Worcestershire County Council Logo


top of this page

Size: View this website with small text View this website with medium text View this website with large text View this website with high visibility

6.5.1 Health Care Assessments and Plans

SCOPE OF THIS CHAPTER

This procedure applies to all Looked After Children. Note Children remanded other than on bail will be Looked After Children. 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 Looked After Children.

RELATED GUIDANCE

DfE and DoH Statutory Guidance on Promoting the Health and Well-being of Looked After Children (March 2015) - Statutory guidance on the planning, commissioning and delivery of health services for looked-after children.

AMENDMENT

In April 2017 this chapter was amended to reflect the updated process within Worcester. A link was also added into Further Information to 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). This guideline covers the identification, assessment and treatment of attachment difficulties in children and young people up to age 18 who are adopted from care, in special guardianship, looked after by local authorities in foster homes (including kinship foster care), residential settings and other accommodation, or on the edge of care. It aims to address the many emotional and psychological needs of children and young people in these situations, including those resulting from maltreatment.


Contents

  1.  The Responsibilities of Local Authorities and Clinical Commissioning Groups
  2. Principles
  1. Health Assessments
  2. Health Plans
  3. Further Information


1. The Responsibilities of Local Authorities and Clinical Commissioning Groups

The local authority, through its Corporate Parenting responsibilities, has a duty to promote the Health and Wellbeing of Looked After Children, including those who are Eligible and those children placed in adoptive placements. This includes promoting the child's physical, emotional and mental health; every Looked After Child needs to have regular health assessments 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 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 Looked After Children 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.

The Local Authority should always advise the CCG when a child is initially accommodated. Where there is a change in placement that will require the involvement of another CCG, the child's 'originating' CCG, outgoing (if different from the 'originating CCG) and new CCG should be informed.

Some of this CCG activity in Worcestershire may be delegated to the local provider services.

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 health and well being.


2. Principles

  • Looked After 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;
  • 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 and wellbeing of looked After Children’. (See Annex C: Principles of confidentiality and consent, DfE and DoH Statutory Guidance on Promoting the Health and Well-being of Looked After Children (March 2015);
  • When a child becomes Looked After, or moves into another CCG area, any treatment or service should be continued uninterrupted;
  • A Looked After 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 Looked After 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 be 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 the new GP;
  • Where a child is placed within another CCG, e.g. where the child is placed in an out of Authority Placement, (see Out of Area Placements Procedure) the ‘originating CCG ’remains responsible for the health services that might be commissioned.


3. Health Assessments

3.1 Good Health Assessment and Planning

Role of S/W in Promoting the Child’s Heath and Wellbeing

The social worker has an important role in promoting the health and wellbeing of Looked After Children:

  • Working in partnership with parents and carers to contribute to the health plan;
  • Ensure that consents and permissions with regard to delegated authorities and health assessments are obtained promptly to avoid any delay. Note: 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 relevant health 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 Looked After 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;
  • Where a Looked After 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 CAMHS;
  • Ensuring the Child has a copy of their health plan.

It is important that at the point of Accommodating a child, as much information as possible is gathered and 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 and relevant health professionals, together with an understanding as to what support they will receive as a result.

Frequency of Health Assessments

Each Looked After Child must have a Health Assessment at specified intervals as set out below.

  • The first Assessment must be conducted before the child's first Looked After Review;
  • For children under five years, further Health Assessments should occur at least once every six months;
  • For children aged over five years, further Health Assessments should occur at least annually.

If a child is transferred from one Looked After Placement to another, it is not necessary to arrange an additional health assessment. In these circumstances, the Social Worker should ensure the child / young person's updated health passport containing a copy of the most recent Health Plan accompanies the child / young person to the new placement.

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 Looked After Review which will take place within 20 working days.

Who carries out Health Assessments?

The first Health Assessment must be conducted by a registered medical practitioner. In Worcestershire this is usually a community paediatrician. Subsequent assessments may be carried out by a suitably qualified, registered nurse, registered midwife or registered health visitor.

Arranging Health Assessments

For an initial health assessment the social work team manager will initiate the process when completing the Start of Looked after episode on FWi.

The Integrated Service for Looked after Children (ISL) Health assessment administrator will liaise with the social worker to provide the relevant documentation for both initial and review health assessments. In order for the Health Assessment to be carried out, the social worker must ensure that the consent to medical treatment and ongoing health assessment has been signed by whoever has Parental responsibility and recorded on FWi.

The social worker should check and complete the paperwork as requested providing the required consents for assessment and sharing of information before returning them to the ISL health assessment administrator.

The health professional conducting the assessment will complete a relevant Health assessment Form, Evaluation and a Health Plan, which will be recorded on the clinician's Carenotes. The Evaluation and Health Plan will be uploaded to FWi by the ISL Health assessment administrator. The information should also be shared with the young person, their GP & carer – this will normally be done by the clinician undertaking the assessment.


4. Health Plans

Each Looked After Child’s Care Plan must incorporate a Health Plan in time for the first Looked After Review, with arrangements as necessary incorporated into the child’s Placement Plan/Placement Information Record.

This Plan must be reviewed after each subsequent Health Assessment and at the child's Looked After Review or as circumstances change.

4.1 Strength and Difficulty Questionnaires

Understanding a Looked After 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 aged 4 – 16yrs who has been looked after for 12 months or more on the 31st March. This will be given to the carer to complete during the health assessment by the school health nurse or health visitor and subsequently returned to WCC for reporting.

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.

(See Appendix B of the ‘DfE promoting the health and well-being of looked-after children’, Strengths and Difficulties Questionnaire.)

4.2 Out of Area Placements

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 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 heath 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.


5. Further Information

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) - covering the identification, assessment and treatment of attachment difficulties in children and young people up to age 18 who are adopted from care, in special guardianship, looked after by local authorities in foster homes (including kinship foster care), residential settings and other accommodation, or on the edge of care.

British Medical Association Consent Toolkit.

Practice Guidance: Supporting Young People with HIV Testing and Prevention.

End