Leicester Children's Joint Strategic Needs Assessment (JSNA). Health and social care needs associated with vulnerable groups.
Female Genital Mutilation
Female genital mutilation (FGM), sometimes known as female circumcision, is the practice of cutting away part or all of a female’s external genitalia. FGM has no health benefits, but it can result in severe, sometimes irreversible, physical and psychological injuries and later health problems. FGM is a human rights abuse as recognised by the World Health Organisation.
The Female Genital Mutilation Act 2003 makes it illegal to help, support or arrange for FGM to be performed on a girl in the UK. It also forbids taking a girl outside the UK to have FGM. From October 2015 the Serious Crime Act for England and Wales requires teachers and regulated health and social care professionals to report to the police cases of FGM in females aged less than 18 years. The Local Safeguarding Children Board’s recently revised its procedures for FGM reporting.
In the UK FGM is more common among communities from Kenya, Somalia, northern Nigeria, Sierra Leone, and Egypt. Over 100,000 women are living with the consequences of FGM in the UK, with 60,000 girls at risk.
Who’s at risk and why?
The most significant risk factor for whether or not a girl will be circumcised is whether or not her family has a history of FGM practice. Other risk factors include
- family indicators;
- a woman/family believe FGM is integral to cultural or religious identity;
- a girl/family has limited level of integration within UK community;
- parents have limited access to information about FGM and do not know about the harmful effects of FGM or UK law;
Audit of Compliance with FGM Safeguarding Procedures
A recent audit on compliance with the Leicester Safeguarding Children Board FGM Procedures was conducted in 2016 and the results of this are being followed up locally. This found that GPs are identifying and recording FGM on mother’s and child’s case notes and that women are now more commonly routinely asked appropriate questions about FGM locally.
Current services in relation to need
All health, social care and education professionals should ensure they are aware of and familiar with the FGM reporting guidance and processes.
The Obstetrics and Gynaecology department at UHL have a pivotal responsibility in providing accessible advice, treatment and support to women affected by FGM whilst ensuring that children are protected.
Mental health services should be improving their ability to cope with the needs of FGM.
A community engagement group is currently being set up to address FGM in Leicester through community capacity building and information sharing.
Some local voluntary and community groups are involved in campaigning against FGM and supporting victims and communities.
Child Sexual Exploitation
Child Sexual Exploitation (CSE) is defined as ‘a form of child abuse [which] involved children and young people receiving something as a result of them performing sexual activities, or having others perform sexual activities on them’. It can also occur without physical contact, when children are groomed to post sexual images on the internet.
In all cases those exploiting the child have power over them, perhaps by virtue of their age or physical strength. These relationships are characterised by being exploitative and relying on ‘fear, deception, coercion and violence.
The Office of the Children’s Commissioner’s Inquiry into Child Sexual Exploitation in Gangs and Groups (CSEGG) identified 11 indicators of CSE risk in children aged 10+ that can be measured using education, police or other public service datasets, to identify children at risk locally:
- Child in Need or Children Looked After
- Children persistently absent from education
- Children permanently excluded from school
- Children misusing drugs and/or alcohol
- Children engaged in offending
- Children reported missing, or Children reported to be ‘absconding’ or ‘breaching’
- Children reported as victims of rape
- Children lacking friends of similar age
- Children putting their health at risk
- Children displaying sexually inappropriate behaviour
- Children who are self-harming or showing suicidal intent.
Audit of Compliance with Safeguarding Procedures
A recent audit on compliance with the Leicester Safeguarding Children Board Multiagency Safeguarding Procedures was conducted in 2016 and the results of this are being followed up locally.
Current services in relation to need
From 5 December 2016, the Leicester City CSE, Missing and Trafficked Children team took responsibility for undertaking return interviews (when these are required) for children and young people who go missing from education, home or care. This should help to identify any additional children and young people at risk that would otherwise not be identified.
In April 2016, a Regional Child Sexual Exploitation Framework was agreed by agencies across the East Midlands, aiming to raise standards, promote good practice and improve the quality and consistency of service delivery across the region.
Gypsy and Traveller Children
Gypsies and Travellers have the lowest life expectancy of any group in the UK, and experience high infant mortality rates. 18% of Gypsy and Traveller women have experienced the death of a child. They experience, and are being held back by, some of the worst outcomes of any group across a range of social indicators. For instance:
- In 2011 12% of Gypsy, Roma and Traveller pupils achieved four or more GCSEs over grade C, compared with 58.2% of all pupils
- There is excess prevalence of miscarriage, stillbirth and neonatal death in Gypsy and Traveller communities
- About 20% of traveller caravans are on unauthorised sites
- Gypsy and Traveller communities are subjected to hostility and discrimination and often lead separate lives to the wider community.
Leicester has a small population of Gypsy, Roma and Traveller people. Gypsy and Traveller people generally live on the 3 sites across the city. Most Roma people live in houses in the East Park Road and Narborough Road areas. There are about 100 children and young people from Gypsy and Traveller backgrounds in Leicester.
Health Status of Gypsy and Traveller People in the UK
- Gypsies and Travellers have poorer health status than non-travellers and more self-reported symptoms than all other UK residents. However, they are less likely to access services.
- Rates of smoking are generally higher, educational attainment lower and life expectancy shorter than average.
- The most marked inequality is found in self-reported anxiety and respiratory problems.
- The mental wellbeing of children and young people may be affected by lack of privacy, overcrowding and domestic violence.
- The health status of Gypsy, Roma and Traveller people is not helped by poor access to care, communication difficulties and stigma and discrimination.
- The educational disadvantage of Gypsy, Roma and Traveller families is the most marked difference between this group and other socially deprived and minority ethnic populations.
Health of Gypsy, Roma and Traveller Children and Young People in Leicester
- Due to most Roma people in Leicester residing in houses, they are more likely to access services in the same way as the general population.
- Clinicians at the Gypsies and Travellers Health Service estimate there are about 100 young people aged 0 to 24 years known in Leicester.
- Young Gypsy and Traveller people are likely to experience high rates of trauma, accidents and lower rates of take up of immunisations and poor dental health.
- There are higher than average rates of drug taking in young males and teenage pregnancy.
- Primary school education for Gypsies and Travellers is common, but education beyond age 11 is rare and levels of literacy are low.
The recommendations based on this JSNA's findings regarding vulnerable groups are available here.