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135 <div class="panel-body">
136 <h1>
136 Health Care Assessments and Plans
136 </h1>
141 <div class="well">
142 <p class="bold">
142 SCOPE OF THIS CHAPTER
143 </p>
144 <p>
144 This procedure applies to all Children in Care. Children remanded other than on bail will be
Children in Care. Different provisions will apply In relation to those children/young people
- see
144 <a href="p_rem_la_yth_det_accomm.html#care_plan">
144 Remands to Local Authority Accommodation or to Youth Detention Accommodation Procedure,
Care Planning for Young People on Remand
144 </a>
144 .
144 </p>
145 <p>
145 This procedure summarises the arrangements that should be made for the promotion, assessment
and planning of health care for Children in Care.
145 </p>
146 <p class="bold">
146 RELATED GUIDANCE
147 </p>
148 <p>
148 <a
href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/413368/Promo
ting_the_health_and_well-being_of_looked-after_children.pdf" target="_blank"
rel="noopener">
148 DfE and DHSC Statutory Guidance on Promoting the Health and Well-being of Looked After
Children (March 2015)
148 </a>
148 </p>
149 <a href="https://www.nice.org.uk/guidance/ng26" target="_blank" rel="noopener">
149 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)
149 </a>
149 </div>
156 <div class="section">
156 <h2 id="responsibilities">
156 1. The Responsibilities of Local Authorities and Clinical Commissioning Groups
156 </h2>
157 <p>
157 The local authority, through its corporate parenting responsibilities, has a duty to promote
the welfare of Children in Care, including those who are eligible and those children placed
in adoptive placements. This includes promoting the child's physical, emotional and mental
health; every Child in Care needs to have a health assessment so that a Health Care Plan can
be developed to reflect the child's health needs and be included as part of the child's
overall Care Plan.
157 </p>
158 <p>
158 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 Children in Care 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.
158 </p>
159 <p>
159 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.
159 </p>
160 <p>
160 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.
160 </p>
161 </div>
162 <div class="section1">
162 </div>
168 <div class="section">
168 <h2 id="principles">
168 2. Principles
168 </h2>
169 <ul>
170 <li>
170 Children in Care 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;
170 </li>
171 <li>
171 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;
171 </li>
172 <li>
172 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 Children in
Care'. (See
172 <a
href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/413368/Pro
moting_the_health_and_well-being_of_looked-after_children.pdf#page=32" target="_blank"
rel="noopener">
172 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)
172 </a>
172 ;
172 </li>
173 <li>
173 When a child becomes Looked After, or moves into another CCG area, any treatment or
service should be continued uninterrupted;
173 </li>
174 <li>
174 A Child in Care 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';
174 </li>
175 <li>
175 A Child in Care should always be registered with a GP and Dentist near to where they live
in placement;
175 </li>
176 <li>
176 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;
176 </li>
177 <li>
177 Where a child is placed within another CCG, e.g. where the child is placed in an out of
Authority Placement (see
177 <a href="p_out_area_place.html">
177 Out of Area Placements Procedure
177 </a>
177 ), the 'originating CCG' remains responsible for the health services that might be
commissioned.
177 </li>
178 </ul>
180 </div>
181 <div class="section1">
181 </div>
187 <div class="section">
187 <h2 id="healthass">
187 3. Health Care Assessments
187 </h2>
188 <h3>
188 3.1 Good Health Assessment and Planning
188 </h3>
189 <h4>
189 Role of Social Worker in Promoting the Child's Health
189 </h4>
190 <p>
190 The social worker has an important role in promoting the health and welfare of Children in
Care:
190 </p>
191 <ul>
192 <li>
192 Working in partnership with parents and carers to contribute to the Health Care Plan;
192 </li>
193 <li>
193 Ensuring that consents and permissions with regard to delegated authorities are obtained
to avoid any delay.
193 <span class="bold">
193 Note
193 </span>
193 : 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
193 <a href="#consent">
193 Section 3.5, Consent to Health Care Assessments
193 </a>
193 );
193 </li>
194 <li>
194 Ensuring that any actions identified in the Health Care Plan are progressed in a timely
way by liaising with health relevant professionals;
194 </li>
195 <li>
195 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 Care Plan being actioned, the impact for the child with regard to their learning
should be highlighted to the relevant health practitioners);
195 </li>
196 <li>
196 Supporting the 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;
196 </li>
197 <li>
197 Where a Child in Care is undergoing health treatment, monitoring with the carers how this
is being progressed and ensure that any treatment regime is being followed;
197 </li>
198 <li>
198 Communicating with the carer's and child's health practitioners, including dentists, those
issues which have been properly delegated to the carers;
198 </li>
199 <li>
199 Social workers and health practitioners should ensure the carers have specific contact
details and information on how to access relevant services, including CAMHS;
199 </li>
200 <li>
200 Ensuring the child has a copy of their Health Care Plan.
200 </li>
201 </ul>
202 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.
