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13.1 Health Care Assessments and Health Care Plans


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

This procedure applies to all children in care and summarises the arrangements that should be made for the promotion, assessment and planning of their health care.


Promoting the Health and Wellbeing of Looked-After Children, (DoH, November 2009).

Guidance D Chapter 2, Arrangements for Placement of Children, Children & Young Persons Act 2001


  1. Principles
  2. Social Workers Role in Promoting the Child's Health
  3. Health Care Assessments
  4. Health Care Plans

1. Principles

  • Looked After Children should be able to participate in decisions about their healthcare and all relevant agencies should seek to maintain a culture that promotes children being listened to and which takes account of their age;
  • 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 about sharing information should not get in the way of promoting the health of Looked After Children. When a child becomes Looked After, or moves into another jurisdiction, any treatment or service should be continued uninterrupted;
  • 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’;
  • A Looked After Child should always be registered with a GP and Dentist near to where they live in placement;
  • A child’s clinical and health record will be principally located with the GP. When the child comes into the Department’s care, or moves placement, the GP should fast-track the transfer of the records to a new GP.

2. Social Workers Role in Promoting the Child's Health

The social worker has an important role in promoting the health and welfare of Looked After Children:

  • Working in partnership with parents and carers to contribute to the health plan;
  • Ensure that consents and permissions with regard to delegated authorities are obtained to avoid any delay. Note: 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 any actions identified in the child’s Health Plan are progressed in a timely way by liaising with health relevant professionals;
  • In recognising that a child’s physical, emotional and mental health can impact upon their learning, where this is necessary, to liaise with the relevant school head to ensure as far as possible this is minimised for the child. (Should there be any delay in the child’s Health Plan being actioned, the impact for the child with regard to their learning should be highlighted to the relevant health practitioners);
  • To support the Looked After Child’s carers in meeting the child’s health needs in an holistic way; this includes sharing with them any health needs that have been identified and what additional support they should receive, as well as ensuring they have a copy of the Care Plan;
  • Where a Looked After Child is undergoing health treatment, to monitor with the carers how this is being progressed and ensure that any treatment regime is being followed;
  • To communicate with the carer’s and child’s health practitioners, including dentists, those issues which have been properly delegated to the carers;
  • Social Workers and health practitioners should ensure the carers have specific contact details and information on how to access relevant services, including CAMHS;
  • Ensuring the Child has a copy of their 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 health or behavioural needs that 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.

3. Health Care Assessments

Caption: health care assessments


Frequency of Health Care Assessments

  3.1.1 Wherever possible, each child who becomes Looked After must have his or her first Health Care Assessment completed within 14 days of first becoming Looked After - in time for the first Looked After Review.
  3.1.2 For children under five years, further Health Care Assessments should occur at least once every six months.
  3.1.3 For children aged five and over, further Health Care Assessments should occur at least annually.


Arranging Health Care Assessments

  3.2.1 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.
  3.2.2 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.
  3.2.3 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.
  3.2.4 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.


Merging Health Care/Health Checks

  3.3.1 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 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.


Black and Minority Ethnic Children

  3.4.1 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.


Children in Secure Settings and/or on Remand

  3.5.1 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.



  3.6.1 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.

4. Health Care Plans

4.1 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.
4.2 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.
4.3 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.
4.4 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:

  • Whether it is necessary for any immunisations to be carried out and if so, when;
  • When it is necessary for a dental check to be carried out;
  • When it is necessary for any hearing or vision checks to be carried out;
  • 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;
  • Whether there are any health or education issues to be addressed, for example, nutrition, sexual health and relationships, substance misuse, personal hygiene;
  • 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.
4.6 This Health Care Plan must be reviewed after each subsequent Health Care Assessment or as circumstances change.