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Appendix D. Argyll & Clyde Health Board - Improving Looked After and Accommodated Children's Access to Services
Topics: Child and Maternal Health; Primary Care
Background
NHS Argyll & Clyde successfully bid for unmet needs funding in 2005 and used this to create and evaluate a looked after and accommodated children ( LAAC) nursing service. LAAC typically suffer poor health outcomes in both absolute and health inequalities relative to others and they access services disproportionately less than the level of need they have.
Funding allocation
The pilot was allocated £342,000
Aim(s)
To investigate the change in access to health services for ( LAAC) in residential care through the establishment of a specialised nursing service.
Methodology
A service evaluation took place and involved data collected before and after the introduction of the nursing service. Originally, it had been planned to carry out a comparison study using control areas but the dissolution of NHS Argyll and Clyde, problems with staff recruitment and the time taken to receive ethical approval for the study to commence were some of the drivers that resulted in the adoption of a service evaluation focus.
The experiences of 168 LAAC domiciled in residential units in Renfrewshire, West Dunbartonshire and Argyll & Bute between August 2006 and March 2007 were studied during the evaluation.
A number of outcome measures were used. These were the proportion of LAAC:
- with completed health records
- pre-admission and comprehensive medicals
- with up-to-date immunisations
- with outstanding medical or dental issues
- registered with a dentist
- whose medical needs had been communicated by a key worker
These were supplemented by a thematically analysed LAAC nurse journal, a service evaluation questionnaire, participant feedback exercise and a qualitative study that investigated the views of residential care workers embedded in the pilot study
Key results
Results were positive for all the key outcome measures.
For example:
- The proportion of LAAC with completed health records increased from 3% to 77%
- Pre-admission and comprehensive medicals increased from 39% to 48%
- LAAC with up-to-date immunisations increased from 9% to 56%
- LAAC with outstanding medical or dental issues decreased by at least 4%
- LAAC registered with a dentist increased from 14% to 62.5%
- LAAC whose medical needs had been communicated by a key worker increased from 23% to 58.5%
In addition, the service evaluation questionnaire and participant feedback both provided positive feedback for the service, highlighting the availability of medical attention and advice and the building of relationships between nurses and young people as the most useful aspects of the service.
However, the study did note a number of systematic and cultural barriers that exist to LAAC accessing universal health services. For example, results from the thematic analysis of the LAAC nurse journals highlighted problems with the procedures relating to the practice of recording and sharing health information between agencies, areas and different parts of the NHS.
Conclusions
The provision of the LAAC nurse service in Renfrewshire, West Dunbartonshire and Argyll & Bute improved access of LAAC in these areas to health services. This was welcomed by both care staff and children.
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