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Contents

1. Introduction
2. Principles
3. Consent
4. Arranging the Initial Health Assessment
5. Review Health Assessments
6. Children Undergoing the Adoption Process
7. Young People aged 16 years and over, who Continue to be the Responsibility of the Local Authority
8. Children Placed out of Borough
9. Children Receiving Short Term Breaks

1. Introduction

Health Assessment for Looked After Children is one component of a statutory requirement to review the Care Plans of children Looked After ((under the Care Planning, Placement and Case Review (England) regulations 2010).

This chapter details the responsibilities of Dudley Children and Families Service in respect of Health Assessment to all children in the Looked After System.

The arrangements below, which have been agreed between Dudley Teaching Primary Care Trust (TPCT) and Dudley Children and Families, describe how to arrange health assessments for all looked after children.  The child's Social Worker or someone with delegated responsibility is required to make these arrangements.  If a case is unallocated a Team Manager should ensure that the arrangements are made for the child's health to be reviewed.

Detailed below are the steps involved in arranging and providing Health Assessments for Looked After Children.

The Social Worker is responsible for ensuring that information is shared with the Trust’s Looked After Children office as soon as possible following the child’s admission to care. This notification will be done in accordance with Section 4, Arranging the Initial assessment.

These procedures only apply to children/young people up to the age of 16 years. For young people over 16 years, see Section 7, Young People aged 16 and over, who Continue to be the Responsibility of the Local Authority.

2. Principles

One of the Corporate parenting responsibilities is ensuring that every Looked After Child is as physically and emotionally healthy as possible.  The Looked After Child's attendance at regular health assessments will help to plan for this outcome.

It is the responsibility of the social worker to notify the appropriate health professional (health visitor or school nurse) when the child is admitted to the Looked After System.

There should be close liaison between the Health Visitor or School Nurse and the Social Worker with responsibility for the child, to ensure a continuity of health care.

Health Assessments are an important element in devising the health plan for Looked After children.  However, no child should be the subject of unnecessary repeated examinations.  Where relevant, reports from previous examinations may be used to meet the requirement for a written assessment, e.g. pre-adoption medical examinations, developmental surveillance interviews, child protection examinations, ongoing medical reviews.  When this is the case, copies of the completed documents should be sent to LAC Health Office to facilitate development of the Personal Health Plan.

The need for any medical examination should be clearly explained to the child, their carers and parents.

Children should be helped to understand their health needs, and how these can be met.  Social Workers, carers and health professionals should encourage children to attend their health assessments.

Parents should be involved with all processes which relate to meeting their child’s health needs providing this is consistent with the child’s best interests and is agreeable to the child.  Parents should be asked for information about the child’s previous health history when the child is first admitted.  Health information from the Core Assessment should be made available to the health professional undertaking the health assessment.

Any difficulties in obtaining a Health Assessment or completing a Health Review should be discussed at the child’s next Looked After Review if this issue cannot be resolved.

3. Consent

Under Trust Consent to Treatment Policy (2002), informed consent should be obtained by the health professional from a person with Parental Responsibility, or the child/young person if deemed competent to do so, prior to the health assessment taking place. (DOH Guidelines).

In situations, where Looked After children require any form of medical intervention, including a health assessment, informed consent must be sought from a person with Parental Responsibility, unless a child is able to give such consent him- or herself.

Children aged 16+ are presumed in law to be competent to give consent.  Children under 16 may be presumed competent, if the medical practitioner/health professional is satisfied that they have “sufficient understanding and intelligence to enable them to understand fully what is proposed” with respect to a particular intervention.

In all cases, where a looked after child/young person cannot evidence such competence, the child's social worker takes the lead responsibility in ensuring that parental consent has been obtained, before any medical intervention. This will be undertaken as part of the placement planning for the child and recorded on the child's Placement Plan as set out below - also please see Decision to Look After A Child Procedure.

In all cases, where a child becomes looked after, the social worker should request for the parent to complete and sign 2 copies of the “Agreement to Health Assessment Form” at the time the remaining LAC paperwork is completed.  The health assessment process must be explained to the parent and the information leaflet “Health Assessment Information for Parent/Carer” must be provided.  Following completion/signature, the parent should retain 1 copy of the agreement.

The social worker must then complete and forward form WSS962 to the LAC Health Office within 7 days for the young person entering the looked after system and attach the original signed consent form to it, retaining a copy on file.  Unless it is not safe to do so, the parent should be informed when an appointment for a health assessment has come through and should be invited to attend.

