Health Needs Assessments and Individual Health Care Plans

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

The purpose of a Health Needs Assessments is to carry out an initial assessment of the child’s physical, emotional and mental health. The Health Needs Assessment will inform the child’s Individual Health Care Plan, and ensure that the placement meets the child's holistic health needs. As a minimum the Residential Practitioner 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 their Health Needs Assessment.

(See Annex B of the ‘DfE Promoting the Health and Well-being of Looked-after Children’, Strengths and Difficulties Questionnaire).

Health Needs 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 Needs 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 themselves.

The social worker is normally responsible for ensuring that Health Needs 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.

Young people aged 16 or 17

Young people aged 16 or 17 with mental capacity are presumed to be capable of giving (or withholding) consent to their own Health Needs Assessment and any medical 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.

Children under 16 - ‘Gillick Competent’

A child of under 16 may be Gillick Competent to give (or withhold) consent to a Health Needs Assessment and medical 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.

Children under 16 - Not 'Gillick' Competent

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

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

The Individual 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 Needs Assessment and all other medical, dental and optical appointments, and facilitate any required treatment regimes;
3. Agreements for the use of non-prescribed medicines, Homely 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 children's home staff;
9. If the child is at risk of self harm or suicide, the interventions/strategies to be adopted in reducing or preventing such behaviour;
10. How the home will contribute to any health monitoring.

Information should also be given about any allergies. See also First Aid, Homely Remedies and Medication Procedure and Provision and Preparation of Meals Procedure.

One of the main responsibilities of the Key Residential Practitioners is promoting the child’s health and educational achievement, liaising with key professionals, including the Designated Nurse for Children Looked After, the child’s GP and dental practitioner.

The Key Residential Practitioners will also ensure that up to date records are kept on the child in relation to their health needs, development, illnesses, operations, immunisations, allergies, medications, administered, dates of appointments with GP's and specialists.

Within some of the complex needs homes, all health appointment outcomes are communicated to all the known professionals via the known communication methods.

The Key Residential Practitioners 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.