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5.5.1 Health Care Assessments and Plans


The full range of statutory obligations and duties to support and promote the health of Looked After children are set out in the Statutory Guidance on Promoting the Health and Wellbeing of Looked After Children (March 2015).

Children remanded other than on bail will be Looked After Children. Different provisions will apply in relation to those children/young people - see the Remands to Local Authority Accommodation or to Youth Detention Accommodation Procedure, Section 8, Care Planning for Young People on Remand.


This chapter was updated in September 2015 in line with the DfE/DoH, Statutory Guidance on Promoting the Health and Well-being of Looked After Children (March 2015) (a link to which has been included). There are new sections in: Introduction, including ‘Principles’, (see Section 1, Introduction); Good Health Planning; (see Section 3, Health Assessments) Strength and Difficulty Questionnaires and Out of Area Placements (see Section 5, Notification of Arrangements for Formal Contact with Health) have been added.


  1. Introduction
  2. Health Plans
  3. Health Assessments
  4. Frequency of Health Assessments
  5. Notification of Arrangements for Formal Contact with Health

1. Introduction

Wirral Council is required to provide good health care for the child and make arrangements to monitor the child’s health care, in accordance with the Health Plan. Health care includes:

  • Medical and dental care/treatment;
  • Advice and guidance on health, personal care and health promotional issues.

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 adoptive placements. This includes promoting the child’s physical, emotional and mental health; every Looked After Child needs to have a health assessment so that a health plan can be developed to reflect the child’s health needs and be included as part of the child’s overall Care Plan.

The relevant Clinical Commissioning Group (CCG) and NHS England have a duty to cooperate with requests from the local authority to undertake health assessments and provide any necessary support services to Looked After Children without any undue delay and irrespective of whether the placement of the child is an emergency, short term or in another CCG. This also includes services to a child or young person experiencing mental illness.

The Local Authority should always advise the CCG when a child is initially accommodated. Where there is a change in placement that will require the involvement of another CCG, the child’s ’originating’ CCG, outgoing (if different for the ‘originating CCG) and new CCG should be informed.

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 well being.

1.1 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;
  • 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’. (See DfE and DoH Statutory Guidance on Promoting the Health and Wellbeing of Looked After Children (March 2015), Annex C: Principles of confidentiality and consent);
  • When a child becomes Looked After, or moves into another CCG area, 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 local authority care, or moves placement, the GP 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 services that might be commissioned.

2. Health Plans

The Health Plan is developed from the assessment of the child’s health needs and forms the health dimension of the Care Plan. It should specify the actions to be taken and the services to be provided to meet the health needs as identified in the assessment, the person or agency responsible for undertaking each action and the timescales and intended outcomes.

3. Health Assessments

It is the Social Worker’s responsibility to make sure health assessments are carried out. Clinical Commissioning Group have a duty to comply with requests for assistance to make sure the assessment happens. The Social Worker must make arrangements for a GP to carry out an assessment of the child’s state of health and provide a written report of the assessment. A copy of each report must be given to the child, subject to his/ her age and understanding, the parent (s)(if appropriate), carer (s)and Independent Reviewing Officer.

Many Looked After children return to their birth parents when they cease to be Looked After. Therefore, it is good practice for the Social Worker to involve parents in health assessments. Where a child has been Accommodated under Section 20 the parents must be given the opportunity to be involved in the child’s health assessment.

When drawing up a Health Plan the Social Worker should ensure that the child is provided with health care, necessary immunisations and any necessary medical and dental attention. This will include registering the child with a GP and arranging regular check-ups with a dentist. In the case of a child with disabilities or special needs, consideration should be given to continuity of specialist care. Use of NHS provision and school health services should be the same for children in care.

Where a child refuses consent to an assessment and it is decided that he/ she is of sufficient understanding to do so, there is no requirement to carry out a health assessment or provide a written report of a health assessment. However, the Social Worker should still consider the child’s health as part of the care planning and review process.

Good Health Assessment and Planning

Role of S/W in Promoting the Child’s Heath

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 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 Virtual 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.

4. Frequency of Health Assessments

The first assessment must be carried out by a registered GP and take place before the child is placed by the Local Authority. If this is not possible then the assessment and written report should be completed before the first child’s first review of the child’s case. (See Looked After Reviews Procedure).

Arrangements must be made by the Social Worker for a registered GP, nurse or midwife to review the child’s health and provide a report of each review at least six months before the child’s 5th Birthday or once every 12 months after the child’s 5th birthday.

The review of health does not apply if the child refuses consent to the assessment providing they are of sufficient age and understanding.

If a health assessment has been carried out within 3 months prior to the start of the placement and a written report has been received, then another assessment does not need to be carried out before the placement or in time for the first review but the cycle for future health assessments must start from the date of the first review.

If no plan exists, the Social Worker should arrange an assessment so that a plan can be drawn up and available for the child’s first Looked After Review which will take place within 20 working days.

5. Notification of Arrangements for Formal Contact with Health

The Social Worker must notify the LAC named nurse and GP when a child or young person becomes Looked After or is moving placement, prior to the event or on the day of the event. The Social Worker must also complete a referral to the LAC named nurse. The preliminary medical should take place before the child or young person becomes Looked After. If this is not possible, it must take place within 14 days unless the child:

  • Has had a medical examination/ assessment within the previous 3 months;

  • Is of sufficient understanding and refuses to submit to the examination.

The preliminary medical report will be submitted to the first Looked After Review and the annual medical report will be submitted to subsequent statutory reviews.

Where the child is to be placed out of the area the Social Worker should notify the LAC named nurse in the area in which the child is currently living and the LAC Nurse and the Local Authority for the area in which the child is to be placed. (See Emergency Placements Out Of Area Procedure - To Follow).

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 to use the Strength and Difficulty Questionnaires (SDQs) to assess the emotional needs of each child.

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 Appendix B of the ‘Promoting the Health and Wellbeing of Looked After Children (DfE, March 2015)’, Strengths and Difficulties Questionnaire.)

Out of Area Placements

Where an Out of Authority placement is sought, the responsible 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 authority should seek guidance from within its own partner agencies and the potential placement area to seek such information out.

The originating CCG, the current CCG (if different) and the proposed area’s CCG should be fully advised of any placement changes and to ensure that any health needs or heath plan are not disrupted through delay as a result of the move.

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

Where the child’s health situation is more complex, it is likely that both health and Social Care services will need to be commissioned; this will need to be undertaken jointly within the originating agencies’ respective fields of responsibility together with the health  and social care services in the area where the child is placed.