If the parent has not signed the “agreement to health assessment” form, and the child is Accommodated under Section 20, the assessment cannot go ahead,.  If the child is looked after under a compulsory order and the local authority therefore shares Parental Responsibility for the child, the social worker may sign the “Agreement of Health Assessment Form” on behalf of the local authority. In these circumstances, the local authority delegates the authority to give parental consent to the health assessment to the child’s social worker.  The consent form signed by the social worker must in these cases be attached to the WSS962.

Where for any reason, the agreement form has therefore not been submitted, either the parent or the social worker must attend the health assessment to give consent at that time.

Following the initial health assessment, future health assessments also need to be requested/confirmed using the WSS962.  In each instance, the social worker must obtain consent from a parent for the health assessment to be undertaken. 

Difficulties in respect of consent should be considered at the child’s Looked After Review if these cannot be resolved.

This procedure does not affect more invasive treatments, which continue to have to be authorised by the parent or – if this is not possible – by the service manager responsible for the child.

4. Arranging the Initial Health Assessment

Under the Care Planning, Placement and Case Review (England) Regulations 2010, the first Health Care Assessment must be conducted by a registered medical practitioner. Subsequent assessments may be carried out by a registered nurse or registered midwife under the supervision of a registered medical practitioner, who should provide the Social Worker with a written report. The first Assessment must be conducted before the first placement or, if not reasonably practicable, before the child's first Looked After Review (unless one has been done within the previous 3 months).

Subject to the principles set out above, the following action should therefore be taken.

The Looked After Children Health Co-ordinator’s office should be notified as soon as possible following admission. This is the responsibility of the Social Worker.  The completed WSS 962 document should be forwarded to the office as soon as possible, along with the signed consent form.  It is particularly important that evidence of consent to the examination is given.

The Health Co-ordinators office will flag child as Looked After (LA) on the working register on Child Health.

The Social Worker should inform the Health Visitor/School Nurse of where the child is now living and the name of the carers and the circumstances of the child’s admission to care. 

The Health Co-ordinator’s office will arrange the health assessment, negotiating with the child, carer, Social Worker, and health professionals.  This should be done within 4 weeks of notification.  The Co-ordinator’s office will provide an up-to-date report on the child’s immunisation and health assessment status as recorded on the Trust Child Health system.

Any other relevant health information will be sought by the Health Co-ordinator from the child’s General Practitioner and any other identified sources, with consent from the young person or person Parental Responsibility, prior to the assessment taking place.

The Social Worker should attend with the child and carer. However, where this is not possible, the carer and child should attend the health assessment. The Social Worker as key worker will decide on the appropriateness of the birth parent attending.

If the child has a Personal Child Health Record (The Red Book), this should be brought to the assessment.

Opportunity should be given for both the child/young person and the carer/parent to speak to the doctor/health professional alone.

When the assessment is completed, a Personal Health Plan will be written in consultation with the child/young person, the carer, the health professional, social worker and the birth parents where appropriate.

The health professional, following health assessment, will complete the documentation, making any appropriate referrals e.g. child health specialties and other clinical services and return it to the Looked After Children Co-ordinator`s office.  An Unscheduled Developmental Examination Record (DER) form will also be completed by the health professional and forwarded to the appropriate Child Health office.

A copy of the personal health plan will be sent to the Social Worker, and to the child`s General Practitioner by the health co-ordinators office.  A copy will be filed in the child`s Trust health record (Child Health Record for under 5 years old and 10m for school aged children).

The health professional will ensure that a copy of the Personal Health Plan is sent to the child at their current address.

The Social Worker will ensure that a copy of the health plan goes to the parent and carer.

The TPCT Child Health Department will enter outcome details from the Unscheduled DER, including planned review date, onto the Working Register, which is attached to the Trust Child Health database.

If there are any questions about the appropriateness of sharing the details of the health assessment with parents or carers, this should be discussed with the health professional either before or at the time of the assessment, by those persons with such concerns.

The administrative staff at the Social Care & Supported Housing area office should be informed by the Social Worker that a health assessment has been completed.  The administrative staff will then ensure a further date is recorded in PARIS for the next health review.  For a child under 5 years this will be in 6 months.  For a child over 5 years a health review is required every 12 months.

If the appointment is cancelled prior to the assessment date, a new appointment will be offered and the social worker notified.

