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282 <h2>
282 Health Care Assessments and Plans
282 </h2>
284 </div>
287 <div id="scope_box">
288 <h3>
288 SCOPE OF THIS CHAPTER
288 </h3>
289 <p>
289 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
289 <a href="p_rem_la_yth_det_accomm.html#care_planning">
289 Remands to Local Authority Accommodation or to Youth Detention Accommodation Procedure, Care
Planning for Young People on Remand or Youth Detention Accommodation
289 </a>
289 .
289 </p>
290 <p>
290 This procedure summarises the arrangements that should be made for the promotion, assessment and
planning of health care for Looked After Children.
290 </p>
291 <h3>
291 RELATED GUIDANCE
291 </h3>
292 <p>
292 <a
href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/413368/Promoting_t
he_health_and_well-being_of_looked-after_children.pdf" target="_blank" rel="noopener">
292 DfE and DHSC Statutory Guidance on Promoting the Health and Well-being of Looked After Children
(March 2015)
292 </a>
292 </p>
293 <p>
293 <a href="https://www.nice.org.uk/guidance/ng26" target="_blank" rel="noopener">
293 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)
293 </a>
293 </p>
294 <h3>
294 AMENDMENT
294 </h3>
295 <p>
295 In October 2018, a new
295 <a href="#consent">
295 Section 3.5, Consent to Health Care Assessments
295 </a>
295 was added.
295 </p>
296 </div>
297 <div id="sections">
299 <h3 id="sections_list">
299 Contents
299 </h3>
300 <ol>
301 <li class="sub_list">
301 <a href="#responsibilities">
301 The Responsibilities of Local Authorities and Clinical Commissioning Groups
301 </a>
301 </li>
302 <li class="sub_list">
302 <a href="#principles">
302 Principles
302 </a>
302 </li>
303 <li class="sub_list">
303 <a href="#health_ass">
303 Health Care Assessments
303 </a>
304 <ol>
305 <li class="sub_list">
305 <a href="#good">
305 Good Health Assessment and Planning
305 </a>
305 </li>
306 <li class="sub_list">
306 <a href="#frequency">
306 Frequency of Health Care Assessments
306 </a>
306 </li>
307 <li class="sub_list">
307 <a href="#who">
307 Who Carries out Health Assessments?
307 </a>
307 </li>
308 <li class="sub_list">
308 <a href="#arrange">
308 Arranging Health Care Assessments
308 </a>
308 </li>
309 <li class="sub_list">
309 <a href="#consent">
309 Consent to Health Care Assessments
309 </a>
309 </li>
310 </ol>
311 </li>
312 <li class="sub_list">
312 <a href="#health_plan">
312 Health Plans
312 </a>
313 <ol>
314 <li class="sub_list">
314 <a href="#strength">
314 Strength and Difficulty Questionnaires
314 </a>
314 </li>
315 <li class="sub_list">
315 <a href="#ooa">
315 Out of Area Placements
315 </a>
315 </li>
316 </ol>
317 </li>
318 </ol>
319 <h3 id="responsibilities">
319 1. The Responsibilities of Local Authorities and Clinical Commissioning Groups
319 </h3>
320 <p>
320 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.
320 </p>
321 <p>
321 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.
321 </p>
322 <p>
322 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.
322 </p>
323 <p>
323 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.
323 </p>
324 <h3 id="principles">
324 2. Principles
324 </h3>
325 <ul>
326 <li>
326 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;
326 </li>
327 <li>
327 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;
327 </li>
328 <li>
328 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
328 <a
href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/413368/Promoting
_the_health_and_well-being_of_looked-after_children.pdf#page=32" target="_blank"
rel="noopener">
328 Annex C: Principles of confidentiality and consent, DfE and DHSC Statutory Guidance on
Promoting the Health and Well-being of Looked After Children ( 2015)
328 </a>
328 );
328 </li>
329 <li>
329 When a child becomes Looked After, or moves into another CCG area, any treatment or service
should be continued uninterrupted;
329 </li>
330 <li>
330 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';
330 </li>
331 <li>
331 A Looked After Child should always be registered with a GP and Dentist near to where they live
in placement;
331 </li>
332 <li>
332 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;
332 </li>
333 <li>
333 Where a child is placed within another CCG, e.g. where the child is placed in an out of
Authority Placement (see
333 <a href="p_out_area_place.html">
333 Out of Area Placements Procedure
333 </a>
333 ), the 'originating CCG' remains responsible for the health services that might be commissioned.
333 </li>
334 </ul>
335 <h3 id="health_ass">
335 3. Health Care Assessments
335 </h3>
336 <h4 id="good">
336 3.1 Good Health Assessment and Planning
336 </h4>
337 <h5>
337 Role of Social Worker in Promoting the Child's Health
337 </h5>
338 <p>
338 The social worker has an important role in promoting the health and welfare of Looked After
Children:
338 </p>
339 <ul>
340 <li>
340 Working in partnership with parents and carers to contribute to the Health Plan;
340 </li>
341 <li>
341 Ensuring that consents and permissions with regard to delegated authorities are obtained to
avoid any delay.
