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CoventryChildren's Services Procedures Manual

Statutory Health Care Assessments and Plans

SCOPE OF THIS CHAPTER

This procedure applies to all Looked After Children, Children in Pre-Adoptive placements and children detained under the Mental Health Act.

This procedure summarises the arrangements that should be made for the promotion, assessment and planning to meet the health needs for Looked After Children.

RELEVANT LEGISLATION AND GUIDANCE

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

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)

AMENDMENT

In March 2018, this chapter was updated and should be read throughout.

Contents

  1. The Responsibilities of Local Authorities and Clinical Commissioning Groups
  2. Principles
  3. Statutory Health Assessments
  4. Health Care Plans

    Appendix 1: Process flowchart: Referral to CAMHS for Looked After Children Placed Outside Coventry and Warwickshire Locality (Coventry City Council & Coventry and Rugby Clinical Commissioning Group (CRCCG) April 2016)

    Appendix 2: Strengths and Difficulies Questionnaire Practice Guidance (November 2017)

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 pre-adoptive placements. This includes promoting the child's physical, emotional and mental health. Every Looked After Child needs to have an up to date health assessment so that a health care plan can be developed to reflect the child's health needs and be included as part of the child's overall Care Plan.

Health assessments are statutorily required to be carried out a minimum of:

  • 6-monthly for babies and children under 5 years of age; and
  • Annually for those aged 5 years and over.

The Originating and Receiving Clinical Commissioning Group (CCG) should have arrangements in place to support the local authority to complete statutory health assessments for Looked After Children within statutory timescales, irrespective of whether the placement of the child is an emergency, short term or in another CCG.

The Local Authority should always advise the CCG when a child is initially accommodated. Where there is a change in placement which will require the involvement of another CCG, the child's Originating CCG, and Receiving CCG should be informed, as well as the child's GP.

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 wellbeing.

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 and level of understanding;
  • 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 or Information Governance concerns 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 and there should be partnership working between social care and health partners to facilitate the co-ordination of packages of care;
  • 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;
  • Importantly, a Looked After Child should not be disadvantaged by moving placements within the City or around the country and should not 'start again' to receive Health services;
  • A Looked After Child should always be registered as a permanent patient with a GP and Dentist (with a minimum of annual dental checks) near to where they live in placement within 5 working days;
  • A child's clinical and health record will be principally located within the GP record. When the child comes into local authority care, or moves placement, the GP should be informed as part of the notification process by the child's social worker and the GP Practice 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 needs that might be required to be commissioned in the placing area.

3. Statutory Health Assessments

3.1 Health Assessment and Planning

Role of social workers in promoting the health needs of the looked after child

Social workers have a pivotal role in promoting the health and welfare of Looked after children. In particular they should:

  • Work in partnership with carers, looked-after children, their birth parents where appropriate and health professionals to contribute to the formulation of the 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 physical health, developmental needs and/or emotional/mental health needs, that impact on their behaviour, which 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 and risk assessments completed to outline any safety plans for the child/young person;
  • Ensure that all the necessary consents and delegated authority permissions have been obtained so that decisions are not delayed. Note: within 2 working days of the child becoming looked-after.  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 information about any health needs or behaviours which could pose a risk of harm to the child, the carer or members of his or her family or household is passed to the carer (or residential care worker) at the time of the placement. At the same time, the carer should receive information about the support that will be available to the child and carer to address or manage these difficulties;
  • Ensure that the health needs are communicated to the child's carer and health practitioners, including dentists and opticians;
  • Take action to liaise with relevant health professionals if actions identified in the health plan are not being followed up. Given the impact that poor physical, emotional and mental health can have on learning, they should also ensure the child’s virtual school head is involved in resolving any health care needs that impact on the child’s education;
  • Ensure the child has a copy of the health plan and is age appropriate;
  • Support foster carers, or the appropriate person in the residential children’s home where a child is placed, to promote the child’s physical and emotional health on a day-today basis. This should include providing their carer with information on the child’s state of health, including a copy of the child’s latest health plan[1];
  • Ensure that there is clarity for carers, GPs and dentists, and for the child, about what health care decisions have been delegated to carers;
  • Where a looked-after child is undergoing health treatment, monitor with the carers how this is being progressed and ensure that any treatment regime is being followed especially when children are moved placements. This includes the carer has  registered the child with a GP, dentist[2] and optician (within 5 working days of placement commencing) as well as attending and prioritising all health assessments and health appointments;
  • Note: for under 2s only, an oral health check completed as part of the child’s statutory initial or review health assessment is adequate to record on Protocol as a dental check, however all looked after children irrespective of age should be registered with a dentist and receive annual oral/dental assessments with a registered dentist;
  • Ensure (with support from health practitioners if required) the carers fully understand their role in completing Strengths and Difficulty Questionnaires (SDQ) annually for all 4-16 year olds;
  • Ensure that dates of attendance for health assessments, dental, SDQ and optician appointments are promptly recorded onto Protocol to capture this data and any gaps in information are followed up. Social workers and health professionals should give carers information on how to contact designated and named health professionals for looked-after children and the looked-after children team, and on how to access services, including CAMHS;
  • Supervising social workers should also support and give information to carers about managing their own health to ensure this does not impact on their ability to meet the needs of the child;
  • That foster carers and residential care staff know it is their responsibility to make sure a child attends their health assessment and all other medical, dental and optical appointments, and facilitate any required treatment regimes. Advice on the training needs of carers should be sought from NHS Coventry and Warwickshire LAC Health Team 024 7696 1443/2;
  • That the children their authority looks after, including teenage parents, have access to available positive activities such as arts, sport and culture, in order to promote their sense of well-being.

