Health Care Assessments and Plans
Scope of this chapter
This procedure applies to all cared for children. Note, however, that as from 3 December 2012, all children remanded other than on bail will be cared for. Different provisions will apply In relation to those children/young people - see Remands to Local Authority Accommodation or to Youth Detention Accommodation Procedure, Care Planning for Young People on Remand.
This procedure summarises the arrangements that should be made for the promotion, assessment and planning of health care for cared for children.
Amendment
This chapter was updated in February 2024.
The local authority, through its Corporate Parenting responsibilities, has a duty to promote the welfare of Cared For Children, including those who are Eligible and those children living in adoptive placements. This includes promoting the child's physical, emotional and mental health; every Cared For 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.
The relevant Integrated Care Board (ICB) 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 Cared for Children without any undue delay and irrespective of whether the placement of the child is an emergency, short term or in another ICB. This also includes services to a child or young person experiencing mental illness.
The Local Authority should always advise the ICB when a child is initially accommodated. Where there is a change in placement that will require the involvement of another ICB, the child's 'originating' ICB, outgoing (if different from the 'originating ICB) and new ICB should be informed.
Both Local Authority and relevant ICB(s) should develop effective communications and understandings between each other as part of being able to promote children's well-being.
- Cared For 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;
- 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;
- Foster carers, residential and supported accommodation staff must be prepared and supported to promote the progress of children in relation to their health, emotional, social and psychological wellbeing;
- Children and young people should be supported to maintain good health and manage long term conditions;
- Health issues (including their mental and sexual health needs, as appropriate) should be identified by the multi-disciplinary team around the child or young person. The child and young person should also have access to local Health services when needed such as CYPMHS;
- Carers should develop good working relationships with Health professionals and services to meet the needs of the child or young person;
- 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 Cared For Children'. (See 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);
- When a child becomes cared for, or moves into another ICB area, any treatment or service should be continued uninterrupted;
- A cared for Child requiring health services should be able to do so without delay or any wait should 'be no longer than a child in a local area with an equivalent need';
- A cared for Child should always be registered with a GP and Dentist near to where they live in placement;
- 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;
- Where a child is placed within another ICB, e.g. where the child is placed in an out of Authority Placement (see Out of Area Placements Procedure), the 'originating ICB 'remains responsible for the health services that might be commissioned.
- Arrangements for managing medication must be safe and effective and promote independence whenever possible. There must be safe management of controlled drugs (such as morphine, pethidine, methadone and Ritalin). See CQC Information on Controlled Drugs.
Role of social worker in Promoting the Child's Health
The social worker has an important role in promoting the health and welfare of cared for Children:
- Working in partnership with parents and carers to contribute to the Health Plan;
- Ensure that consents and permissions with regard to delegated authorities are obtained to avoid any delay. Note: 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;
- Ensure that any actions identified in the Health Plan are progressed in a timely way by liaising with health relevant professionals;
- In recognising that a child's physical, emotional and mental health can impact upon their learning, where this is necessary, to liaise 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);
- To support the cared for Child's carers in meeting the child's health needs in a 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;
- Where a cared for Child is undergoing health treatment, to monitor with the carers how this is being progressed and ensure that any treatment regime is being followed;
- To communicate with the carer's and child's health practitioners, including dentists, those issues which have been properly delegated to the carers;
- Social Workers and health practitioners should ensure the carers have specific contact details and information on how to access relevant services, including CYPMHS;
- Ensuring the Child has a copy of their Health Plan.
It is important that at the point of a child becoming cared for, as much information as possible is understood about the child's health, especially where the child has health or behavioural needs that 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.
Each Cared For Child must have a Health Care Assessment at specified intervals as set out below.
- 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 Children Cared For Review (unless one has been done within the previous 3 months);
- For children under five years, further Health Care Assessments should occur at least once every six months;
- For children aged over five years, further Health Care Assessments should occur at least annually.
If a child is transferred from one home 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.
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 Cared For Review which will take place within 20 working days.
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 Arranging Health Care Assessments)
The Social Worker should liaise with the carer/residential staff to arrange the first assessment with the child's GP or Designated Nurse for cared for children.
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.
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 Information Record.
The health professional conducting the assessment will complete a relevant CoramBAAF Form and a Health Plan, which should be passed to the child's Social Worker - who should give copies to carers/residential staff.
Please see Initial Health Assessment - Guide for Social Workers.
Each cared for Child's Care Plan must incorporate a Health Plan in time for the first Children Cared For Review, with arrangements as necessary incorporated into the child's Placement Plan/Placement Information Record.
This Plan must be reviewed after each subsequent Health Care Assessment and at the child's Children Cared For Review or as circumstances change.
Information should also be given about any allergies. See also Health and Safety Procedure.
Understanding a Cared For 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.
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.
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.
The originating ICB, the current ICB (if different) and the proposed area's ICB 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.
Where these are Placements at a Distance the Care Planning, Placement and Case Review (England) Regulations 2010 make it a requirement that the responsible authority consults with the area of placement and that Director of the responsible authority must approve the placement.
Where the child's health situation is more complex, it is likely that both health and 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 social care services in the area where the child is placed.
Who Pays? Determining which NHS commissioner is responsible for making payment to a provider
Legislation, Statutory Guidance and Government Non-Statutory Guidance
DfE and DHSC Statutory Guidance on Promoting the Health and Well-being of Looked After Children
Good Practice Guidance
Last Updated: February 2, 2024
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