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5.5.1 Health Care Assessments and Plans

REGULATIONS AND STANDARDS

See also Fostering Services (England) Regulations 2011 Regulation 15, and Fostering National Minimum Standards, 6.

RELATED 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)

SCOPE OF THIS CHAPTER

This procedure applies to all Looked After Children.

It summarises the arrangements that should be made for the promotion, assessment and planning of health care for Looked After children.

This chapter should be read in conjunction with DfE and DoH Statutory Guidance on Promoting the Health and Well-being of Looked After Children, March 2015.

AMENDMENT

In August 2017, information was added to Section 3, Health Care Assessment - the completed SDQs are scored, high scores that indicate a possible concern in terms of emotional health or behavioural difficulties are flagged with the child’s social worker, and with the REVIVE Team. Additional services may be recommended, including referral to CAMHS, or accessing local services such as the REVIVE Team to ensure that all emotional needs are met. Section 4, Health Plans, was updated with regards to SDQ questionnaires highlights areas of potential difficulty and concern that should be addressed by the Child’s Health Plan. The SDQ should not be used as a replacement for good clinical assessment by a health professional, nor should a low score on the SDQ lead to a social worker not acting on concerns that they may have. If a social worker has any concerns about a child’s emotional well-being, they can request a consultation with the REVIVE Team, and recommendations arising from that consultation should form part of the child’s health plan. A link was also added 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) in the Related Guidance section.


Contents

  1. The Responsibilities of Local Authorities and Clinical Commissioning Groups

  2. Principles

  3. Health Care Assessment
  4. Health Plans

    Appendix 1: BAAF LAC Medical Procedures and Information

    Appendix 2: BAAF Form IHA - C Initial Health Assessment Recommended for Children from Birth to 9 Years

    Appendix 3: BAAF Form IHA - YP Initial Health Assessment Recommended for Young People 10 Years and Older

    Appendix 4: BAAF Form RHA - C Review Health Assessment Recommended for Children from Birth to 9 Years

    Appendix 5: BAAF Form RHA - YP Review Health Assessment Recommended for Young People 10 Years and Older


1. The Responsibilities of Local Authorities and Clinical Commissioning Groups

The Local Authority, through its Corporate Parenting responsibilities, has a duty to promote the welfare 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 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 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 for the ‘originating CCG) and new CCG should be informed.

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 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;
  • Those who are 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;
  • Recognising the need for 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 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 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 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 Care Assessments

3.1 Good Health Assessment and Planning

Role of the Social Worker in Promoting the Child’s Health

The social worker has an important role in promoting the health and welfare 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 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 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 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.

3.2 Frequency of Health Care Assessments

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

  • The first Assessment must be completed before the child's first Looked After Review (within 20 working days of a child becoming Looked After if not before unless one has been done within the previous 3 months). The social worker has responsibility to ensure the Designated Doctor (ELHT) for LAC receives written consent and the completed placement plan within 5 working days of the child becoming Looked After; and
  • 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 Looked After Placement to another, the Social Worker should furnish the carer/residential staff with a copy of the child's Health 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 first Looked After Review which will take place within 20 working days.

3.3 Who carries out Health Assessments?

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 Safeguarding Unit admin team with a written report (see Arranging Health Care Assessments).

3.4 Arranging Health Care Assessments

Children’s Social Care should liaise with the East Lancashire Hospitals NHS Trust (ELHT) Health Safeguarding Team to arrange the first assessment with the Registered Medical Practitioner.

Before a Health Assessment takes place, the safeguarding unit supply the ELHT with health and education information so that health records can be available to the Registered Medical Practitioner at the time of the appointment.

In order for the Health Assessment to be conducted, the social worker must ensure that the parent(s) or Service Leader has given written consent - this will be recorded on the Placement Plan.

There is guidance for social workers in the processes for enabling the arrangements of health assessments and relevant consents.

See also:

Appendix 1: Coram BAAF LAC Medical Procedures and Information

Appendix 2: Coram BAAF Form IHA - C Initial Health Assessment Recommended for Children from Birth to 9 Years

Appendix 3: Coram BAAF Form IHA - YP Initial Health Assessment Recommended for Young People 10 Years and Older

Appendix 4: Coram BAAF Form RHA - C Review Health Assessment Recommended for Children from Birth to 9 Years

Appendix 5: Coram BAAF Form RHA - YP Review Health Assessment Recommended for Young People 10 Years and Older

The Registered Medical Practitioner conducting the assessment will complete an Initial health assessment form and a Health Plan, which should be passed to the child's social worker, GP - who should give copies to carers/residential staff.

Four months before a subsequent health assessment is due to be completed the Safeguarding Unit provide the date of the planned assessment to the Policy Team within Children's Social Care. This triggers the sending of a Strengths and Difficulties Questionnaire (SDQ) to the child's carer and their school. The completed SDQs are scored, and the TOTAL score is entered in the child’s record. High scores that indicate a possible concern in terms of emotional health or behavioural difficulties (SDQ Total Score >17) are flagged with the child’s social worker, and with the REVIVE team. The care plan for each child will be scrutinised, ensuring that there are adequate services in place to meet that child’s needs. Additional services may be recommended, including referral to CAMHS, or accessing local services such as the REVIVE team to ensure that all emotional needs are met.


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.

This Plan must be reviewed after each subsequent Health Care 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.

The SDQ Questionnaire highlights areas of potential difficulty and concern that should be addressed by the Child’s Health Plan. The SDQ should not be used as a replacement for good clinical assessment by a health professional, nor should a low score on the SDQ lead to a social worker not acting on concerns that they may have. If a social worker has any concerns about a child’s emotional well-being, they can request a consultation with the REVIVE team, and recommendations arising from that consultation should form part of the child’s health plan. These recommendations will be made in light of NICE guidelines around the health of Looked After Children, including NG 26 (Attachment), QS 31 (Quality Standard around health of Looked After Children).

See:

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 REVIVE service can be used to facilitate discussions about accessing mental health services in other areas.

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.

End