SCOPE OF THIS CHAPTER
This procedure applies to all Looked After Children. Children remanded other than on bail will be Looked After Children. Different provisions will apply in relation to those children/young people - see Remands to Local Authority Accommodation or to Youth Detention Accommodation Procedure, Care Planning for Young People on Remand or Youth Detention Accommodation.
This procedure summarises the arrangements that should be made for the promotion, assessment and planning of health care for Looked After Children.
This chapter was updated in April 2020 and should be re-read.
- The Responsibilities of Local Authorities and Clinical Commissioning Groups
- Health Care Assessments
- Health Plans
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 which 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 wellbeing.
- 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 (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 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 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 3.5, Consent to Health Care);
- Ensuring 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, liaising 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);
- Supporting 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, monitoring with the carers how this is being progressed and ensure that any treatment regime is being followed;
- Communicating 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 which 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.
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 within 20 working days of the first placement;
- 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.
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 process that the Social Worker should follow for ALL newly LAC children/young people is listed below:
- Social Worker informs LAC Health Administrator, cc'ing LAC Planning and Review Officer, of date child/young person became LAC;
- LAC Health Administrator completes IHA-YP/IHA-C form and sends to the Social Worker asking them to check information listed and return the form within 2 days with signed consent for IHA medical. Planning and Review Officer, Head Of Virtual School, Horizons Centre and Contact Service are cc'd into email to Social Worker;
- If IHA form not received within 2 days, LAC Health Administrator send another email to Social Worker cc'ing their Team Manager and Business Support Deputy Team Manager;
- When IHA form has been received – with consent – Form is then sent over to Carmelita House;
- Carmelita House will allocate appointment to complete IHA and inform LAC Health Administrator who will then contact carer or Social Worker (especially for Unaccompanied Minors) to confirm they are able to attend;
- LAC Health Administrator then send email confirmation of appointment to carer or Social Worker with details along with a map to venue;
- When IHA completed CH will then scan over to LAC Health Administrator completed form and she then update Mosaic with information - i.e. immunisation/dentals/GP details etc;
- LAC Health Administrator then send email to Social Worker/IRO informing them completed IHA form has been uploaded onto Mosaic and they should note comments in HAP in Part C.
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 Placement Plan (see Delegation of Authority to Foster Carers and Residential Workers Procedure).
For further information on consent, see Department of Health and Social Care Reference Guide to Consent for Examination or Treatment.
3.6 Ealing specialist health services for looked after Children and Young People
3.6.1 Children and Adolescent Mental Health Service (CAMHS)
This service works with children, young people and families with social, emotional, behavioural or mental health issues, in order to prevent matters becoming more serious. Specialist multi-agency support is available from social workers, family therapists, psychologists and psychiatrist.
A referral may be made to the CAMHS service that is local to the child's placement.
3.6.2 Looked After Children's Health Team
Social Workers and Ealing's looked after children have access to the services of the Looked After Children's health team including a band 8 and a band 7 Nurse for health advice, education and support. The nurses can be contacted at Carmelita House.
The team also has a designated LAC nurse, LAC GP and Paediatrician.
3.6.3 Substance Misuse Service
Looked after children requiring support due to substance misuse issues can access Ealing RISE services (external commissioned service) or if placed away from Ealing from services more local to the young person. The cgl EASY Project Young Person Service can support young people up to the age of 18 years. The cgl RISE project is for anyone 18 and over who lives in, or is registered with a GP in Ealing (www.ealingrise.org.uk).
3.6.4 Looked After Children's Clinical Psychology Support
This service has been set up by Ealing Children's Services in collaboration with Ealing Child and Adolescent Mental Health Services in order to improve the emotional and psychological wellbeing of looked after children.
The service offers:
- Tier 2 Clinical Psychologists based within the Connect Teams and Leaving Care Service;
- Consultation and support to social workers, link workers, foster carers and residential staff to decide how to best help looked after children and young people who have emotional and behavioural difficulties. This includes help in identifying and accessing appropriate mental health services for children who are placed out of borough;
- Training to social workers, link workers, foster carers and residential staff on relevant psychological issues and behavioural management;
- Psychological Assessment of looked after children and young people. These assessments can be used to decide if there is a need for therapeutic input and also to assist in the care planning for looked after children;
- Therapeutic work with looked after children and young people either individually or jointly with their foster family.
3.6.5 Strengths and Difficulties Questionnaire
Every looked after child will also have a 'strengths and difficulties' questionnaire completed annually in order to monitor emotional/mental wellbeing.
3.6.6 The LAC Health Steering Group
The LAC Health Steering Group is administered by the Local Authority and chaired by the Designated Nurse for Looked After Children and deputised by the Head of Service Leaving Care.
The group meets 6 weekly to review health related KPI's and also to review policy and process in relation to the health of looked after children. It is attended by Tier 2 CAMHS Psychologists, the Designated Doctor for LAC, LAC nurses, administrators and the Head's of Service for Leaving Care and Looked After Children (named HOS Connect & Fostering).
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.
This plan must be reviewed after each subsequent Health Care Assessment and at the child's Looked After Review or as circumstances change.
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.
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.
4.2 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 Health 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 (as amended) make it a requirement that the responsible authority consults with the area of placement and that the 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.