Health Care Assessments and Plans

1. The Responsibilities of Local Authorities and Integrated Care Boards

The local authority, through its corporate parenting responsibilities, has a duty to promote the welfare of looked after children, including those who are eligible and children placed for adoption. This includes promoting the child's physical, emotional and mental health; every Looked After Child needs to have a health assessment so that a Health Plan can be developed as part of the child's overall care plan.

The relevant Integrated Care Board (ICB) and NHS England have a duty to cooperate with requests from the local authority to undertake health assessments and provide any necessary support services to Looked After Children. This also includes services to a child or young person experiencing mental illness.

Dudley Children's Services should always advise the ICB when a child is initially accommodated. Where there is a change in placement which will require the involvement of another ICB, the child's 'originating' ICB, outgoing (if different for the 'originating ICB) and new ICB should all be informed.

Local Authorities and ICBs should develop effective communications and understandings to support them in carrying out their duty to promote children's wellbeing.

2. Principles

• Looked After Children should be able to participate in decisions about their healthcare and all relevant persons and agencies should promote a culture listens to children and takes account of their wishes and feelings about their health;
• Foster carers and residential staff must be prepared and supported to promote the progress of children in relation to their health, emotional, social and psychological wellbeing;
• Children and young people should be supported to maintain good health and manage long term conditions;
• Health issues (including their mental and sexual health needs, as appropriate) should be identified by the multi-disciplinary team around the child or young person. The child and young person should also have access to local Health services when needed such as CAMHS;
• Carers should develop good working relationships with Health professionals and services to meet the needs of the child or young person;
• There needs to be a balance between confidentiality and providing information about a child's health. This is a sensitive area, but 'fear about sharing information should not get in the way of promoting the health of looked After Children'. (See Annex C: Principles of confidentiality and consent, DfE and DHSC Statutory Guidance on Promoting the Health and Well-being of Looked After Children (March 2015);
• When a child becomes Looked After, or moves into another ICB area, any treatment or service should be continued uninterrupted;
• A Looked After Child requiring health services should be able to access them without delay: any wait should 'be no longer than a child in a local area with an equivalent need';
• A Looked After Child should always be registered with a GP and Dentist near their placement;
• A child's clinical and health record will be principally located with the GP. When the child comes into local authority care, or moves placement, the GP should fast-track the transfer of the records to a new GP;
• Where a child is placed within another ICB, e.g. where the child is placed in an out of Authority Placement (see Out of Area Placements Procedure), the 'originating ICB' remains responsible for the health services that might be commissioned.;
• Arrangements for managing medication must be safe and effective and promote independence whenever possible. There must be safe management of controlled drugs (such as morphine, pethidine, methadone and Ritalin). See CQC Information on Controlled Drugs.

3. Health Care Assessments

3.1 Good Health Assessment and Planning

Role of Social Worker in Promoting the Child's Health

The social worker has an important role in promoting the health and welfare of Looked After Children:

• Working in partnership with parents and carers to contribute to the Health Plan;
• Ensuring that consents and permissions with delegated authority are obtained to avoid any delay. Note: however, should the child require emergency treatment or surgery, then every effort should be made to contact those with parental responsibility to both communicate this and seek for them share in providing medical consent where appropriate. Nevertheless, this must never delay any necessary medical procedure (see Section 3.5, Consent to Health Care Assessments);
• Ensuring that any actions identified in the Health Plan are progressed in a timely way by liaising with relevant health professionals;
• Liaising with the Virtual School Head to minimise any impact that health issues (physical, emotional and mental) may have on the child's learning;
• Liaising with relevant health practitioners to highlight the potential impact on the child's learning of any delay in actioning his/her health plan;
• Sharing all necessary information about the child's identified health needs with the carers, supporting them in addressing these needs, and accessing additional support where appropriate;
• Where a Looked After Child is undergoing health treatment, monitoring with the carers how this is progressing, and ensuring that any treatment regime is being followed;
• Communicating with the health practitioners, including dentists, those issues which have been properly delegated to the carers;
• Ensuring that the carers have information on how to access relevant services, including CAMHS;
• Ensuring the child has a copy of their health plan.

At the point of accommodating a child, it is important to obtain as much information as possible about the child's health, especially where the child has health or behavioural needs which potentially pose a risk to themselves, their carers and others. Any such issues should be fully shared with the carers, and an understanding should be reached as to what support they will receive as a result.

3.2 Frequency of Health Care Assessments

Each Looked After Child must have a Health Care Assessment at specified intervals as set out below.

• The first Assessment must be conducted before the first placement (unless one has been done within the previous 3 months). If that is not reasonably practicable, the assessment must be completed and the Health Care Plan drawn up before the child's first Looked After Review;
• 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, the social worker should furnish the carer/residential staff with a copy of the child's Health Care Plan.

3.3 Who carries out Health Assessments?

The first Health Care Assessments 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 (see Section 3.4, Arranging Health Care Assessments).

