The Health and Well-being Standard
Regulation 10
Registration of Health Care at Children’s Homes
In June 2023, information in relation to allergies was added into Section 3, Health Care Plans.
This section should be read in conjunction with the Derbyshire Children’s Services Procedures, Decision to Look After and Care Planning Procedure.
Every Looked After Child should have a Health Assessment soon after being placed and then at specified intervals; as set out below.
The purpose of a Health Assessments is promote the child’s physical, emotional and mental health. The Health Assessment will inform the child’s Health Care Plan, and ensure that the placement meets the child's holistic health needs. As a minimum the child’s main carer will be required to complete the carer’s two-page version of the Strengths and Difficulties Questionnaire (SDQ) for the child in time to inform their health assessment.
(See Annex B of the ‘DfE Promoting the Health and Well-being of Looked-after Children’, Strengths and Difficulties Questionnaire).
Health Assessments must be conducted by a suitably qualified medical practitioner; who should provide the social worker with a written report.Health Assessments should not be seen as an isolated event but rather be seen as part of the continuous cycle of care planning (assessment, planning, intervention and review) and build on information already known from health professionals, parents and previous carers, and the child himself or herself.
The Social Worker is normally responsible for ensuring that Health Assessments are undertaken, but this responsibility may be undertaken by the home.
In order for the assessment to be conducted it will be necessary to ensure the Consents section of the child's Placement Plan has been completed and signed by the parent or a person with Parental Responsibility.
Young people aged 16 or 17 with mental capacity are presumed to be capable of giving (or withholding) consent to their own medical assessment/treatment, provided the consent is given voluntarily and they are appropriately informed regarding the particular intervention. If the young person is capable of giving valid consent, then it is not legally necessary to obtain consent from a person with Parental Responsibility.
A child of under 16 may be Gillick Competent to give (or withhold) consent to medical assessment and treatment, i.e. they have sufficient understanding to enable them to understand fully what is involved in a proposed medical intervention.
In some cases, for example because of a mental health issue, a child’s mental state may fluctuate significantly, so that on some occasions the child appears Gillick Competent in respect of a particular decision and on other occasions does not.
If the child is Gillick Competent and is able to give voluntary consent after receiving appropriate information, that consent will be valid, and additional consent by a person with parental responsibility will not be required.Where a child under the age of 16 lacks capacity to consent (i.e. is not Gillick Competent), consent can be given on their behalf by any one person with Parental Responsibility. Consent given by one person with Parental Responsibility is valid, even if another person with Parental Responsibility withholds consent. (However, legal advice may be necessary in such cases.) Where the local authority, as corporate parent, is giving consent, the ability to give that consent may be delegated to a carer (or registered manager of the children’s home where the child resides) as a part of ‘day-to-day parenting’, which will be documented in the child’s Placement Plan.
For further information on consent, see Department of Health and Social Care Reference Guide to Consent for Examination or Treatment.Each child's Individual Care and Placement Plan drawn up by the home should include a section on health care needs and set out how these will be promoted by the home ensuring the child’s holistic needs are met.
Additionally, each child must have a Health Care Plan (which may be part of the child’s Individual Care and Placement Plan or may be a separate Plan) drawn up by the social worker.
The initial Health Care Plan should be produced before the first Looked After Review. The Health Care Plan should then be updated after each Health Assessment or as circumstances change.
Strengths and Difficulty Questionnaires:
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 Annex B of the ‘DfE Promoting the Health and Well-being of Looked-after Children’, Strengths and Difficulties Questionnaire).
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 Questionnaire (SDQs) to assess the emotional needs of each child.
The matters that should be considered in drawing up the Health Care Plan (and addressed in the home’s Individual Care and Placement Plan) are as follows:
Information should also be given about any allergies. See also First Aid, Home Remedies and Medication Procedure and Provision and Preparation of Meals Procedure.
One of the responsibilities of the child's Key Carer will be promoting his/her health and educational achievement, liaising with key professionals, including the Clinical Nurse Specialists for Looked After Children, the child’s GP and dental practitioner.
The Key Carer will also ensure that up to date records are kept on the child in relation to his/her health needs, development, illnesses, operations, immunisations, allergies, medications, administered, dates of appointments with GP's and specialists.
The Key Carer must also ensure the child is registered with a GP and other health care professionals as set out in Health and Wellbeing, Health Notifications and Access to Services Procedure.Also see: Key Carer Guidance.
The Key Carer must also ensure the child is registered with a GP and other health care professionals as set out in Health and Wellbeing, Health Notifications and Access to Services Procedure.