If no contact is made and the child does not attend, the Health Co-ordinator`s office will attempt contact with the carer.  The social worker will be notified of the outcome.  No further appointment will be offered until the social worker confirms the placement details and the compliance of the carers.

5. Review Health Assessments

For children under five years, further Health Care Assessments should occur at least once every six months. For children aged over five years, further Health Care Assessments should occur at least annually. If a child is transferred from one Looked After Placement to another, it is not necessary to plan an assessment within the first month. In these circumstances, the Social Worker should furnish the carer/residential staff with a copy of the child's current Health Care Plan.

Review dates will be triggered from the Working Register of the TPCT Child Health System.

The Health Co-ordinators office will request a completed up to date WSS 962 form from the social worker.  It is imperative that all changes of circumstances of each child in the Looked After system are notified to the Health co-ordinator by the Social Worker as soon as possible.  This includes movement within Dudley, out of borough, or cessation of the episode.

The review will be undertaken by the health professional who is responsible for delivery of mainstream health services to the child, e.g. Health Visitor or School Nurse.  Where the child does not attend school locally, arrangements will be made on an individual basis.  A medical examination will not take place unless the need for one is identified either at the previous health assessment or by the health professional at this contact.

Following the health assessment, action should be taken as detailed for the initial assessment, as described in Section 4, Arranging the Initial Assessment.

6. Children Undergoing the Adoption Process

It is a statutory requirement for children for whom adoption is the proposed plan to undergo a specific medical examination by a named medical practitioner before the child is considered by the Adoption Panel - see Placement for Adoption Procedure.

This examination takes precedence over other assessments and will take the place of the Looked After health assessment, in line with Section 2, Principles.

When the Social Worker is aware that there is a plan to arrange permanent placement through adoption for the child, the need for and timing of a Looked After health assessment should be discussed with the health co-ordinator.   It is important to do this as soon as possible after the decision is taken.    

The designated doctor’s office will liaise with the health co-ordinator’s office to ensure all appropriate documentation is completed and the episode and outcome entered onto the child health system as for Looked After Health Assessment.

7. Young People Aged 16 years and over who Continue to be the Responsibility of the Local Authority

All young people transferring to the Leaving Care Team should be offered a health interview, by the Leaving Care health advisor, if they have not had one from school health service within the agreed timescale.

Details will be passed within the Leaving Care Team, to the health advisor.

The health advisor will support the young person in taking responsibility for addressing their own health needs as per the Personal Health Plan, including registering with a General Practitioner and dentist.

The need and timing of any further health reviews will be discussed with the young person by the health advisor.

8. Children Placed out of Borough

THE SOCIAL WORKER WILL INFORM THE HEALTH CO-ORDINATOR’S OFFICE OF THE CIRCUMSTANCES AS SOON AS POSSIBLE WHEN A CHILD/YOUNG PERSON IS PLACED OUT OF BOROUGH.  THE SOCIAL WORKER SHOULD ALSO NOTIFY THE PRIMARY CARE TRUST IN THE AREA OF PLACEMENT.

WHERE CHILDREN ARE PLACED OUTSIDE DUDLEY, BUT STILL HAVE A HEALTH VISITOR FROM DUDLEY, OR ARE ATTENDING A DUDLEY SCHOOL, IT MAY BE APPROPRIATE FOR THEM TO HAVE THEIR HEALTH ASSESSMENT UNDERTAKEN WITHIN DUDLEY.

In such cases, action should be taken as detailed above.

Where children are placed outside Dudley, arrangements for health assessments will be made on an individual basis via the LAC Health Office.  The completed WSS 962 form should be forwarded to the LAC Health Office as usual.  Where possible arrangements are made via the Named Nurse or Community Paediatrician for Looked After Children in the area or via the private facility where necessary.

This will be dealt with on an individual basis until agreement is reached with the service providers.

9. Children Receiving Short Term Breaks

The regulations for looked after children receiving short-term breaks are the same as for all Looked After children. However, as most of these children will be undergoing regular medical reviews either at school or the child development centre, a separate medical will not be required.

The Health Visitor/School Nurse for the child should be contacted by the Social Worker when short-term breaks are first being considered and the arrangement is being made under Section 20 - See Short Breaks Procedure.

Form WSS 360 will be completed by the Nurse or Doctor and be made available at the F meeting, to which the relevant

Health Professional should be invited. This will be the initial health assessment.

An informal review will occur at the 6 month interval, to which the Health Professional will be invited to give an update.

Form WSS 360 will be updated annually for the formal statutory review to which the Health Professional will be invited.

End