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.
This procedure summarises the arrangements that should be made for the promotion, assessment and planning of health care for Looked After Children.
AMENDMENTIn December 2018, a new Section 3.5, Consent to Health Care Assessments was added.
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.
The social worker has an important role in promoting the health and welfare of Looked After Children:
Each Looked After Child must have a Health Care Assessment at specified intervals as set out below.
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 current and up to date Health Care Plan.
If no plan exists, the social worker should arrange an assessment so that a plan can be drawn up and available for the child's first looked after review which will take place within 20 working days.
The social worker should liaise with the carer/residential staff to arrange the first assessment with the child's delegated paediatrician.
Before a Health Assessment takes place, social workers must complete Part A of the CoramBAAF 'Initial Health Assessment Form' to ensure it is available at the time of the appointment.
In order for the Health Assessment to be conducted, the social worker must ensure that the parent(s) have given consent unless the child is subject to a Care Order - this will usually be recorded on the Placement Information Record.
The health professional conducting the assessment will complete a relevant CoramBAAF Form and a Health Plan, from which a draft health care plan should be passed to the child's social worker - who should give copies to carers/residential staff. A formal health care plan must be given to the social worker within 20 days of the assessment taking place.
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).For further information on consent, see Department of Health and Social Care Reference Guide to Consent for Examination or Treatment.
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.
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.
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 (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.