Health Care Assessments and Plans

1. Health Care Assessments

Every child or young person in our care should have a health care assessment soon after being placed and then at specified intervals as set out below.

The purpose of a health care assessment is to carry out an initial assessment of the child's physical, emotional and well-being  needs. The health care assessment will inform the child's Health Care Plan and ensure that the placement meets the child's holistic health needs. As a minimum, the child's main carer will be required to complete the two-page version of the Strength and Difficulties Questionnaire (Local Resources) for the child in time to inform their health assessment.

(See Annex B of the 'DfE Promoting the Health and Well-being of Looked-after Children', Strengths and Difficulties Questionnaire).

Specific health care assessments must be conducted by a suitably qualified medical practitioner who should provide the child's social worker with a written report.

• The first assessment must be conducted before the child is placed at the home, and included in the placement plan. It should then be reviewed prior to and in readiness for the first review meeting within the first 28 days of the placement;
• For children aged between two and five years, further assessments should occur at least every six months;
• For children aged over five years, further assessments should be at least annually;
• Health care assessments must be conducted more frequently where the child's health needs dictate.

Health care assessments should not be seen as an isolated event but rather be seen as part of the continuous cycle of care planning (assessment, planning, intervention and review) and build on information already known from health professionals, parents and previous carers, and the child himself or herself.

The Social Worker is normally responsible for ensuring that health care assessments are undertaken, but this responsibility may be undertaken by the home. Health and care needs should also correlate with those identified within the child's Education, Health and Care Plan, if they have one.

In order for the assessment to be conducted, the social worker should ensure that all the necessary consents and delegated authority permissions have been obtained so that decisions are not delayed. Young people (dependant on their age and understanding) can provide informed consent for the assessment.

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 an issue with their mental health, a child's mental state may fluctuate significantly, so that on some occasions the child appears competent in respect of a particular decision and on other occasions does not.

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 ( although, 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 (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.

2. Health Care Plans

Each child's Placement Plan should identify the child's health and well-being needs (if any) and set out how these will be met by the home.

The initial Health Care Plan should be produced before the first Looked After Review. The Health Care Plan should then be updated after each relevant assessment or as circumstances and needs change.

The health needs of the child must be assessed at regular intervals and the child's care plan must include an individual health plan which explains the approach that staff will follow, and the desired outcomes required to meet the child's health needs. These outcomes, recorded in the health plan, will be the basis on which the registered manager will be expected to meet regulation 10.The Health Care Plan should describe how the child's health and well-being needs will be addressed to improve or meet identified health outcomes.

The Health Care Plan (and the Placement Plan as necessary) should cover the following:

1. Whether there are any specific health physical, emotional or mental healthcare needs - and how the home will meet them;
2. Responsibilities of staff to support a child to attend their health assessments, and all other medical, dental and optical appointments, and facilitate any required treatment regimes;
3. Agreements for the use of non-prescribed medicines, homely remedies or use of first aid;
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 and by whom;
5. Whether it is necessary for any immunisations to be carried out and a record of these to be maintained;
6. Any specific treatment or therapeutic interventions, strategies or remedial programmes required;
7. Any necessary preventative measures to be adopted;
8. Detail of the health care decisions that are delegated to children's home staff;
9. If the child is at risk from suicide or self harming behaviours, the interventions/strategies to be adopted in reducing or preventing these risks;
10. How the home will contribute to any health monitoring;
11. Clear evidence of effective joint working with the wider network, including Full Circle, CYPMHS, clinicians and health specialists, with decisions and actions clearly identified in care planning.

Information should also be given about any allergies. See also First Aid, Home Remedies and Medication Procedure and Provision and Preparation of Meals Procedure.

3. Designated Key Worker

One of the key responsibilities of the child or young person's Key Worker is promoting their health and educational achievement, liaising with key professionals, including the Named Nurse for Looked After Children, the child's GP, optician and dental practitioner, and such medical, nursing, psychiatric and psychological advice, treatment and other services as the child may require.

The Key Worker will also ensure that up to date records are kept for the child in relation to his/her health needs, development, illnesses, operations, immunisations, allergies, medications, dates of appointments with GP's and specialists.

Also see: Key Worker Guidance.