Health Care Assessments and Plans


The Health and Well-being Standard
Regulation 10


Promoting the Health and well-being of looked-after children - Statutory Guidance for Local Authorities, Clinical Commissioning Groups and NHS England (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) - 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.


  1. Health Care Assessments
  2. Health Care Plans
  3. Designated Key Worker

1. Health Care Assessments

Every Child Looked After should have a Health Care Assessment soon after being placed and then at specified intervals; as set out below.

The purpose of a Health Care Assessments is to carry out an initial assessment of the child’s physical, emotional and mental health. The Health Care 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 completed the carer’s two-page version of the Strengths and Difficulties Questionnaire (SDQ) for the child in time to inform his or her health assessment.

Health Care Assessments must be conducted by a suitably qualified medical practitioner; who should provide the social worker with a written report.
  • The first assessment must be conducted before the child’s first placement, or if this is not reasonably practicable, before the child’s first Looked After Review – unless one has been conducted in the previous 3 months;
  • For children aged between 2 and 5 years, further assessments should occur at least every 6 months;
  • For children aged over 5 years, further assessments should be at least annually;
  • Health Care Assessments must be conducted more frequently where the child’s health needs dictate.

Health Care 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 Care Assessments are undertaken, but this responsibility may be undertaken by the home.

In order for the assessment to be conducted, the social worker should ensure that all the necessary consents and delegated authority permissions have been obtained so that decisions are not delayed. Young people (dependant on their age and understanding) can provide informed consent for the assessment.

2. Health Care Plans

Each child's Placement Plan, should identify the child’s health care needs (if any) and set out how these will be met by the home.

The initial Health Care Plan should be produced before the first Child Looked After Review. The Health Care Plan should then be updated after each Health Care Assessment or as circumstances change.

The Health Care Plan should describe how the child’s physical, emotional and mental health needs will be addressed to improve health outcomes.

The Health Care Plan (and the Placement Plan as necessary) should cover the following:

  1. Whether there are any specific health physical, emotional or mental healthcare needs - and how the home will meet them;
  2. Responsibilities of staff to make sure a child attends their Health Assessment and all other medical, dental and optical appointments, and facilitate any required treatment regimes;
  3. Agreements for the use of non-prescribed medicines, Home Remedies or use of first aid;
  4. Any specific medical or other health interventions which may be required, including whether it is necessary for any invasive procedures and how they will be undertaken;
  5. Whether it is necessary for any immunisations to be carried out;
  6. Any specific treatment or therapeutic interventions, strategies or remedial programmes required;
  7. Any necessary preventative measures to be adopted;
  8. Clarify which health care decisions have been delegated to carers;
  9. If the child is a risk of self harm, the interventions/strategies to be adopted in reducing or preventing such behaviour;
  10. How the home will contribute to any health monitoring.

3. Designated Key Worker

One of the key responsibilities of the child's Key Worker is promoting his/her health and educational achievement, liaising with key professionals, including the Named Nurse for Children Looked After, the child’s GP and dental practitioner.

The Key Worker 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 Worker must also ensure the child is registered with a GP and other health care professionals as set out in Health Notifications and Access to Services Procedure.

Also see Key Worker Guidance.