As a minimum, looked-after children need to receive annual dental checks and appointment date recorded onto Protocol.

[1] Where the child is ‘competent’ in line with Fraser Guidelines, their consent should be obtained. NSPCC factsheet on Gillick competency and Fraser Guidelines.
[2] Social workers and carers require regular training to understand their roles in identifying and responding to the emotional and mental health needs of looked-after children.

The role of Independent Reviewing Officers (IROs)

The IRO should, as part of the child’s case review, notes any actions and updates

to ensure that the health plan continues to meet the child’s needs. The IRO should be proactive in bringing any deficiencies in the quality of the health plan or its delivery to the attention of the appropriate level of management within the local authority, using the local dispute resolution process if necessary. The local authority should, in turn, discuss any concerns with the Designated Looked After Children’s Nurse, so that outstanding issues are addressed without unnecessary delay. IROs should always ensure that looked-after children are involved in the review of their care plan and its component parts, and have their wishes and feelings heard and respected. Further information relating to the statutory requirements of the IRO’s role can be found in the Independent reviewing officers' handbook.

3.2 Frequency of Health Care Assessments

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

Initial Health Assessment
  • The Initial Health Assessment (IHA) should result in a health care plan, which is available to inform the child's first statutory review meeting chaired by the Independent Reviewing Officer (IRO). The case review must happen within 20 working days from when the child started to be looked after.
Review Health Assessment
  • For children under 5 years, a review of the health care plan should occur at least once every 6 months;
  • For children aged 5 to 18 years, a review of their health care plan should occur at least every 12 months.

3.3 Who carries out the Statutory Health Assessments?

The Initial Health Care Assessment is conducted by a registered medical practitioner. Subsequent (review) assessments may be carried out by a registered nurse or registered midwife. This will result in an update of the health care plan. (See Section 3.4, Arranging Statutory Health Assessments).

3.4 Arranging Statutory Health Assessments

Initial Health Assessment

Packs are located in each base which include all the required LAC Health consents. The social worker will need to ensure that all consent forms are signed by the appropriate person. The consent for the child to receive statutory health assessments is signed by the person with parental responsibility for that child. This consent is enduring and is used to schedule all subsequent assessments throughout the duration of the child's time in care. A photocopy of the consent form must be given to the parent, another must be given to the carer and then the original form is scanned and uploaded onto Protocol, named Master LAC consent.

The other consent forms are the PH Parental Health Forms. Each birth parent signs their PH form and this allows access to their medical records.

The M&B Form (Obstetric/Birth history) is signed by the birth mother so the birth records can be reviewed.

All the consent forms should be forwarded via secure email to lachealthforms@coventry.gcsx.gov.uk within 3 working days of the child coming into care:

  • Master LAC consent form;
  • Demographic form;
  • Placement plan, including explicit details of why the child has come into care;
  • Child and Family Assessment;
  • M&B signed by birth mother (Obstetric history consent form to access antenatal records);
  • PH form for both parents signed by each parent to access their health records.

