Health Care Assessments and Plans

1. Health Care Assessments

Each child should have a Health Care Assessment soon after being placed and then at specified intervals; as set out below.

The purpose of Health Care Assessments is to promote children's physical and mental health and to inform the child's Health Care Plan (which may be a separate plan or may be incorporated in to the Child's Care Plan) and ensure that the placement meets the child's holistic health needs.

Health Care Assessments must be conducted by a suitably qualified medical practitioner; who should provide the social worker with a written report:

• The first assessment must be conducted before the child's first placement, or if not reasonably practicable, before the child's first Looked After Review – unless one has been conducted in the previous 3 months;
• 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.

The social worker is normally responsible for ensuring that Health Care Assessments are undertaken, but this responsibility may be undertaken by the Home.

In order for the assessment to be conducted, it will be necessary to ensure the Consents section of the child's Placement Plan has been completed and signed by the parent or a person with parental responsibility.

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 health issue, 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 (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.

For further information on consent, see Department of Health and Social Care Reference Guide to Consent for Examination or Treatment and Consents and Delegated Authority Procedure.

2. Health Care Plans

Each child's Placement Plan, drawn up by the Home, must include the health care needs for the child and how they will be promoted by the Home.

Additionally, each child must have a Health Care Plan (which may be part of the child's Care Plan or may be a separate Plan) drawn up by the Placing Authority/social worker.

The initial Health Care Plan should be drawn up in time for the first Looked After Review, after a Health Care Assessment has been undertaken. The Health Care Plan should then be updated after each Health Care Assessment or as circumstances change.

1. Whether there are any specific health care needs - and how the Home will meet them;
2. If it is agreed that Paracetamol or other painkillers can be used to provide relief for headaches, menstrual or other pain; also whether there are any restrictions;
3. On the use of non-prescribed medicines, Home Remedies or use of first aid;
4. The involvement of the child's parents or significant others in health issues during the placement;
5. 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;
6. The extent to which the child is able to retain or administer medication, or requires support to do so;
7. Whether it is necessary for any immunisations to be carried out;
8. Any specific treatment or therapeutic interventions, strategies or remedial programmes required;
9. Any necessary preventative measures to be adopted;
10. Whether there are any illegal or other activities including self-harming which it is known or suspected the child is engaged in which may be harmful to the child's health, and the interventions/strategies to be adopted in reducing or preventing the behaviour;
11. Whether the placement will contribute to any other health related assessments;
12. Whether the Home will contribute to any health monitoring.

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 Keyworker

One of the key responsibilities of the child's Keyworker will be for promoting the child’s  health and educational achievement, liaising with key professionals, including the Clinical Nurse Specialist, the child's GP and dental practitioner.

The Keyworker will also ensure 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.

The Keyworker must also ensure the child is registered with a GP and other health care professionals as set out in Health and Wellbeing, Health Notifications and Access to Services Procedure.

Also see Keyworker Guidance.

Further Information

Legislation, Statutory Guidance and Government Non-Statutory Guidance

DfE and DoH Statutory Guidance on Promoting the Health and Well-being of Looked After Children (2015)

Good Practice Guidance

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]

Who Pays: Determining Which NHS Commissioner is Responsible for Commissioning Healthcare Services and Making Payments to Providers