology an average waiting time of 21 days from referral to first appointment. Further Information can be found in the JSNA Chapter: Emotional Health and Wellbeing of Children and Young People

Educational attainment

There is a virtual Head teacher who reports to the Corporate Parenting board. In addition, the implementation of the Virtual Head teacher's Improvement Plan is approved and monitored by the Education and NEET sub-group. The Assistant Director for School Effectiveness and Inclusion chairs this group. The Virtual Head teacher monitors the achievement of all pupils and is responsible for ensuring that the achievement gap with national outcomes is closing. The Personal Education Plan (PEP) review is the means by which each young person's achievement is monitored and supported. The PEP review is also the process which monitors the use of pupil premium plus to secure appropriate support for individuals.


Currently children in Medway have 5 placement options as detailed in figure 4. Placements in most instances are made via the placement co-ordinator and officers who are based in the Access to Resources Team. The Access to Resources Panel meets weekly to agree and discuss placements some of which may have been an emergency and as such have not gone through the Access to Resources Team to be placed. Medway has a number of gaps in provision including placements for children with profound and multiple disabilities, sibling groups and young people leaving care at 16+. As of 30th October 2014 Medway had a total of 12 parent and Child placements in Independent Fostering

In September 2014, just over 10% (40 children) of Looked After Children in Medway had a disability. This represents a 38% increase on the previous year. Currently there is no residential provision for Looked After Children with profound and multiple disabilities in Medway. As such children travel routinely over an hour from outside of Medway to access Medway schools.

The numbers of large sibling groups are increasing with April 2015 seeing one group of 7 siblings and one group 5 siblings being placed. Sufficient data doesn't currently exist to determine whether or not this trend will continue.

In September 2014 there were 58 young people aged 16+ in care and 198 eligible for leaving care services. The Southwark Judgement 2009 clarified the responsibilities of Local Authorities to provide accommodation to a young person assessed as a “Child in Need” under section 20 of the Children Act 1989. The Institute of Public Care projected that the numbers of eligible Looked After Children in Medway aged 16 and 17 and Care leavers aged between 18 and 24 would be between 241 and 221 in the next five years adequate provision must be made to address their needs.

Placement Stability

Nationally it is recognised that in-house fostering provision provides the most cost effective and efficient provision for the majority of Looked After Children. Since 2012 there has been a year on year decline in the number of in-house foster carers. In November 2014 the number sat at 183. In this same period the number of placements to Independent Foster Care Agency carers has increased from 77 to 95 and private and voluntary residential homes has increased from 12 to 29.

Child Sexual Exploitation

External providers who are currently supporting young people with CSE have identified greater information sharing and more specialist training as the two greatest needs of providers. The Medway Safeguarding Children Board (MSCB) has agreed 6 priority areas for 2014-17. Amongst these priorities action will be taken to monitor and evaluate the effectiveness of safeguarding children activities, undertake a case file audit, to ensure that a culture of learning and improvement exist across the organisation, to ensure that the policy and procedures co-ordinates the multi-agency approach.

Leaving care

The duties and responsibilities that Local Authorities have towards care leavers ae set out in The Children Act 1989 which was updated in 2010 to include Planning Transition to Adulthood for Care Leaves. It includes The Care Leaves (England) Regulations 2010. We have high aspirations for our children just like any other parent and helping them plan for their future educational and employment careers is essential. A Leaving Care nurse has joined the Looked After Children's health team to ensure amongst other things that health histories for all care leavers are produced in a timely manner and that ongoing contact, support and advice in relation to health issues is provided to care leavers. Pathway Plans prior to a young person reaching age of 16 years and 3 months are produced by the Children in Care social work team in conjunction with the child, families and other agencies in order to support the child's progress into adulthood in an order way. The development of Personal Education Plans for all 16-18 year olds is now underway and the Care2Work scheme is becoming increasingly embedded in order to support apprenticeships, traineeships and work opportunities.