The child will be appointed to see a registered medical practitioner within 5-7 working days of receipt of the paperwork. The social worker must attend this appointment or send a representative from Social Care who knows the child and their history, such is the importance of this Initial Health Assessment.

A copy of the Initial Assessment Summary and health care plan will be returned to the social worker and IRO within 20 working days from the date of accommodation to inform the first review meeting. The social worker will ensure the care plan is shared with the carer, residential care placement and birth parent/person with parental responsibility, if appropriate to do so. For older children who are Fraser competent, their consent should be received to share the Summary and Care Plan. The date of the Initial Health Assessment appointment should be recorded onto Protocol.

NB: Only the GP (or referring CCG) receives a full copy of the assessment.

Review Health Assessments (every 6 months for 0 years old, every 12 months for 5-18 years old)

Eight weeks prior to the assessment expiry, the social worker will receive an email from lachealthforms@coventry.gcsx.gov.uk to check the demographic details are still correct and to update Protocol if details are incorrect/out of date.

They will also provide an update of any significant changes to the child's care that might have an impact on the child or young person's emotional health, including reasons for any placement move or breakdown, changes related to the care of any siblings, court proceedings, parent health issues or bereavement. This will provide the examining clinician with vital details to inform their Review Health Assessment (RHA).

The social worker must forward the following to lachealthforms@coventry.gcsx.gov.uk a minimum of 8 weeks prior to the expiration of the previous health assessment date:

  • Demographic form;
  • Placement plan, including explicit details of why the child has come into care;
  • SDQ - scored for each domain and overall total score.
The child will be appointed to see a health care professional, to ensure they are seen within statutory timescales. The social worker should attend this assessment. A copy of the Review Assessment  and Care Plan should available for the LAC Review meeting and will inform the overall Care Plan for the child. The social worker will ensure this is shared with the carer or residential care placement. The date of the review health assessment needs to be promptly recorded onto Protocol.

4. Health Plans

The first Looked After Child's Overall Care Plan must incorporate the Health Care Plan, to inform the health needs of the child at the first Looked After Review, with arrangements as necessary incorporated into the child's Placement Plan/Placement Information Record.

The Care Plan must be reviewed after each subsequent Health Assessment, and inform the discussions at the child's Looked After Review meetings or if circumstances change.

social workers should review the health Summary Assessment and Care Plan and track the child's health needs are being addressed and met; escalating any issues/blockages to their manager, named Health professional/s or GP.

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 complete Strength and Difficulty Questionnaires (SDQs) annually to assess the emotional health and wellbeing needs of each child, aged 4-16 years. The data is submitted annually to the Department for Education.

The SDQ Questionnaire and scoring, along with any other tool which may be used to assist, should be forwarded with the paperwork one month in advance of the Review Health Assessment, to inform the health assessment and update the health care plan.

The SDQ score should also be input onto Protocol and if the score lies beyond the 'normal' range then a discussion should be made with the CAMHS LAC service to discuss plans for intervention to support the young person’s emotional health needs.

(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 Area placement is sought, the responsible local 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 local authority should seek guidance from within its own partner agencies and the potential placement area to seek such information out PRIOR TO PLACEMENT.

The Originating CCG, the current CCG (if different) and the Receiving CCG, should be fully advised of any placement changes and to ensure that any health needs can be met and the heath care plan is not disrupted through delay as a result of the placement move.

Where these are Placements at a Distance, the Care Planning, Placement and Case Review (England) Regulations 2010 (as amended) make it a requirement that the responsible authority consults with the area of placement and that the Director of the responsible authority must approve the placement.

Where the child's health situation is more complex, both health and the Local Authority Commissioner will need to be involved in the placement arrangement, to ensure that health needs are met; this will need to be undertaken jointly within the originating LA and CCG together with the receiving LA and CCG in the area where the child is placed.

Appendices

Appendix 1: Process flowchart: Referral to CAMHS for Looked After Children Placed Outside Coventry and Warwickshire Locality (Coventry City Council & Coventry and Rugby Clinical Commissioning Group (CRCCG) April 2016)

Appendix 2: Strengths and Difficulies Questionnaire Practice Guidance (November 2017)