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3.8.4 Health Care Assessments and Health Care Plans

SCOPE OF THIS CHAPTER

This procedure applies to all Looked After Children. Note, however, that as from 3 December 2012, all children remanded other than on bail will be Looked After Children. Different provisions will apply in relation to those children/young people - see Section 8, Care planning for young people on remand in the Remands to Local Authority Accommodation or to Youth Detention Accommodation Procedure.

This procedure summarises the arrangements that should be made for the promotion, assessment and planning of health care for Looked After children.

RELEVANT GUIDANCE

For detailed guidance, see Statutory Guidance on Promoting the Health and Well-being of Looked After Children (March 2015).

BMA, Consent Toolkit

NICE 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, NG26 (2015)

AMENDMENT

In March 2019, new Section 3.2, Consent to Health Care Assessments was added.


Contents

1. The Responsibilities of Local Authorities and Clinical Commissioning Groups
2. Principles
3. Health Care Assessments
  3.1 Good Health Assessment and Planning
  3.2 Consent to Health Care Assessments
  3.3 Health Care Plans
  3.4 How the Health Care Plan may Affect the Placement Plan
  3.5 Strength and Difficulty Questionnaires
  3.6 Out of Area Placements


1. The Responsibilities of Local Authorities and Clinical Commissioning Groups

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 those children placed in adoptive placements. 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 to reflect the child’s health needs and be included as part of the child’s overall Care Plan.

The relevant Clinical Commissioning Group (CCG) 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 without any undue delay and irrespective of whether the placement of the child is an emergency, short term or in another CCG. This also includes services to a child or young person experiencing mental illness.

The Local Authority should always advise the CCG when a child is initially accommodated. Where there is a change in placement that will require the involvement of another CCG, the child’s ’originating’ CCG, outgoing (if different for the ‘originating CCG) and new CCG should be informed.

Both Local Authority and relevant CCG(s) should develop effective communications and understandings between each other as part of being able to promote children’s well being.


2. Principles

  • Looked After Children should be able to participate in decisions about their healthcare and all relevant agencies should seek to promote a culture that promotes children being listened to and which takes account of their age;
  • That others involved with the child, parents, other carers, schools, etc are enabled to understand the importance of taking into account the child’s wishes and feelings about how to be healthy;
  • There is recognition that there needs to be an effective 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 CCG area, any treatment or service should be continued uninterrupted;
  • A Looked After Child requiring health services should be able to access these without delay and 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 to where they live in 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 CCG, e.g. where the child is placed in an out of Authority Placement, (see Out of Area Placements Procedure) the ‘originating CCG ’remains responsible for the health services that might be commissioned.


3. Health Care Assessments

3.1 Good Health Assessment and Planning

Role of S/W 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;
  • Ensure that consents and permissions with regard to delegated authorities 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 3.2, Consent to Health Care Assessments);
  • Ensure that any actions identified in the Health Plan are progressed in a timely way by liaising with health relevant professionals;
  • In recognising that a child’s physical, emotional and mental health can impact upon their learning, where this is necessary, to liaise with the Virtual School Head to ensure as far as possible this is minimised for the child. (Should there be any delay in the child’s Health Plan being actioned, the impact for the child with regard to their learning should be highlighted to the relevant health practitioners);
  • To support the Looked After Child’s carers in meeting the child’s health needs in an holistic way; this includes sharing with them any health needs that have been identified and what additional support they should receive, as well as ensuring they have a copy of the Care Plan;
  • Where a Looked After Child is undergoing health treatment, to monitor with the carers how this is being progressed and ensure that any treatment regime is being followed;
  • To communicate with the carer’s and child’s health practitioners, including dentists, those issues which have been properly delegated to the carers;
  • Social workers and health practitioners should ensure the carers have specific contact details and information on how to access relevant services, including CAMHS;
  • Ensuring the child has a copy of their health plan.
It is important that at the point of accommodating a child, as much information as possible is understood about the child’s health, especially where the child has health or behavioural needs that potentially pose a risk to themselves, their carers and others. Any such issues should be fully shared with the carers, together with an understanding as to what support they will receive as a result.

