Health CommitteeWritten evidence from the British Association for Adoption and Fostering (ETWP 74)

1. This response is being submitted on behalf of the BAAF Health Group, which is also a special interest group of the Royal College of Paediatrics and Child Health (RCPCH). The Health Group was formed to support health professionals working with children in the care system, through training, the provision of practice guidance and lobbying to promote the health of these children. With over 500 members UK-wide, an elected Health Group Advisory Committee with representation from community paediatricians working as medical advisers for looked after children and adoption panels, specialist nurses for looked after children, psychologists and psychiatrists, the Health Group has considerable expertise and a wide sphere of influence. Our area of concern is the particularly vulnerable group comprised of looked after and adopted children and young people.

2. We are submitting this response with regard to the roles of doctors and nurse providing services for looked after children, including those with a plan for adoption. Doctors provide three distinct roles which are described in detail in the attached document Model job descriptions and competencies for medical advisers in adoption and fostering. In summary these are:

The designated doctor who provides a strategic role, advising health trusts and commissioners, and overseeing services.

The named doctor who provides direct service delivery and assists in strategic planning.

The medical adviser for adoption who assists adoption agencies and advises the adoption panel.

3. Although the model job descriptions and competencies document published by BAAF did not address the roles of specialist nurses for looked after children, their contribution is equally significant and all of our comments apply equally to their posts.

4. Our members tell us that paediatric colleagues, trusts and commissioners have a poor understanding of the complexity of health needs of looked after children, and the health services required to meet these needs. Yet these children are amongst the most vulnerable in society, as evidenced by the well known poor outcomes of low educational achievement, high teenage pregnancy rates, and higher rates of mental health burden, and over representation amongst prison populations.

5. Our members also tell us that these services are often inadequately resourced relative to the needs of this population. Furthermore, this vulnerable group requires specialised services which do not fit well with the prevalent outpatient model of service delivery.

6. Health professionals providing services for these children have often received no training specific to their role. It is only recently that the Royal College of Paediatrics and Child Health (RCPCH) has included any specific training requirements for adoption and fostering in their syllabus for Higher Specialist Training. Most paediatricians appointed to these roles have had no specialised training prior to undertaking this work and are expected to “learn on the job”. Historically BAAF has been the sole provider of health training for this work, through national conferences and organising and supporting regional health groups which provide medical advisers with training and peer support.

7. Workforce surveys by BAAF have revealed that many experienced medical advisers and specialist nurses are approaching retirement age and there is a lack of trained medical advisers and specialist nurses to continue this work. BAAF has been in dialogue with the RCPCH to address this through training, and has also contributed to the Intercollegiate Competencies for health professionals in adoption and fostering which should be published soon.

8. It is critical that the specialised nature of this work is understood, so that sufficient emphasis is given to recruiting, training and supporting the continuing education of medical advisers for looked after children.

December 2011

Prepared 22nd May 2012