Health and Wellbeing, Health Notifications and Access to Services

1. Meeting Children’s Health and Wellbeing Needs

1.1 Principles

The registered manager must ensure that each child’s day-to-day health and well-being needs are met; that children receive advice, services and support in relation to their health and well-being; and that children are helped to lead healthy lifestyles.

Staff should work to make the Home an environment that supports children’s physical, mental and emotional health, in line with the approach set out in the Home's Statement of Purpose.

Staff must help each child to:

• Achieve the health and well-being outcomes that are recorded in the child's relevant plans (see also Health Care Assessments and Plans Procedure);
• Understand the child's health and well-being needs and the options that are available in relation to the child’s health and well-being, in a way that is appropriate to the child's age and understanding;
• Take part in activities, and attend any appointments, for the purpose of meeting the child's health and well-being needs; and
• Understand and develop skills to promote the child's well-being.

‘Wellbeing’ means the quality of a child's life. This is multi-dimensional and includes dimensions of physical, emotional and social well-being; both for the immediate and future life of the child. It incorporates subjective measures such as happiness, perception of quality of life and life satisfaction as well as objective measures around supportive personal relationships, education and training resources and health status.

1.2 Working in Partnership with Others

DfE and DHSC Statutory Guidance on Promoting the Health and Well-being of Looked After Children provides information about the statutory obligations and duties of local authorities and Health bodies to support and promote the health of looked-after children.

The responsible local authority (the local authority that looks after the child) must make sure that its looked after children are provided with appropriate healthcare services. The health of looked after children must be assessed at regular intervals and the child's Care Plan must include an individual health plan setting out the approach that the placing authority will follow, and the desired outcomes required to meet the child's health needs. See Health Care Assessments and Plans Procedure.

For children with special educational needs and disabilities, staff must establish whether the child has an EHC plan. If the child does, staff must take account of the health objectives it specifies.

The specific responsibilities of the Home towards supporting the health and well-being of each child should be agreed with the placing authority and recorded in the child's Placement Plan. It is the joint responsibility of the registered manager of the Home and the placing authority that this is agreed at the time of placement.

Staff should have sufficient understanding of relevant health services, including the functions of the designated nurse for looked-after children in their area. They should support children to navigate these services, advocating on their behalf where necessary and appropriate. The Home's manager must ensure the Home has good links with health agencies to promote children’s good health, is well informed about local health services such as CAMHS and sexual health services in the area it covers and takes this into account when deciding on admissions.

1.3 Supporting Children’s Health and Wellbeing

Staff should encourage children to take a proactive role in looking after their day-to-day health and wellbeing. Where children have specific health needs or conditions, they should be supported to manage these subject to their age and understanding. When a child needs additional health or wellbeing support, staff should work with the child's placing authority to enable proper and immediate access to any specialist medical, psychological or psychiatric support required, and challenge them if this doesn't happen. Homes have a key role in organising and ensuring each child's attendance at the necessary primary and secondary health services. Most health services that a child needs to access will be provided by other organisations. If these services are not accessible, or are withdrawn, staff should inform and engage with those who also hold a responsibility for the child's health to ensure their health needs are met.

The registered manager must ensure that staff have the relevant skills and knowledge to be able to:

• Respond to the health needs of children;
• Administer basic first aid and minor illness treatment;
• Help children to manage long-term conditions and where necessary meet specific individual health needs arising from a disability, chronic condition or other complex needs.

Where appropriate, the child's family should be involved in supporting their child's health needs as well as in providing permission for treatment.

1.4 Advice, Support and Guidance

In line with their individual health plans and the ethos of the Home, children must be offered advice, support and guidance on health and wellbeing to enhance and supplement that provided by their school through Personal, Social and Health Education (PSHE). Staff should have the relevant skills and knowledge to be able to help children understand, and where necessary work to change negative behaviours in key areas of health and well-being such as, but not limited to, nutrition and healthy diet, exercise, mental health, sexual relationships, sexual health, contraception and use of legal highs, drugs, alcohol and tobacco.

See also procedures on Drugs, Alcohol and Smoking.

2. Notifications and RegistrationsE

When a child is placed in the Home, the social worker must arrange for the Health Authority, in the area where a child is placed, to be notified of the placement.

The manager of the Home should arrange for the following:

• For the child to be allocated with a Link Worker (Keyworker) who will be responsible for promoting their health and educational achievement, liaising with key professionals, including the Clinical Nurse Specialist, the child's GP and dental practitioner. The Link/Keyworker will also be responsible for ensuring that up to date information is kept on the child in relation to their health needs, development, illnesses, operations, immunisations, allergies, medications, administered, dates of appointments with GP's and specialists (see Keyworker Guidance);
• For the child to be registered with a GP;
• For the child to be registered with a Dentist;
• For the child to be registered with an Optician;
• For a Health Care Assessment to be carried out in relation to the child as set out in Health Care Assessments and Plans Procedure.

Details of the registration or any changes must be recorded, by the social worker, in the Placement Information Record, a copy of which must be forwarded to the Home by the social worker, at the latest, within 14 days of the placement.

Additionally, the child's Medical Record should be updated.

3. Access to Health and Specialist Services

Each child must have access to the dental, medical, nursing, psychiatric and psychological advice, treatment and other services they require.

Children’s health needs must be identified (including their mental and sexual health needs, as appropriate), and they must have access to local health services when they need them.

If a child's needs are such that specialist health care is required e.g. children with a disability or visual impairment, the Home's manager must ensure that local specialist services are secured, in conjunction with the social worker and relevant healthcare professionals from the Placing Authority. The Home's manager should keep the General Medical Practitioner informed of the process of care and any suggested changed to the child's care.

If there are any serious concerns about the emotional or mental health of a child, the Home's manager must alert the social worker, and seek a review of the child's placement and/or request an assessment under the Mental Health Act 1983.

Any strategies/services that are provided, must be outlined in the child's Placement Plan/Health Care Plan.

Also see: Registration of Healthcare at Children's Homes.

4. Appointments

If children appear to require or request it, appointments should be made for them to see their GP or other medical practitioners as appropriate.

When appointments are made, account should be taken of the child's wishes, for example, to see a practitioner of a preferred gender identity. Also, appointments should preferably be made which do not disrupt the child's education.

Parents, those with parental responsibility and the child's social worker should, if possible, be consulted before making appointments; and they should be informed of the outcome.

See: Consents and Delegated Authority Procedure.

As appropriate, the Chronology/Referral and Information Record should be updated to take account of these appointments. Care should be taken to ensure that the top copy, held by the social worker, and the copy held in the Home are updated.

Additionally, the child's Medical Record should be updated.

Further Information

Legislation, Statutory Guidance and Government Non-Statutory Guidance

DfE and DHSC Statutory Guidance on Promoting the Health and Well-being of Looked After Children