3.4 Arranging Health Care Assessments

The social worker must ensure that the parent(s) have given consent to the health assessment - or that there are grounds to proceed without their consent - this will usually be recorded on the Placement Information Record.

The process for arranging an Initial Health Care Assessment is:

• The social worker notifies admin via a change of circumstances form on the day of admission;
• Admin update CCM immediately upon receipt of the change of circumstances form;
• Admin notify Safeguarding, LAC Health, Health Commissioning, LACES – also out of Borough LA if appropriate;
• The LAC Health Admin Team book the child into a clinic;
• The invitation to the clinic is emailed to the social work admin team, who complete Part A of CoramBAAF Form IHA-C or IHA-YP as appropriate. This form must be returned within 5 days of admission;
• The social worker must attend the health assessment and, if possible, should invite the parents. The carer should also be present;
• Two days after the clinic attendance, the LAC Health Team will input the date of the assessment directly on to CCM.

The health professional conducting the assessment will complete a relevant CoramBAAF Form and a Health Plan, which should be passed to the child's social worker - who should give copies to carers/residential staff.

3.5 Consent to Health Care Assessments

A valid consent will be necessary for a Health Care Assessment. Who is able to give this consent will depend on the age and understanding of the child. In the case of a very young child, the local authority as corporate parent can give the consent. An older child with mental capacity may be able to give their own consent.

Young people aged 16 or 17

Young people aged 16 or 17 with mental capacity are presumed to be capable of giving (or withholding) consent to their own medical assessment/treatment, provided the consent is given voluntarily and they are appropriately informed regarding the particular intervention. If the young person is capable of giving valid consent, then it is not legally necessary to obtain consent from a person with Parental Responsibility.

Children under 16 – 'Gillick Competent'

A child of under 16 may be Gillick Competent to give (or withhold) consent to medical assessment and treatment, i.e. they have sufficient understanding to enable them to understand fully what is involved in a proposed medical intervention. 

In some cases, for example because of a mental disorder, a child's mental state may fluctuate significantly, so that on some occasions the child appears Gillick Competent in respect of a particular decision and on other occasions does not.

If the child is Gillick Competent and is able to give voluntary consent after receiving appropriate information, that consent will be valid, and additional consent by a person with parental responsibility will not be required.

Children under 16 - Not 'Gillick' Competent

Where a child under the age of 16 lacks capacity to consent (i.e. is not Gillick Competent), consent can be given on their behalf by any one person with Parental Responsibility. Consent given by one person with Parental Responsibility is valid, even if another person with Parental Responsibility withholds consent. (However, legal advice may be necessary in such cases). Where the local authority, as corporate parent, is giving consent, the ability to give that consent may be delegated to a carer (foster carer or registered manager of the children's home where the child resides) as a part of 'day-to-day parenting', which will be documented in the child's Care Plan (see Delegation of Authority to Foster Carers and Residential Workers).

For further information on consent, see Department of Health and Social Care Reference Guide to Consent for Examination or Treatment.

4. Health Plans

Each Looked After Child's Care Plan must incorporate a Health Plan in time for the first Looked After Review, with arrangements as necessary incorporated into the child's placement plan/placement information record.

The Health Plan must be reviewed after each subsequent Health Care Assessment and at the child's Looked After Review or as circumstances change.

Information should also be given about any allergies. See also Health and Safety Procedure.

4.1 Strength and Difficulty Questionnaires

Understanding a Looked After Child's emotional, mental health and behavioural needs is as important as their physical health. All local authorities are required to use the Strength and Difficulty Questionnaires (SDQs) to assess the emotional needs of each child.

(See Appendix B of the 'DfE promoting the health and well-being of looked-after children', Strengths and Difficulties Questionnaire.)

4.2 Out of Area Placements

Where an Out of Authority placement is sought, the Dudley Children's Services should make a judgment with regard to the child's health needs and the ability of the services in the proposed placement area to fully meet those needs. Children's Services should seek guidance from its own partner agencies and from agencies in the potential placement area to seek such information out.

The originating ICB, the current ICB (if different) and the proposed area's ICB should be fully advised of any placement changes and to ensure that any health needs or heath plan are not disrupted through delay as a result of the move.

Where the child's health situation is complex, it is likely that both Health and Children's Social Care services will need to be commissioned; this will need to be undertaken jointly within the originating agencies' respective fields of responsibility together with the Health and Children's Social Care services in the area where the child is placed.

Who Pays? provides information on which NHS Commissioner is responsible for making payment to a provider.

Further Information

Legislation, Statutory Guidance and Government Non-Statutory Guidance

DfE and DHSC Statutory Guidance on Promoting the Health and Well-being of Looked After Children

Good Practice Guidance

Children's Attachment: Attachment in Children and Young People who are Adopted from Care, in Care or at High Risk of Going into Care, NICE Guidelines (NG26)