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Contents

1. General Principles
2. Who can give Consent to Medical Treatment
3. Consent - Usual/Routine Day to Day Activities
   
   Appendix 1: Medical Consents Flowchart
   
   Appendix 2: Medical Consents Authorisation Form

1. General Principles

The health care of children and young people who are Looked After is often poor because it is not clear who has responsibility for ensuring that medical treatment is arranged and carried out. The parental nature of the tasks that you as a carer carry out on a daily basis means that you are often in the best position to look after and promote the health of the children in your care.

As an Authority we want to ensure that you are able to carry out this responsibility effectively. In order to do that we will delegate responsibility for certain health matters to you as the carers for the children in your care.

This will always be done in consultation with the person who has Parental Responsibility (unless there are circumstances which make this impossible).

For the purposes of this policy medical treatment means any type of medical dental or surgical intervention.

Even if general parental Consent has been obtained, the parent or those holding Parental Responsibility should be consulted beforehand about treatment required and parental agreement obtained whenever possible.

2. Who can give Consent to Medical Treatment

2.1 Legal Position

A child if she/he is over the age of 16 or younger than 16 if the Doctor believes that he/she is mature enough has the legal capacity to give consent for medical treatment.

In addition:

Under the Children Act 1989 S3(5)

A person who does not have Parental Responsibility for a particular child but has the care of the child - may do what is reasonable in all circumstances if the case for the purpose of safeguarding or promoting the child's welfare.

This will apply in all circumstances of an emergency or life threatening nature.

Others can consent in the following circumstances:

1. Children Subject to Care Orders, Interim Care Orders under Children Act 1989, Freed for Adoption
   
   Where the child is Freed for Adoption, Parental Responsibility is with the Adoption Agency. In relation to Care Orders and Interim Care Orders Parental Responsibility is shared between local authority and parents.
   
   On behalf of the local authority or adoption agency, the Directorate of Social Services or another nominated officer, may delegate to carers the right to consent to medical treatment for the child.
2. Children Accommodated under S20 Children Act 1989, Children Placed for Adoption with no Freeing Order
   
   Parental Responsibility remains with the parents. Parents can authorise Directorate of Social Services or other named officer to give consent to urgent treatment and specified items of preventative treatment and can authorise the delegation of this power to carers, or can authorise carers directly.
3. In the Absence of a parent (e.g. an Unaccompanied Asylum Seeking Child) the Children Act 189 S3(5) allows for the Local Authority who has care of the child to give and delegate consent, i.e. the Director of Children's Services or another nominated Officer, may delegate to carers the right to consent to medical treatment and health screening for the child.
4. Children Subject to Emergency Protection Orders/Police Protection Orders
   
   Parental Responsibility is conferred on the applicant for the period of the Order. Any person with parental responsibility under an Emergency Protection Order must take (but may only take) action, which is reasonably required to safeguard or promote the child's welfare bearing in mind the duration of the Order.
5. Wardship
   
   Parental responsibility remains with the parents. The High Court authorise any non-routine medical procedures.

3. Consent - Usual/Routine Day to Day Activities

In all cases consent to day-to-day activities and medical treatment should be addressed under current procedure for Looked After Children within Placement Agreements with all relevant parties involved, especially birth parents and adoptive parents as appropriate, and including a record of any disputes and resolutions regarding consent. In addition Dudley's Medical/Health Screening Consent Forms should be completed ensuring all planned interventions, including surgical interventions, are referred to Divisional Managers.

Placement Agreements and Medical/Health Screening Consent Forms should be completed and regularly reviewed both within and in line with Statutory Review periods to reflect any changes to placements and persons with delegated authority for consent.

Guidance

(A) Consent to usual and routine day-to-day activities

Dudley's Directorate of Children's Services places young people with carers on the assumption that they act as a "reasonable parent" in given situations. All day-to-day living decisions are delegated to carers on the assumption and expectation that as carers they behave towards young people in a way that is consistent with the policy, values and guidelines of the Directorate.

The overall aim and intent is for carers to be able to make reasonable and appropriate spontaneous decisions on behalf of the young people they care for and not to have to seek consents unnecessarily.

This is a particular issue for young people themselves who feel that they have to wait an unnecessary length of time before being able to return a consent form, e.g. for a day trip at school. This makes them unnecessarily stand out as ' different' to the rest of their classmates.

Decisions which cannot be delegated to a carer on a day-to-day basis should be clearly identified in the Placement Plan and Care Plan by the Social Worker, otherwise the assumption will be that carers can consent to the involvement of children they are caring for in usual and routine activities associated with schools and clubs, activities or hobbies.

