Health and Wellbeing Board	8^th May 2024
Report of Martin Kelly Corporate Director of Children Services and Education, City of York Council and Michelle Carrington, Place Nurse Director, Humber and North Yorkshire Integrated Care Board.

Developing a Corporate Parent approach to support the Health and Wellbeing of Care Leavers.

Summary

1. This report aims to brief members of the board on issues which are pertinent to care leavers and why it is important to consider the specific health and wellbeing needs of this group.

2. The report provides an overview of issues raised by care leavers and an update on some initial scoping work to develop a targeted response.

3. Our aim is to secure a collaborative approach in York to corporate parenting and the board are asked to support this work.

Background

4. The multiple inequalities for care leavers across health, education and employment have been well documented over the last decade. The Nuffield Foundation reported in 2018 that care leavers were twice as likely than peers to live in poverty, have poor health and suffer from depressive symptoms.

5. Care leavers experience independent living significantly earlier than their peers, often having to navigate managing bills such as housing and council tax at a very young age. Out of necessity this can lead to compromises which have an immediate or longer-term impact on health outcomes.

6. It is important that we address health inequalities and act as a good parent would to improve accessibility, whilst supporting a softer transition to the full responsibilities that are associated with adult independent living.  

7. In December 2023 the York partnership received a two-day formal visit from the National Implementation Advisor for Care Leavers, Mark Riddell, who met with many key stakeholders including young people. He was asked to provide feedback on inspection readiness and comment on areas of practice where we could improve.

8. The advisor found many strengths and good support for care leavers in the city but felt this work could be strengthened with targeted effort in key areas of risk to young people. These being, Education/Employment, Housing and Health

9. There are plans to develop subgroups of the Corporate Parenting Board in these areas with appropriate political and stakeholder representation, including young people. The Chair of the Health and Wellbeing Board will be invited to the Health Subgroup.

10. The report also identified, led by care leaver feedback, some specific issues that would improve the health and wellbeing of care leavers and address inequalities. These included:

· Free prescriptions as they cannot afford these.

· Eyecare and spectacles

· Access to local dentistry and emergency dental care

· Access to opportunity for employment within the health system

11. The inequalities and variation in offers across the Integrated Care System (ICS) were highlighted by City of York Council (CYC) and York Place at the newly formed ICB CYP Integrated Start Well Board in January 2024. The Board made a commitment to quickly scope the detail of offers from health and local authorities and to bring back a report at the next meeting, due to take place 29 January 2024. This scoping includes the bullet points in point 10 above but also further offers such as the use of health passports, mental and emotional well-being support, SEND, social prescribing, how the voice of care leavers is captured, and the local authority offer.

12. It was also agreed that the issue would be taken to the ICB System Ethics Group (SEG) to consider if prioritising this group of young people would have ethical dilemmas and how the advice from the SEG would help inform collective agreement on next steps. This advice will form part of the further debate at the ICB CYP Board. The ethical debate was formed around a specific story of a care leaver in York and their young child and the impact on them from navigating the current system and the lengthy waits for support.

13. In the meantime, CYC and York Place have reached out to various local employers, the largest being York and Scarborough Teaching Hospitals NHS Trust who have agreed to ensure any care leavers with an interest in a health profession will be nurtured and potentially offered employment opportunities as part of their strategic workforce plans in place.

Main/Key Issues to be Considered

14. The board are asked to note this work and consider how it may wish to be updated.

Consultation

15. We have received feedback directly from young people on these issues through participation groups ‘Show me I Matter’ and ‘I still Matter’. In addition to the list above young people also mention access to a Child and Adolescent Mental Health Service (CAMHS) up to the age of 25 as being an important priority. As part of the discussion at the ICB CYP Board it was also agreed to hold a specific session with care leavers, inviting the system to hear their voice and this is planned for later in the year.

Options      

16. The Board are not being asked to consider options for a decision.

Analysis

17. The Board are not being asked to consider an options appraisal for a decision.    

Strategic/Operational Plans

18. Improving support to care leavers by being a better corporate parent is entirely in line with the ICS and the York Joint Local Health and Well-being Strategy (JLHWBS) vision for Start Well, Live Well, Age Well and Die Well. More recently the ICB are in the process of revising their strategic intentions to include radically improving children's well-being, health and care, reducing inequalities and transformed by engagement. The ICB CYP Board will help define and develop the priorities for our children and young people.

Our Joint Local Health and Wellbeing Strategy talks to the issue of care leavers where we aim for a healthier and fairer city, one which lifts people out of poverty, prevents now to avoid harm later and builds a collaborative health and care system. Of our 10 big goals improving the life chances for care leavers will contribute to reducing inequalities, building social connection and improving mental health.

        Implications

· Financial

There are no financial implications in this report.

· Human Resources (HR)

There are no HR Implications

· Equalities

This report aims to highlight the issue of inequality for care leavers and the impact on their long-term outcomes. It also aims to highlight the ethical responsibilities which need to be considered in developing a differentiated response to address the inequalities identified.

· Legal

There is a statutory requirement placed on local authorities with regards to care leavers and statutory responsibilities in areas which impact on care leavers such as for looked after children and safeguarding. Various parliamentary acts bestow responsibilities on us all such as the Children's Act – this can leave partners open to judicial review of any decisions we may make.

· Crime and Disorder

There are no crime and disorder implications set out in this report.

· Information Technology (IT)

There are no IT implications from this report

· Property

There are no Property implications from this report.

· Other

There are no other implications which need to be considered.

        Risk Management

19. This report addresses the complexity of prioritising one group over another to provide targeted services. These risks and benefits are being considered broadly through the following ethical lens:

· Improving benefits and preventing harm:  The ICB has a duty of care to act as a corporate parent to care leavers to maximise good (beneficence) while minimising harm (non-maleficence)

· Mitigating unfair advantage:  There is a duty to mitigate unfair disadvantage experienced by care leavers, which dovetails with one of the ICB’s key principles of promoting equity.

· Equal moral concern: This requires differential treatment that recognises not everyone faces equal vulnerability from a given threat to health.

        Recommendations

20. The Health and Wellbeing Board are asked to consider:

i. Are there other stakeholders within the Health and Wellbeing Board who can support or contribute to this agenda, particularly the health subgroup of the corporate parenting board?

Reason: To help address the inequalities experienced by care leavers and improve long term outcomes through a strong commitment I the city to corporate parenting.

i. Does the Health and Wellbeing Board wish to be updated on the progress of this work? 

Reason: To provide system leadership with appropriate support and challenge.

Contact Details

Author:	Chief Officer Responsible for the report:
Martin Kelly Corporate Director Children Services and Education City of York Council martin.kelly@york.gov.uk Michelle Carrington Place Nurse Director Humber & North Yorkshire Integrated Care Board michelle.carrington1@nhs.net	Martin Kelly Corporate Director Children Services and Education City of York Council martin.kelly@york.gov.uk
	Report Approved	X	Date	22/04/2024
	Chief Officer’s name Title
	Report Approved	X	Date	23/04/2024
.
Wards Affected:					All	X
For further information please contact the author of the report