Looked after children are a vulnerable population at risk of unidentified and unmet health needs. Coordinated input from health, social care, and education services for these children is required by government but is not easily achieved.

The focus on looked after children has sharpened with the Quality Protects programme, a major initiative launched in 1998 to improve their life chances. In 2002, the Department of Health (DH) published guidance on how to develop a health service for looked after children.¹

“Children in special circumstances”, including looked after children, are prominent in the National Service Framework (NSF) for Children Young People and Maternity Services. Implementation of the DH guidance is explicitly required by the NSF.

The Children Act 2004 sets out a new framework for children’s services with Directors of Children’s Service and Lead Members for children in each local authority.² The government is establishing Children’s Trusts to drive the coordination and integration of planning, commissioning, and delivery of health, social care, and education services.

How are these agencies to work together more effectively? There are well recognised facilitators and barriers to coordinating multi-agency practice.³ Poor communication between agencies and a lack of understanding of each other’s roles and responsibilities has been a barrier and is a recurring feature in reports of child abuse and child deaths.

An integrated care pathway (ICP) is a health sector concept that “determines locally agreed multidisciplinary practice based on guidelines and evidence, where available, for a specific patient user group. It forms all or part of the clinical record, documents the care given and facilitates the evaluation of outcomes for continuous quality improvement”.⁴ The ICP concept is multifaceted and complex but consists of both a process (of development and continuing maintenance) and a set of operational products. It can usefully be extended as a tool to improve multi-agency working.

An ICP to promote the health of looked after children has been developed in Birmingham. The products include a process map, updated health assessment documentation, and a variance reporting strategy.⁵

At its best an ICP can be a mechanism to enhance collaborative working across agencies for specific populations such as looked after children.