Health Check For Child Services

Health care in Scotland is a decade behind education in terms of providing quality services to young people in care, experts have warned.

The poor social outcomes for young people who are looked after by local authorities are widely acknowledged. But whereas schools and councils are taking action to tackle issues such as the low educational attainment and high rates of offending among looked-after children, too little progress has been made in health, according to the Scottish Healthy Care Network (SHCN).

An SHCN conference in Glasgow this week, Healthy Care Matters, will discuss the challenge posed by looked-after children, who are at higher risk of developing drug and alcohol problems, have poorer sexual health, have a rate of smoking four times the national average, and lower nutrition levels. About two-thirds of young people living in residential care can be described as having a clinically diagnosed emotional disorder with as many as a third having a history of sexual abuse.

Where young people move home frequently, keeping track of their records can be difficult. Medical histories, vaccination records and test results fail to catch up with the young people and the effective care which they need becomes harder to deliver.

As Steven McCluskey, national development officer for SHCN says, “The evidence suggests that the health outcomes of looked-after children in Scotland remain significantly poorer than children without a history of care.”

SHCN aims to share models of good practice and encourage collaboration between professional groups dealing with Scotland’s 13,000 looked after children.

Judy Furnivall is a lecturer at the Scottish Institute for Residential Child Care (SIRCC), a partner in the event. She acknowledges that there has been progress in education, but says, “Where educationalists were about 10 years ago is where we are now in health. The educational agenda has been firmly grasped by the Scottish Government. Now we are seeking recognition of the importance of health.”

A 2004 report, Forgotten Children, analysed data from health checks on all the children in care homes in Lothian and concluded the main issue was “not the state of the children’s health on the day they enter the system. It is rather the unmet need prior to their being accommodated”.

Furnivall says local authorities need to do more. “Parents hold their children’s health in mind. What are needed for looked-after children are structures and systems which emulate what parents would provide.”

The cost of tackling long term ill health means it is worth spending more on looked after children now, she suggests. “We cannot afford not to invest in them.”

Allyson McCollam, chief executive Scottish Development Centre for Mental Health, will speak at the conference on the importance of mental health issues and the need for early intervention. “This applies to everyone, but especially this group.” Effective mental health services for these young people depend on clear communication between services, better awareness of their needs and an effective bridge into specialist mental health services she says.

The conference will also hear that challenging risk-averse practice in residential childcare can contribute to positive mental health for these young people. Maxwell Smart, assistant residential services manager for East Lothian, says young people should not be cocooned from risk and can be introduced to potentially risky activities in the context of trusting relationships with carers.

Meanwhile specialist nurses dedicated to looked after and accommodated children and young people are another important source of trusting relationships and effective healthcare. Elaine Greaves, working in East Renfrewshire, will describe how she and colleagues adopt public health approaches. Much of their work involves tracing and putting together background health information, because medical records are often so patchy.

At the conference a filmed extract of 365, the National Theatre of Scotland’s production which recently premiered at the Edinburgh International Festival, will be shown. The play explores the transition made by a group of young people from care to independence and their experiences in a practice flat. It also invites the audience to consider whether local authorities are fulfilling their responsibilities to secure good health for children and young people. As McCluskey says, this is one of the biggest challenges for a Scottish society that seeks to place the protection and care of children and young people at the heart of its public services.