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AimsLooked After Children (LAC) are a vulnerable group. UK numbers have increased 1% annually for the past 7 years and services are thought to be variable. Our aim was to produce a comprehensive profile of LAC’s health and wellbeing needs.MethodsSystematic review of published literature 2000–2015 relating to LAC health, following references thereafter and review of relevant national publications on problems facing LAC.ResultsAbstract G83(P) Table 1Percentage of LAC with 5 Physical Health conditionsVisual impairmentHearing deficitSpeech delayIncomplete immunisationsDevelopmental delayMelzer (UK)1661462[1]Chernoff (US)25163123[2]Nathanson3028332460(AUS)[3]Rodrigues232012(UK)[4]Steele (US)[5]52Sexual HealthLAC are twice as likely to become pregnant compared with peers[11,12]. 25% of female care leavers become pregnant or give birth within one year of leaving care[13]. Males are more likely to be teenage fathers; 5%–6%% Vs 0.7% teenagers who have never been in care[14]Abstract G83(P) Table 2Percentage of LAC with key Mental Health disordersAny disorderConduct disorderHyperkinetic disordersEmotional disorderGen Pop, Green[6]10624Melzer145388.412Sempik[7]725023Tarren-Sweeney[8]17-4510-304-36McMillen[9]61472033Lehman (Norway) [10]5121.51924Steele (US)[5]44181027Youth OffendingCare leavers comprise 35% of the prison population under 21 years and 27% overall[15,16]. 50% of women and 25% men in Young Offenders Institutes have spent time in care[17].Substance Misuse10% of 16–17 year olds report substance misuse issues, despite this only 50% receive an intervention their problem[18]. Cannabis is the most frequently used substance, tried by 73% of LAC[19].EducationAbstract G83(P) Table 3Comparison of 5x Pass GCSE results: Grade A-C[20]Non-LAC (inc Maths and English)64% (53%)LAC (inc Maths and English)18% (14%)ConclusionAll examined aspects of LAC’s health and wellbeing are worse than the non-LAC population. There is significant need within the LAC population, and services for LAC should reflect the high levels of need.

AimsRising use of emergency departments has resulted in increased costs and poor quality of care for children and young people. Clear evidence on which interventions work in reducing the number of unplanned admissions is important for those who use and commission emergency department services and to improve the quality of healthcare services. There is a policy imperative to shift care out of hospitals but insufficient evidence on the effectiveness of out of hospital care. This review aims to identify, critique, and collate outcomes in published evidence for nurse-led out hospital care for children and young people with chronic conditions.MethodsTwo databases were systematically searched from 1965–2017, to identify randomised controlled trials that used nurse-led out of hospital care to reduce emergency department attendances in children and young people (0–18 years) with at least one chronic condition. The pooled incidence rate ratio (IRR) was estimated using the R package metaphor.ResultsFive randomised controlled trials (3 USA, 1 Canada, 1 Scotland) met the inclusion criteria. All five trials were included in the qualitative review but four were included in the meta-analysis due to heterogeneity in outcome measures. Four papers reported on CYP with asthma and the fifth on chronic illness. Only three papers reported significant effect for a reduction in emergency department attendances. Study quality was moderate, with a medium risk of bias. The meta-analysis fitted a random-effects model, which estimated a pooled IRR of 0.65 (95% CI 0.40, 1.03) implying a non-significant positive effect of nurse-led out of hospital care on reducing emergency department attendance.ConclusionsAlthough this review found no association between emergency department usage and nurse-led out of hospital care, the effect sizes were large and three papers found positive associations. Only five randomised controlled trials were included in this review, most of which studied children and young people with asthma, highlighting the need for further research in this area.

AimsIntegrated General Practitioner-Paediatrician ‘In-Reach’ clinics aim to improve access to care and professional learning across primary-secondary care. The aim of this pilot project is to understand the range of presenting conditions and outcomes among children referred by General Practitioners (GP) to GPs-Paediatrician ‘In-Reach’ clinics, instead of hospital outpatients’.MethodsRetrospective case review of 101 patient’s notes. Cases identified through an electronic search of consultations during a 6 month period in 2017. 202 cases were identified, listed alphabetically by patient surname, and alternate records were chosen systematically for inclusion. A senior clinician identified the presenting problem using ICD10 codes grouped into tier one categories, and clinic outcomes.ResultsOur sample comprised 101 children (0–18 years) presenting with 115 problems. Constipation, eczema, and asthma accounted for 25% of problems. The top 5 ICD10 categories, representing 60% of the total, were digestive, dermatological, musculoskeletal, nervous, and respiratory problems (‘other’ comprised a large range of conditions each with small numbers of patients) (table 1).Abstract G377 Table 1Presenting problems among children referred to In-Reach clinicsICD10 categoriesPercentage of total referralsDigestive 18 Skin/subcutaneous tissue 16 Muscloskeletal 10 Respiratory 8 Nervous 8 Other 40 Nearly a third of problems required only reassurance, one in five required a prescription, and a specialist referral was made for 24% of children seen (table 2).Abstract G377 Table 2Outcome for children seen in in-reach clinicsManagement plan recommendationOutcome (percentage of total)Reassurance 28 Specialist hospital referral±medication 24 Medication recommended with GP management 22 Self-management 8 Primary care referral±medication 8 Continue GP plan 6 GP monitoring 4 ConclusionA substantial proportion of children had common problems requiring reassurance or simple management in primary care. Specialist referral was required for 24% of children. If this sample is representative, approximately three quarters of children, who would otherwise have been referred for hospital outpatients’ appointments, could be seen and managed with support in primary care settings. These preliminary results suggest that integrating care across the primary-secondary care interface could help improve access to care.

AimTo describe access to services for Looked After Children (LAC) and care leavers from two neighbouring Inner-city Boroughs.MethodWe identified care standards for LAC and care leavers through examining NICE and statutory guidance. We compared local practice against those standards by interviewing commissioners and service providers.ResultsHousing: 25% of local LAC are housed with foster carers within their own boroughs (England average 58%). The remaining 75% of LAC are spread over 70 different localities, 25% are placed a significant distance away. Any child requiring residential placement must be placed out of area as there is no residential home provision within either borough.Healthcare: There is insufficient capacity within local LAC teams to conduct all annual health assessments for LAC placed in other boroughs, therefore services are heavily reliant on 3rdparty assessments. These services are more costly and their quality is thought to be variable.Access to mental health services is very good for LAC placed locally; however there is no dedicated provision for those not placed locally. Where possible LAC travel back, at their own cost, to access local services. Alternatively they await mainstream services in the locality they are placed.Care leavers: Commissioners identified care leavers as a group in need of additional support services. Local authorities retain responsibility for certain aspects of the wellbeing of LAC when they become care leavers. Consequently all housing is local and 90% of care leavers live in the borough. This change of locality creates additional difficulties for the young people adapting to living independently.ConclusionsSignificant inequalities in access to care for LAC and care leavers exist. There is a 2 tier system; LAC placed within the borough have notably better access to services than those placed outside. Ofsted have acknowledged inequalities in access as a national problem; ‘local authorities do not have a complete understanding of all the services offered in other localities leading to delays in delivering appropriate care’1. More work nationally is required to describe needs of LAC housed out of area, and to shape services accordingly.