341 <span class="bold">
341 Note
341 </span>
341 : 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
341 <a href="#consent">
341 Section 3.5, Consent to Health Care
341 </a>
341 );
341 </li>
342 <li>
342 Ensuring that any actions identified in the Health Plan are progressed in a timely way by
liaising with health relevant professionals;
342 </li>
343 <li>
343 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);
343 </li>
344 <li>
344 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;
344 </li>
345 <li>
345 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;
345 </li>
346 <li>
346 Communicating with the carer's and child's health practitioners, including dentists, those
issues which have been properly delegated to the carers;
346 </li>
347 <li>
347 Social workers and health practitioners should ensure the carers have specific contact details
and information on how to access relevant services, including CAMHS;
347 </li>
348 <li>
348 Ensuring the child has a copy of their health plan.
348 </li>
349 </ul>
350 <p>
350 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.
350 </p>
351 <h4 id="frequency">
351 3.2 Frequency of Health Care Assessments
351 </h4>
352 <p>
352 Each Looked After Child must have a Health Care Assessment at specified intervals as set out
below.
352 </p>
353 <ul>
354 <li>
354 The first Assessment must be conducted before the first placement or, if not reasonably
practicable, in time for the Health Care Plan before the child's first Looked After Review
(unless one has been done within the previous 3 months);
354 </li>
355 <li>
355 For children under five years, further Health Care Assessments should occur at least once every
six months;
355 </li>
356 <li>
356 For children aged over five years, further Health Care Assessments should occur at least
annually.
356 </li>
357 </ul>
358 <p>
358 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 Health Care Plan.
358 </p>
359 <p>
359 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.
359 </p>
360 <h4 id="who">
360 3.3 Who carries out Health Assessments?
360 </h4>
361 <p>
361 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
361 <a href="#arrange">
361 Section 3.4, Arranging Health Care Assessments
361 </a>
361 ).
361 </p>
362 <h4 id="arrange">
362 3.4 Arranging Health Care Assessments
362 </h4>
363 <p>
363 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. The
social worker must ensure that the parent(s) have given consent for the medical and subsequent
reviews to take place - this should be recorded on the Placement Information Record/Initial Health
Assessment Form at the point of becoming Looked After. If parental consent is not possible, this
must be escalated to a social work manager for a decision and must not delay the initial health
assessment. Both documents should be forwarded to the administrator of the health of Looked After
Team (
363 <span class="bold">
363 Email
363 </span>
363 :
363 <a href="mailto:oxl-tr.bexleylac@nhs.net" target="_blank" rel="noopener">
363 oxl-tr.bexleylac@nhs.net
363 </a>
363 ,
363 <span class="bold">
363 Tel
363 </span>
363 : 0203 004 0092) within 5 working days. An appointment will then be arranged.
363 </p>
364 <p>
364 The Social Worker should liaise with the Health of Looked after children administrator and ensure
the carer/residential staff Are aware of the appointment date and time. The social worker should
attend the appointment to provide any additional information to the paediatrician which will
inform the medical.
364 </p>
365 <p>
365 The health professional conducting the assessment will complete a relevant CoramBAAF Form and a
Health Plan, which will be forwarded to the child's social worker - who should give copies to
carers/residential staff within 2 weeks.
365 </p>
366 <h4 id="consent">
366 3.5 Consent to Health Care Assessments
366 </h4>
367 <p>
367 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.
367 </p>
368 <h5>
368 Young people aged 16 or 17
368 </h5>
369 <p>
369 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.
369 </p>
370 <h5>
370 Children under 16 – 'Gillick Competent'
370 </h5>
371 <p>
371 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.
371 </p>
372 <p>
372 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.
372 </p>
373 <p>
373 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.
373 </p>
374 <h5>
374 Children under 16 - Not 'Gillick' Competent
374 </h5>
375 <p>
375 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
375 <a href="p_del_auth_fc_resid.html">
375 Delegation of Authority to Foster Carers and Residential Workers Procedure
375 </a>
375 ).
375 </p>
376 <p>
376 For further information on consent, see
376 <a
href="https://www.gov.uk/government/publications/reference-guide-to-consent-for-examination-or-tre
atment-second-edition" target="_blank" rel="noopener">
376 Department of Health and Social Care Reference Guide to Consent for Examination or Treatment
376 </a>
376 .
376 </p>
377 <h3 id="health_plan">
377 4. Health Plans
377 </h3>
378 <p>
378 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.
378 </p>
379 <p>
379 This plan must be reviewed after each subsequent Health Care Assessment and at the child's Looked
After Review or as circumstances change.
379 </p>
380 <h4 id="strength">
380 4.1 Strength and Difficulty Questionnaires
380 </h4>
381 <p>
381 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.
381 </p>
382 <p>
382 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.
382 </p>
383 <p>
383 (See
383 <a
href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/413368/Promoting_t
he_health_and_well-being_of_looked-after_children.pdf#page=30" target="_blank" rel="noopener">
383 Appendix B of the 'DfE promoting the health and well-being of looked-after children', Strengths
and Difficulties Questionnaire
383 </a>
383 ).
383 </p>
384 <h4 id="ooa">
384 4.2 Out of Area Placements
384 </h4>
385 <p>
385 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.
385 </p>
386 <p>
386 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.
386 </p>
387 <p>
387 Where these are Placements at a Distance the Care Planning, Placement and Case Review (England)
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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.
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