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Contents

1. Health Care Assessments
2. Health Care Plans

1. Health Care Assessments

The purpose of Health Care Assessments is to promote children's physical and mental health and to inform the child's Health Care Plan.

1.1 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 conducted before the first placement or, if not reasonably practicable, in time for the Health Care Plan to be completed before the child’s first Looked After Review (unless an assessment 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 Looked After Placement to another, it is not necessary to plan an assessment within the first month. In these circumstances, the child’s 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 within a month of the placement so that a Health Care Plan can be drawn up.

1.2 Arranging Health Care Assessments

The social worker is responsible for ensuring that health care assessments are undertaken.  They will be arranged by the child's social worker making a referral to the Designated Nurse for LAC.

In order for the health care assessment to be conducted, the social worker must ensure that the consents section of the child's Placement Information Record has been completed and signed by the parent.

Once notice of an appointment has been received, the social worker will inform the child, parents and staff/carer of the purpose of and arrangements for the health care assessment, and either accompany the child and parents or arrange for staff/carers to accompany the child, as appropriate.

Where the child refuses a health care assessment, this must be recorded.  The child should be encouraged to take advantage of the opportunity of the health care assessment to discuss health issues.

Who Carries Out Health Care 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 Social Worker with a written report (See Section 1.2, Arranging Health Care Assessments).

1.3 Merging Health Care/Health Checks

Some looked after children receive a great deal of health intervention; it may therefore be appropriate to combine review health care assessments with other necessary health checks.  For example, if a child has disabilities or a Statement of Special Educational Need (SEN) or when children are known to have complex medical needs and regularly attend hospital, the medical information already available should be accepted as being the child's health record.  In these circumstances, the child's social worker in conjunction with his or her manager and the Designated Nurse for LAC can decide to record the dates of medical assessments as the dates of the child's health care assessments.  The reasons for this must also be recorded.

1.4 Black and minority ethnic children

Black and minority ethnic children can suffer considerable health disadvantage.

They can be vulnerable to certain hereditary illnesses (e.g. sickle cell anaemia), can be predisposed to certain forms of diabetes, and there is evidence of high levels of depression amongst certain ethnic groups. It is important that:

• An accurate family history is taken;
• The emotional and behavioural development of black and minority ethnic children is accurately and fully assessed;
• Prior discussion with the child takes place in order to enable choice (e.g. in the gender of the doctor that a child may see);
• Arrangements are made for children undergoing health assessments to use the language in which they feel most confident.

1.5 Children in secure settings and/or on remand

The health needs of children in secure accommodation and/or on remand should not become secondary to issues of keeping them secure or on remand, nor should health expectations be any lower than for other groups of children.

1.6 Refugees

Unaccompanied refugee children are unlikely to have medical records from their country of origin, and any medical history they themselves give is likely to be incomplete. Their immunisation status may be unknown, and they may have had no previous health surveillance.

2. Health Care Plans

Each looked after child must have a Health Care Plan in time for the first Looked After Review, with arrangements as necessary incorporated into the child's Placement Information Record.

The Designated Nurse for LAC will draw up the child's Health Care Plan based on the information in the health care assessment, in conjunction with the child, staff/carer (as appropriate), GP and any other relevant professional.  The plan will then be passed to the child's social worker who will update the child's electronic records and arrange for copies to be sent to the child (depending on age), the parents and the staff/carers.

Where the child expresses a wish not to disclose the contents of the Plan to his or her parents and this is accepted by the social worker (having regard to the child's age and understanding and after consultation with his or her manager), the parents will not receive a copy.

The child's social worker is responsible for implementing the Health Care Plan and will do this with the assistance of the health professionals identified in the plan.  The specific responsibilities of the staff/carers will also be identified in the Plan.

The Health Care Plan will set out how the health care needs of the child will be addressed, including the following matters:

1. Whether it is necessary for any immunisations to be carried out and if so, when;
2. When it is necessary for a dental check to be carried out;
3. When it is necessary for any hearing or vision checks to be carried out;
4. Whether there are any specific health care needs - and how they will be met, including future hospital appointments, referrals to specialist services and/or any specific treatment, strategies or remedial programme's required;
5. Whether there are any health or education issues to be addressed, for example, nutrition, sexual health and relationships, substance misuse, personal hygiene;
6. 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.

This Health Care Plan must be reviewed after each subsequent Health Care Assessment or as circumstances change.

End