Parental involvement in such decisions should be sought by the Social Worker wherever and whenever possible as good practice would dictate, and issues of consent clearly discussed with parents in the formulation of the Placement Plan and Care Plan.

Also see:

Overnight Stays and Contact with Relatives and Friends Procedure

Passports, Holidays and School Trips Outside the UK Procedures

School Trips within the UK Procedures

(B) Consent to Medical Treatment and Health Screening

The health care of young people who are looked after is often poor because it is not clear who has responsibility for ensuring that medical treatment and health screening is arranged and carried out. The parental nature of the tasks that carers carry out on a daily basis means they are often in the best position to look after and promote the health of the young people in their care.

As an authority we want to ensure that carers are able to carry out this responsibility effectively. In order to do that we have delegated responsibility for certain health matters to the carers for the young people in their care.

This will always be done in consultation with the parents (unless there are circumstances which make this impracticable or impossible).

For the purposes of this policy medical treatment means any type of medical, dental or surgical intervention, and health screening means the statutory health checks required for all looked after children and young people.

Even if general parental consent has been obtained, the parent or those holding parental responsibility should be consulted beforehand about the intervention required and parental agreement obtained whenever possible.

Who can give (and sign for) consent to medical treatment and health screening?

Legal Position:

A child if she/he is over the age of 16 or younger than 16 if the Doctor believes that he/she is mature enough has the legal capacity to give consent for medical treatment.

In addition, under the Children Act 1989 S3(5):

A person who does not have parental responsibility for a particular child but has the care of the child - may do what is reasonable in all circumstances for the purpose of safeguarding or promoting the child's welfare.

This will apply in all circumstances of an emergency or life threatening nature. Others can consent in the following circumstances:

1. Children Subject to Care Orders or Interim Care Order under Children Act 1989, Placement Order Adoption and Children Act 2002
   
   Where the child is subject of a Placement Order, parental responsibility is with the Adoption Agency. While the child is placed with prospective adopters, parental responsibility is given to them (S25(3) A&CA 2002). In relation to Care Orders and Interim Care Orders parental responsibility is shared between local authority and parents. On behalf of the local authority or adoption agency, the Director of Children's Services or another nominated officer, may delegate to carers the right to consent to medical treatment and health screening for the child.
2. Children Accommodated under S20 Children Act 1989, Children Placed for Adoption with no Placement Order
   
   Parental responsibility remains with the parents. Parents can authorise the Director of Children's Services or other named officer to give consent to urgent treatment and specified items of preventative treatment, including health screening, and can authorise the delegation of this power to carers or can authorise carers directly.
   
   In the absence of a parent (e.g. an Unaccompanied Asylum Seeking Child) the Children Act 1989 S3(5) allows for the local authority who has care of the child to give and delegate consent, i.e. the Director of Children's Services or another nominated officer, may delegate to carers the right to consent to medical treatment and health screening for the child.
3. Children Subject to Emergency Protection Orders and Police Protection Orders
   
   Parental responsibility is conferred on the applicant for the period of the Order. Any person with parental responsibility under an Emergency Protection Order must take (but may only take) action, which is reasonably required to safeguard or promote the child's welfare bearing in mind the duration of the Order.
4. Wardship
   
   Parental responsibility remains with the parents. The High Court authorise any non-routine medical procedures. Health screening is routine for looked after children.

What if anyone refuses or declines to give consent to medical treatment or health assessment?

As outlined above children and young people can give consent for themselves, but equally they can decline or refuse it.

In all cases the wishes and views of the child or young person concerned should be respected and listened to. In such cases it will be necessary for the carer to inform the Social Worker, and it may be appropriate and necessary to involve the Designated Nurse or other health professional in ensuring the benefits of the intervention are fully and properly explained and understood by the child or young person concerned. However, should a child or young person continue to refuse this should be respected. Where this is deemed to have 'significant harm' implications for the child or young person the Social Worker will consider this under children's safeguarding procedures.

Where a child or young person is accommodated under S20 of the Children Act 1989, and the person with parental responsibility declines or refuses to give consent this will be referred to the Social Worker. Where this is deemed to have 'significant harm' implications for the child or young person the Social Worker will consider this under children's safeguarding procedures.

In all other circumstances, i.e. where a person shares parental responsibility declines or refuses to give consent, this will be referred to the Social Worker. Where this is deemed to have 'significant harm' implications for the child or young person the Social Worker will consider this under children's safeguarding procedures.

Appendix 1: Medical Consents Flowchart

Appendix 2: Medical Consents Authorisation Form

Click here to view Consent to Medical Treatment/Health Screening for a Looked After Child Form

End