203 <h3>
203 <span>
203 3.2 Frequency of Health Care Assessments
203 </span>
203 </h3>
204 <p>
204 Each Child in Care must have a Health Care Assessment at specified intervals as set out
below:
204 </p>
205 <ul>
206 <li>
206 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 Case Review (unless
one has been done within the previous 3 months);
206 </li>
207 <li>
207 For children under 5 years, further Health Care Assessments should occur at least once
every 6 months;
207 </li>
208 <li>
208 For children aged over 5 years, further Health Care Assessments should occur at least
annually.
208 </li>
209 </ul>
210 <p>
210 If a child is transferred from one 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.
210 </p>
211 <p>
211 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 Case Review which will take place within 20
working days.
211 </p>
212 <h3>
212 3.3 Who carries out Health Assessments?
212 </h3>
213 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
213 <a href="#arrange">
213 Section 3.4, Arranging Health Care Assessments
213 </a>
213 ).
214 <h3>
214 3.4
214 <a id="arrange">
214 </a>
214 Arranging Health Care Assessments
214 </h3>
215 <p>
215 The social worker should liaise with the carer/residential staff to arrange the first
assessment with the child's GP or Nurse for Children in Care.
215 </p>
216 <p>
216 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.
216 </p>
217 <p>
217 In order for the Health Assessment to be conducted, the social worker must ensure that the
parent(s) have given consent - this will usually be recorded on the Placement Plan /Initial
Health Assessment Form at the point of becoming Looked After.
217 </p>
218 <p>
218 The health professional conducting the assessment will complete a relevant CoramBAAF Form
and a Health Care Plan, which should be passed to the child's social worker - who should
give copies to carers/residential staff.
218 </p>
219 <h3 id="consent">
219 3.5 Consent to Health Care Assessments
219 </h3>
220 <p>
220 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.
220 </p>
221 <p class="bold">
221 Young people aged 16 or 17
221 </p>
222 <p>
222 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.
222 </p>
223 <p class="bold">
223 Children under 16 – 'Gillick Competent'
223 </p>
224 <p>
224 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.
224 </p>
225 <p>
225 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.
225 </p>
226 <p>
226 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.
226 </p>
227 <p class="bold">
227 Children under 16 - Not 'Gillick' Competent
227 </p>
228 <p>
228 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
228 <a href="p_del_auth_fc_resid.html">
228 Delegation of Authority to Foster Carers and Residential Workers
228 </a>
228 ).
228 </p>
229 For further information on consent, see
229 <a
href="https://www.gov.uk/government/publications/reference-guide-to-consent-for-examination-or
-treatment-second-edition" target="_blank" rel="noopener">
229 Department of Health and Social Care Reference Guide to Consent for Examination or Treatment
229 </a>
229 .
229 </div>
230 <div class="section1">
230 </div>
236 <div class="section">
236 <h2 id="healthplan">
236 4. Health Care Plans
236 </h2>
237 <p>
237 Each child's Care Plan must incorporate a Health Care Plan in time for the first Case
Review, with arrangements as necessary incorporated into the child's Placement Plan.
237 </p>
238 <p>
238 This plan must be reviewed after each subsequent Health Care Assessment and at the
child's Case Review or as circumstances change.
238 </p>
239 <h3>
239 4.1 Strength and Difficulty Questionnaires
239 </h3>
240 <p>
240 Understanding a 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.
240 </p>
241 <p>
241 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 Care Plan.
241 </p>
242 <p>
242 (See
242 <a
href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/413368/Promo
ting_the_health_and_well-being_of_looked-after_children.pdf#page=30" target="_blank"
rel="noopener">
242 Appendix B of the 'DfE promoting the health and well-being of looked-after children',
Strengths and Difficulties Questionnaire
242 </a>
242 .)
242 </p>
243 <h3>
243 4.2
243 <a id="ooa">
243 </a>
243 Out of Area Placements
243 </h3>
244 <p>
244 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.
244 </p>
245 <p>
245 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.
245 </p>
246 <p>
246 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.
246 </p>
247 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.
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293 <a id="scrollup">
293 <i class="up">
293 </i>
293 </a>
294 <div id="background">
295 <p id="bg_text">
295 Trix procedures
295 </p>
296 <p id="bg_text_msg">
296 Only valid for 48hrs
296 </p>
297 </div>
302 <script type="text/javascript">
310 </script>
313 </body>
314 </html>