The purpose of Health Care Assessments is to promote children's physical and mental health and to inform the child's Health Care Plan.

Health Care Assessments will usually be conducted at the Sheldon Clinic. 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.

The Senior Clinical Medical Officer, Designated Nurse or other suitably qualified medical practitioner who carries out the assessment, should complete a CoramBAAF Medical Assessment form and the Health Care Plan.

  • The first Assessment must be conducted before the first placement, or as soon as possible after the child's placement so that a Health Care Plan can be drawn up in time for the first Looked After Review (unless one has been done within the previous three months), and any necessary follow up assessment must be arranged by the social worker;
  • For children aged up to five years, reviews of the Health Care Assessment should occur at least every six months;
  • For children aged over five years, reviews of the Health Care Assessments should occur at least annually.

The social worker is responsible for ensuring that Health Care Assessments and reviews are undertaken and will accompany the child and parents to the Clinic.

In order for the Assessment to be conducted, the social worker must ensure that the Consents section of the child's Placement Plan has been completed and signed by the Parent. 

3.2 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 Procedure).

For further information on consent, see Department of Health's Reference guide to consent for examination or treatment.

3.3 Health Care Plans

Each Looked After Child's Placement Plan must incorporate a Health Care Plan in time for the first Looked After Review. (The Health Care Plan is the document completed by the medical practitioner at the time of the Health Care Assessment). The Plan must be updated after each review of the Health Care Assessment and at the child's Looked After Review or as circumstances change.

3.4 How the Health Care Plan may Affect the Placement Plan

The Placement Plan for each Looked After Child must incorporate how the health care needs of the child will be addressed.

As necessary, the Placement Plan should address the following matters:

  1. Whether there are any specific health care needs - and how they will be met;
  2. Whether it is agreed that Paracetamol or other painkillers can be used to provide relief for headaches, menstrual or other pain; also whether there are any restrictions on the use of non-prescribed medicines, Household Remedies or use of first aid;
  3. The involvement of the child's parents or significant others in health issues during the placement;
  4. Any specific medical or other health interventions which may be required, including whether it is necessary for any Invasive Procedures and how they will be undertaken;
  5. The extent to which the child is able to retain or administer medication, or requires support to do so;
  6. Whether it is necessary for any immunisations to be carried out;
  7. Any specific treatment or Therapeutic Interventions, strategies or remedial programmes required;
  8. Any necessary preventive measures to be adopted;
  9. Whether the child is allowed to smoke and any measures agreed to reduce the behaviour;
  10. Whether there are concerns about substance misuse, including soft or hard drugs and alcohol;
  11. Whether there are any issues in relation to the child's sexual health - see Sexual Health and Relationships Guidance;
  12. Whether there are any concerns about teenage pregnancy - (see Teenage Pregnancy and Sexual Health Guidance) the placement will contribute to any health monitoring;
  13. Whether there are any illegal or other activities including self-harming which it is known or suspected the child is engaged in which may be harmful to the child's health, and the interventions/strategies to be adopted in reducing or preventing the behaviour;
  14. Whether the placement will contribute to any other health-related assessments;
  15. Whether the placement will contribute to any health monitoring.

3.5 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.

The SDQ Questionnaire, along with any other tool which may be used to assist, can be used to identify the needs and be part of the child’s Health Plan.

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

3.5 Out of Area Placements

Where an Out of Authority placement is sought, the responsible authority 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. The placing authority should seek guidance from within its own partner agencies and the potential placement area to seek such information out.

The originating CCG, the current CCG (if different) and the proposed area’s CCG 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 these are Placements at a Distance the Care Planning, Placement and Case Review (England) Regulations 2010 make it a requirement that the responsible authority consults with the area of placement and that Director of the responsible authority must approve the placement.

Where the child’s health situation is more 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.

End